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Do People With Low Thyroid Prefer Double Hormone Therapy?

When people have low thyroid hormone levels, they don't feel good. An old-fashioned treatment can often help.
Do People With Low Thyroid Prefer Double Hormone Therapy?
Test tube with blood sample for thyroid hormone test

Judging by the number of prescriptions dispensed annually, hypothyroidism is one of the most common medical conditions in the country. Doctors usually treat this low thyroid condition by prescribing levothyroxine. Its brand names include Euthyrox, Levothroid, Levoxyl, Synthroid, Tirosint and Unithroid.

What Is the Best Way to Correct Low Thyroid Hormone Levels?

Levothyroxine is a synthetic form of the natural thyroid hormone known as T4. That’s because it has four iodines. Enzymes in the body knock one iodine off to turn it into the active form, T3, also called triiodothyronine. Most of the time, physicians assume that people taking the proper dose of T4 will readily convert it to T3. Consequently, patients only need to take levothyroxine to correct their low thyroid levels. However, while some people do quite well on T4 alone, others continue to experience troubling symptoms (Journal of Clinical Endocrinology and Metabolism, Sep. 1, 2020).

Helping People Who Need More Than T4:

For quite some time, we have been hearing from readers who report feeling better on Armour Thyroid (desiccated thyroid extract) than on Synthroid or Levothroid alone. Now, a study presented at the Endocrine Society annual meeting shows that many patients prefer treatment with combination therapy that includes both T3 and T4 (ENDO 2021, March 20-23, 2021).

In the randomized controlled trial, 75 people with low thyroid levels took levothyroxine alone, combination therapy or desiccated thyroid extract (Armour, Westhroid) for three months at a time in a double-blind trial. Nearly half of them reported that they felt best on desiccated thyroid extract, a very old-fashioned treatment. The thyroid glands of pigs provide desiccated thyroid extract (DTE). Like combination therapy, it too supplies T3 as well as T4.

The lead investigator, Thanh D Hoang, DO, noted:

“There are now proven good treatment options for the more than one in 10 patients with hypothyroidism who continue to experience symptoms of fatigue, mental fogginess, weight gain and other symptoms despite taking levothyroxine.”

DTE Is Not Appropriate for Everyone:

Because companies derive DTE from pigs, people whose religious practices forbid pork are not able to use it. Patients with alpha-gal allergy should also avoid Armour and similar products (AACE Clinical Case Reports, May-June 2020). Because they react badly to all mammalian products, taking DTE could trigger a very serious, if delayed, allergic reaction.

Why Treating Low Thyroid Levels Is Important:

When thyroid hormone levels are low, people can feel terrible. Symptoms range from fatigue and constipation to weakness, dry skin, depression, high cholesterol and hair loss. Most health care providers are well aware of these, but they may not pay as much attention to cognitive difficulties or clumsiness. This can have serious consequences in the real world.

Researchers at the University of Kentucky tested 32 people with thyroid cancer who had to stop taking thyroid hormone for medical tests (Thyroid, Jan. 2015). They administered several psychological tests and tested the patients in a driving simulator. Later, after the participants had again started taking thyroid hormone, they took the tests over.

When their thyroid hormone levels were very low, people hit the brake far more slowly. Presumably their reflexes suffered. The volunteers drove nearly as badly as if they were intoxicated with alcohol. Once hormone levels normalized again, they drove with significantly more skill.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
  • Ettleson MD & Bianco AC, "Individualized therapy for hypothyroidism: Is T4 enough for everyone?" Journal of Clinical Endocrinology and Metabolism, Sep. 1, 2020. DOI: 10.1210/clinem/dgaa430
  • Slayden TA et al, "A bull in a pill shop: Alpha-gal allergy complicating treatment options for postprocedural hypothyroidism." AACE Clinical Case Reports, May-June 2020. doi: 10.4158/ACCR-2019-0495
  • Smith CD et al, "Reversible cognitive, motor, and driving impairments in severe hypothyroidism." Thyroid, Jan. 2015. DOI: 10.1089/thy.2014.0371
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