You finally got the diagnosis of hypothyroid and your doctor is ready to put you on thyroid medication. Stop for just a minute because this little pill will impact your life more than you could ever imagine.
I know you just want to “feel better” but the decisions you make right now are going to affect your health on down the road. So I want you to understand exactly what you are getting into by taking thyroid medication because I didn’t and it's a huge regret for me.
Then, once you are informed I want you to decide with your doctor which medication is right for you. Yes, you definitely have a say in the matter and depending on how much experience you doctor has treating thyroid disease you may end up educating him a little.
The first thing I would have done differently when I got the call to take thyroid medication is set up another appointment. I would have told the nurse I wanted to go over the results with my doctor in person and that I had some questions. Grab that free lab test check sheet I’ve offered on the home page. If I had a resource like that I could have printed it off and taken it with me. That’s what I wish I had done and I hope you decide to do that now.
Before you go to that next appointment I want you to really think about your life and reflect on what brought you to this moment. Do you have a strong family history of thyroid disease, has your diet been really bad, have you had a recurring infection, did you just have a baby, are you under a ton of stress or do you have other illnesses that could be contributing to your low thyroid function? Sorry for the run on sentence. In no way do I want you to blame yourself in a for this condition, I just want you to think back then start digging for answers.
Had I thought about these questions I would have said I hadn’t really felt good for several years since I did that low carb diet after having my second child. Since then my liver and gallbladder function were off (which I knew from a physical).
At the time of my diagnosis my diet was terrible- always on the go and eating lots of processed food. Although I had been trying to clean up my diet and exercise some, I didn’t have the energy or drive to be consistent. My IBS had been flaring up way more than usual and I really had a lot of symptoms I hadn’t addressed.
What all this should have told me (knowing what know now) is no wonder my body wasn’t making enough thyroid hormone! I had IBS (gut not functioning well), elevated liver enzymes (liver and gut weren’t converting thyroid hormone); my diet was crap (lack of nutrients). I wish I would have said:
“Hmmm, since I’m at this crossroads and faced with taking thyroid medication for the rest of my life maybe I should try a detox, clean up my diet, give my body the nutrients it needs and see how I feel over the next month or so. If I’m feeling better my doctor could continue to monitor me and if I feel the same or worse I could take the medication.”
Please believe I truly understand how awful you’re feeling right now. But I’m begging you to at least think about giving yourself this chance to heal so someday you’re not looking back wondering if it would have worked.
So here’s how I would have handled the next doctor’s visit. Since I’d have my handy reference chart I would have asked my doctor what my TSH was and if I had antibodies. Then I'd go over the rest of the numbers and ask questions about those. Let’s run through a few scenarios I could have encounter and go over how I would handle them:
My question: What’s my TSH and did I have elevated antibodies?
D=Doctor, P= Patient
1.) D: Your TSH was 4.2 and your antibodies were negative.
P: Ok so my TSH is above normal but I’m not showing antibodies. I'd ask if I have enough T4 ( because you need enough to convert to T3) and if that's good I'd ask about my reverse T3 ( this tells if its floating around or getting into the cells- think of it like insulin resistance). I'd ask questions based on my results then I'd say I think I will try some diet and lifestyle changes first, could you check those again in a month or so?
My TSH would have been out of functional range but may be in normal reference range. I’m going for optimal thyroid function here so I’m considering it high but this would be a great time to make some lifestyle changes and see if I could heal without meds.
2.) D: Your TSH is 5.6; I didn’t test your antibodies.
P: Ok that is out of range but I’d really like to know what I’m dealing with and what’s causing this. I’m sure you would too, so I’d like for you to run the antibody test. I actually need a full thyroid panel.
I’d hand him the paper. If he refuses, sorry to be so blunt, but I’d get a different doctor. I wouldn’t care if he was my family doctor for 10 years, he is not going to be open minded enough to help me long term.
If he agrees to do the tests I’d tell him I was going to go ahead with some lifestyle changes and depending on whether I felt better or worse I may want him to retest some things before starting medication. Then I’d ask if he could work with me on this.
3.) D: Your TSH is 8.2 and your TPO antibodies are 268.
P: Ok, I’d like to discuss my medication options and I want you to help me with some lifestyle changes. I don’t want to stay on the medication long term, just support my thyroid until I can lower the inflammation that is causing my autoimmunity and get my TSH back in range if that’s possible. Could we go over my other labs to see what medication would be best for me?
