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When Levothyroxine Doesn’t Do the Job After Graves’ Disease

Graves' disease often leads to obliteration of the thyroid gland. That means replacing the missing thyroid hormone. What's the best approach to feel good?

People who develop Graves’ disease  because of an autoimmune disorder make too much thyroid hormone. This is diagnosed as hyperthyroidism. Symptoms include: hand or finger tremors, anxiety, weight loss, sweating, frequent trips to the bathroom, and palpitations. A common treatment for Graves’ disease is surgical removal of the thyroid gland. But people must have thyroid hormone to survive. That frequently leads to a prescription for levothyroxine. It doesn’t always solve the problem.

After Graves’ Disease, Synthroid Disappoints:

Q. I had my thyroid removed as a result of Graves’ disease many years ago. I take Synthroid, and my doctor tells me my TSH levels are normal.

Nevertheless, I suffer from chronic, low-grade fatigue, depression and lethargy. I think I heard on your radio show that there is a different treatment. Could you tell me more?

A. Dr. Antonio Bianco is an endocrinologist who has studied this challenge. He reports that some people do not efficiently convert T4 (levothyroxine, aka Synthroid) to the active form of thyroid hormone, T3 (triiodothyronine).

They may feel better if they also take some T3. You can learn more about this and other strategies in our eGuide to Thyroid Hormones. This online resource may be found in the Health eGuide section of PeoplesPharmacy.com.

Listen to Dr. Bianco Tell the Story of Hypothyroidism Treatment:

If you would like to learn more from the horse’s mouth, so to speak, here is a link to an in-depth conversation we recently had with Dr. Bianco. We think anyone with hypothyroidism will find this free podcast fascinating.

Show 1196: What to Do If Thyroid Treatment Doesn’t Work for You
People who find that the standard thyroid treatment doesn’t resolve all their symptoms of hypothyroidism may wish to discuss combination therapy

Want to learn even more? There is a bonus interview with Dr. Bianco at this link.

Bonus Interview: Dr. Antonio Bianco Describes His Remarkable Thyroid Research
Dr. Bianco’s thyroid research helps explain why some people may feel better with a combination of T3 and T4 to treat their hypothyroid condition.

Other readers Weigh in on Thyroid Disorders:

Midge shares this thought:

“So glad to see your column and comments on Thyroid, and why standard treatment doesn’t work for some. It sure didn’t work for me. I asked my GP to please switch me over to a natural thyroid (Armour, NatureThroid, etc) but she refused. So, I changed doctors, to one I knew did prescribe a natural thyroid. Six months later all the knots in my back were gone, no more muscle pain, and I was back down to my lifelong weight (130 lbs from 165lbs) I felt like my old self. My wit was back, and no longer felt stupid or foggy. 

“I have never been able to understand why MDs think that if a broken thyroid can’t produce thyroid hormones, that it can convert T4 to T3. An over-simplification for sure, but not too far off.

“Thank you so much for all you do. Seventy-seven years and counting thanks to you and others who really understand so much about how our bodies work and what keeps them working!”

Heidi is a REALLY long-term radio listener:

“Yes, I DO APPRECIATE The People’s Pharmacy.

“I started listening to your Saturday 90-minute radio broadcasts every week in the late 1970’s. In 2000 I moved from Cary, NC to Delray Beach, FL and listened to your broadcasts on radio, but then the station went religious. No More radio broadcasts for me. I read your newsletters on my computer and read your column in the Palm Beach Post.

“I have LEARNED A LOT from your informative writings and think I can decide what is best for me. I only take Levothyroxine as I have Gravess disease. I am 88 years young, playing golf, water aerobics, walk and enjoy life. Hopefully, I will make it 12 more years to the 100 mark!!!”

Meg is another person with Graves’ disease:

“This is a subject dear to my heart, because I had both Hashimoto’s and later Graves’ disease. After essentially obliterating my thyroid gland with radioactive iodine it was often difficult to get my levels just right simply by taking T4 (levothyroxine). And I felt lousy. Even taking synthetic T3 didn’t help my low energy until I started taking natural desiccated thyroid.

“Because it is animal derived, doctors are loathe to prescribe it and will tell you that it does not have the same ratio of T4:T3 as humans. While that is true, I really appreciate having energy and feel like I finally have my life back. Shop around for an endocrinologist who doesn’t just treat you ‘by the numbers’ and listens to how you feel.”

Michelle also had her thyroid gland obliterated because of Graves’ disease:

“I had Graves’ disease and thyroid cancer. I had a total removal of my thyroid in 2016 and was started on Synthroid. I never felt quite right on it.

“I saw a naturopath who prescribed desiccated thyroid in 2019, which I had to get through a compounding pharmacy. It has made a world of difference. My endocrinologist is opposed to it but has allowed me to make the decision.”

Share your own experience with Graves’ disease in the comment section. Don’t forget to check out the free podcast with Dr. Bianco and consider our eGuide to Thyroid Hormones at this link.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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