Wondering if t4 (Synthroid) Treatment of Hypothyroidism is the Answer


Prosanta asks metabolism.com if her thyroid blood test results indicate that treatment with t4 is required. I suspect that she is also wondering if other forms of treatment might be better (Armour Thyroid for example).

Here is what Prosanta writes:

Iamsuffering from Diabetes type2.recently on routine Blood test—
FT3(ECLIA) 2.33pg/ml
FT4 1.07ng/ml
TSH 9.32microIU/ml
AntiThyroid Peroxidase 37.02IU/ml
Do I need to take only Levothyroxine

In response to her question I offer my thoughts on whether someone beginning with thyroid hormone replacement therapy should start with t4.

Hi Prosanta

You know I can’t recommend medical therapy in this forum. I can make some general comments, however.

There is debate among endocrinologists about what level of TSH indicates a clinical degree of thyroid deficiency, but there is no doubt that a TSH of 9 is abnormally high. Since elevated TSH almost always indicates that the pituitary gland is releasing excessive TSH in response to thyroid hormone deficiency, unless there is a pituitary tumor (exceedingly rare), replacement therapy with thyroid hormone is indicated.

Thyroid hormone replacement therapy in the U.S. usually consists of taking a pure t4 product such as Synthroid or levothyroxine (generic t4). On this website you will notice extensive posting about treating hypothyroidism with alternative forms of thyroid hormone replacement, particularly desiccated thyroid products such as Armour Thyroid. An appropriate concern in a situation like yours is whether to take t4 only or to use desiccated thyroid or t4 plus t3 therapy.

If you are like most people in this country being treated with t4, you will wonder why someone might need alternative forms of thyroid hormone replacement. In the past year or so researchers have discovered that a portion of the population lacks the ability to normally metabolize t4 into the highly biologically active t3. This means that affected individuals may continue to experience symptoms of thyroid hormone deficiency when treated with conventional t4 therapy [http://www.metabolism.com/2009/11/07/breakthrough-discovery-thyroid-hormone-therapy-part-2/ ]. How does a person know if they won’t respond to t4? The simpliest approach is to try t4 and see how you feel. Then you and your doctor can decide whether you are a t4 responder or not.

You may be aware that Armour Thyroid and similar products are in very short supply in the U.S. Even if some advocates of desiccated thyroid therapy for hypothyroidism argue that only desiccated thyroid can result in a full return to normal, in my opinion the present shortage makes t4 therapy the clear initial choice. If symptoms of hypothyroidism persist even after a full course of t4 has been tried, then you may be forced to join the ranks of those struggling with the pharma industry to get desiccated thyroid products.

Please discuss these ideas with your own physician.

The disclaimer and terms of service of metabolism.com applies to this and all my posts on this website.

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  • Ronald K Cobbs MD

    I agree with Dr Pepper, one of my mentors, that the TSH listed is abnormally elevated indicating a weakening thyroid. Endocrinologists debate about what level of TSH is considered elevated enough to require treatment.

    There are several differing methods. The one that I have found in the literature and that I use is the following. If the TSH is 10 or greater most endocrinologists will treat. If the TSH is elevated but not 10 or greater then you look at the Anti TPO level. If elevated it indicates an ongoing autoimmune antithyroid attack that will only result in further weakening of the thyroid in the future. If so, treatment is usually prescribed by the treating physician.

    In the labs that you posted the AntiTPO is 37 but you did not give the normal range for the lab used. If it is elevated, as it would in our lab which uses 35 as the upper limit, then treatment generally is given. This is the method I use.

    Others wait until the TSH is 10 or great since the literature states that most of these patients will also go on to develop symptomatic hypothyroidism in the future. If the Anti TPO is elevated and you do not choose to treat then repeating the TSH in several months and on a regular basis is a good idea. Most patients with elevated AntiTPO levels will ultimately find that their TSH values will continue to rise as the thyroid fails and will wind up on therapy.

    As you have read on this website, some people (and many on this forum) who need therapy choose desiccated thyroid. It is no secret that I follow the main stream endocrine literature and usually start therapy with synthetic T4 . However if therapy normalized the TSH and free T4 but the patients do not feel better, I add T3 (cytomel) to the therapy. While there is literature to support this method, many on this website might disagree.

    Ultimately, as was well stated by Dr Pepper, I can not specifically recommend therapy to you on a online forum. it is best to discuss this with your physician or health care professional in order to develop a plan that is best for you.

  • Natural Patterson

    I am on Levothyroxine 100 mcg. I had my thyroid removed and in less than a year I have gained 25 pounds. My diet consist of about 1200 cal per day. Why am I gaining weight? I was told that my harmone levels was out of control. What advice can you give me?

    Thank you!