In this case my thyroid would probably need some support. I'm looking to see what's out of range. Is there is enough T4? Is what I have converting? We’ll discuss more about elevated antibodies in another post.
4.) A fourth scenario I wanted to throw in is if I had just had a baby and my TSH and antibodies were elevated. I’d practice good self-care (hard as a new Mom I know) and give my body some time to see if things go back to normal.
In this case I know my hormones are contributing to this and I would need to give them a chance to rebalance and avoid things that fire up that immune response. I’d get retested in a couple of months. The exception is if everything was extremely out of range and I couldn’t even function then I'd go ahead and look at medication.
I hope you found seeing how I would have handled different situations helpful. I’m not a medical doctor, I can’t diagnose, treat or cure disease and it is not my intention to give any medical advice, only share my thoughts and experience. I recommend you discuss your particular situation with your physician.
Once you’ve tried lifestyle changes if your thyroid still struggles then it may be time to look at thyroid medication. Remember EVERY cell in your body needs adequate thyroid hormone to function properly. A very important thing to understand is thyroid medication is replacing the hormone your body would naturally make but isn’t.
So once you take it for a while your pituitary is not going to be signaling your thyroid gland to make more (or less) hormone because it’s picking up that there is an adequate amount (from the medication you’re taking). In essence the gland stops functioning because it’s not getting any messages to produce anything. It’s like it has fallen asleep.
Once you’re dependent on thyroid hormone it’s hard to come off of it because that sleeping gland doesn’t want to wake up. If you do stop the medication and your gland hasn’t healed you’re still not going to produce enough thyroid hormone to support your body.
Also, NEVER stop thyroid medication cold turkey- you will feel awful and could have serious complications. The best rule of thumb with thyroid medication is start low and increase gradually and then if you decide to try to come off of it work with your doctor to slowly taper off.
Thyroid medication is basically hormone replacement. The two types available are naturally dissected and synthetic. Naturally dissected is made from animal glands (typically pig) and synthetic is chemically made in a lab. Neither is best for everyone, your unique composition and symptoms will determine how your body processes it.
Most doctors will prescribe a synthetic hormone which is a bioidentical, man-made T4 only medication. Levothyroxine falls under the names: Synthroid, Levoxyl, Tirosint and Unithyroid . There are generics of these and they have different names in other countries.
Remember T4 is inactive hormone that your body has to convert to T3 (active hormone). So many women that have gut or liver problems don’t do well converting these. Like most people I started out on Synthroid, felt better for a couple of weeks then started feeling worse. I was on too high a dose to start with and had anxiety, heart palpitations and insomnia. Insist on a low dose working up.
It took me over a year (and a few physician changes) to get a doctor who finally agreed to let me try Armour. This made such a HUGE difference in the way I felt.
If T4 only medication doesn’t work for you then your doctor could add synthetic T3 or switch you to naturally dissected thyroid medicine. But you’ll need to give it a few weeks to see how you do and your doctor will retest until he gets your level optimal.
Synthetic T3 medication falls under the names Cytomel and Liothyronine. You will probably need to get this combination at a compounding pharmacy and it will cost more than taking one medication. The advantage is that T4/T3 ratios are customized to your needs. Another option is Thyrolar, a synthetic combination of T4 & T3 in a fixed ratio of 4:1.
Naturally dissected (NDT) are not bioidentical and come in fixed ratios of T4/T3. Many doctors think naturally dissected medications are out of date and that synthetics are better. I think this comes from not being as familiar with them and that Big Pharma pushes synthetics (Synthroid is one of the top prescribed medications).
There are no incentives for prescribing naturally dissected thyroid. Examples of NDT would be Armour, WP Thyroid, and Nature Thyroid. Like any medication (food, fillers or supplement) people can be allergic to NDT. The big advantage of NDT is your body doesn’t have to convert all the T4 on its own, there is already T3 available that can be absorbed and go to work in your cells. Another great thing about NDT is that it has all 4 of the T’s in it (T1, T2, T3, and T4). While we don’t know a lot about T1 and T2, emerging research is showing they are biologically active.
I hope going through these different scenarios and different thyroid medication options will help you make the right decision for your health.
My greatest wish for you is to feel your very best while working to get your thyroid healthy. If you have been battling thyroid disease for a while I’d love to hear where you’re at now and what medication works best for you.
