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Issue #216 July 3, 2014

Welcome to KnowYourThyroid.

Happy 4th of July to everyone. I hope you have a great weekend!

Today, Dr. Jeanne Willis Shiffman will explain the new thyroid medications and why the changes were made.




New Thyroid Medications—Are They Right For You?

 By Dr. Jeanne Willis Shiffman

There are two newer “hypo-allergenic” thyroid medications on the market, aimed at patients who know or suspect that they are sensitive to tablet fillers and dyes, or who want to avoid certain substances as a matter of choice.

Tirosint is levothyroxine, or synthetic T4, which is the same as Synthroid.    It is a liquid gel cap consisting of only glycerin, gelatin, and water.

WP Thyroid is a natural T4/T3 thyroid replacement, like Armour.  It is made by the same company that makes Nature-throid, and is similar to it.  It is a tablet and contains only two inactive ingredients—inulin from chicory root, and medium chain triglycerides from coconut.

Both of these contain animal products so they would not be a welcome choice for vegetarians and vegans.  The gelatin in the Tirosint comes from cows and the WP Thyroid is derived from pig thyroid.

Another issue is price.  Tirosint is a brand name product.  It costs about five times more than generic levothyroxine, so if you are paying out of pocket, this is a sizable increase.   If your only concern is the dyes used to differentiate different strength thyroid pills by color, then you can try just using the 50 mcg dose of Synthroid/levothyroxine.  These are the no-dye white pills and you could use multiples of the 50 mcg dose or cut them in half to get the right amount for you.

For WP Thyroid, it is relatively inexpensive, about the same as other generic thyroid medications, but there is an issue with availability.  Any pharmacy in the United States could supply it if they want, but many choose not to.  It can be obtained from a mail order pharmacy if needed.

Finding the right thyroid medication can take some experimenting with the help of your doctor.  At the Steinmetz Center for Integrative Medicine, I use all different thyroid medications depending on the patient’s clinical situation and personal preference.  Many endocrinologists will refuse to prescribe desiccated (pig thyroid) medications such as Armour and Nature-throid, saying that they are not accurate like the synthetic preparations and that the hormone levels will fluctuate too much on them.  I, however, have been prescribing these medications for over 5 years now and check the labs regularly, and I have never seen any swings in the lab results, nor have any patients reported fluctuations on them.  The only difference in the lab results is that these medications will cause the T3 levels to increase and can drive down the T4 levels some, but still in the normal range.

Doing the proper labwork can be critical for figuring out what thyroid medicine is right for you.  I check the TSH, free T4 and free T3.  I often also check the reverse T3 and thyroid antibodies.  Many people do well on the standard generic synthetic T4 pills and don’t need to change if they feel well on them.  But, many people don’t feel improvement on them, or only a partial improvement.  For these patients, the free T3 is often on the low normal side and when T3 is added to their medication regimen, they feel much better.  This can be done by switching to a desiccated thyroid medicine to get the T4/T3 blend, or by adding on synthetic T3 to the synthetic T4.  The brand name form of synthetic T3 is called Cytomel and the generic is liothyronine.  There is also a synthetic T4/T3 blend called Thyrolar.  Finally, some patients choose to have a T4/T3 blend compounded for them to get the exact doses they need in one long-acting capsule.  With any changes in your thyroid medicine, you should recheck the labs in six weeks and let your doctor know how the change affected you.

Jeanne Willis Shiffman, MD was introduced to integrative medicine during her first year at Georgetown University School of Medicine by world renowned Dr. James Gordon, and she has been pursuing studies in the field ever since. Before Georgetown, Dr Shiffman worked as a CIA analyst for over 6 years, and she brings these skills to her medical practice to help her patients get to the root of their problems. Dr Shiffman likes to works with her patients as a team and is respectful of her patients’ ideas and goals.