Thyroid Treatment

Treatment of hypothyroidism

The conventional treatment of hypothyroidism is synthetic T4 or Levothyroxine. In the right amount, Levothyroxine will normalize your thyroid levels. The body can convert T4 to T3  which is the most active form of thyroid hormone but not T3 to T4. When you try to correct your underactive thyroid with thyroxine pills the conversion of T4 to T3 may not be optimal and you will end up missing some T3. That’s why you may not get rid of all your symptoms by just taking thyroxine tablets. There are 13 strengths of Levothyroxine tablets. They range from 12.5 mcg to 300 mcg. Try to stick to the name brand when you are treated with levothyroxine. Examples of levothyroxine are Synthroid, Levoxyl, Levothyroid, and Unithroid.  Armour Thyroid is a combination of T4 and T3 and comes in several different strengths. Regardless of the treatment you are using, the dose of thyroid hormone needs to be adjusted and monitored over time.


For hypothyroidism, your doctor will typically aim at normalizing your TSH level, which is the pituitary hormone that regulates the thyroid gland. A normal TSH indicates that you are getting the right amount of medication. However, despite achieving and maintaining normal blood tests, you may continue to suffer from fatigue, low grade depression, and weight gain. The reason could be that you are missing some T3 hormone.The solution may be the use of a well balanced combination of the two thyroid hormones T4 and T3, in the right amounts. T3 treatment can help patients achieve the right T3 levels, but it is not enough to treat the hypothyroidism alone.

Are all Levothyroxine products interchangeable?

For doctors, two different products of Levothyroxine are interchangeable when, after switching from one preparation to another, the thyroid tests and most importantly TSH levels remain the same at least 6-8 weeks after the switch. Although by in large few preparations might be interchangeable, there is always a slight difference that may or may not be clinically relevant. Unfortunately, the new FDA regulations evaluate equivalency not based on strict thyroid testing but on the content of Levothyroxine in the preparations. The difference of content among preparations tolerated is very significant. As a result manufacturers of Levothyroxine abide by the new rules and this allows for clinically significant differences among Levothyroxine preparation names. There are now many generic Levothyroxine preparations that are accepted  as equivalent because the difference in content of the active ingredient is now viewed as acceptable.


When you switch from a specific brand to a generic form of Levothyroxine, you may be at risk for becoming over medicated or under medicated which can lead to consequences including symptoms and other health effects and this has been confirmed by recent research. Unfortunately, again your pharmacist has the right to give you a generic instead of a specific brand name or can switch you from one generic to another. Considering that your thyroid balance can be significantly affected by switching Levothyroxine preparations while being treated for your hypothyroidism, I recommend that you stick to the same product name. Also, you need to be aware that some of the Levothyroxine preparations include exipients that could contain gluten and if you suffer from gluten sensitivity or Celiac disease, that can be an issue for many people. Many generic preparations do not disclose whether they contain gluten or not so if you have a gluten issue, watch out! Be proactive and make sure that your pharmacist is dispensing the same product name and preferably a well established brand.

Generic vs. brand Levothyroxine

The question of whether or not brand name and generic pharmaceuticals are equivalent remains controversial. Although some studies have found significant variations in potency, efficacy, and preparation protocols, the FDA considers them to be interchangeable, and pharmacies can and will switch them at their own discretion. The differences between brand name and generic thyroid hormone can be particularly dramatic, with one study finding a potency variation of 12.5%. In addition, thyroid disorders are often extremely sensitive to even slight changes in treatment. It is therefore important to ensure patients receive consistent, accurate dosing for optimal effects, particularly in pediatric patients who are still growing and developing. Until stricter regulations are enforced, it is perhaps prudent to avoid generic thyroid hormone supplements altogether. And if you are given generic Levothyroxine, try to stick to the same one to avoid thyroid imbalance and its effects.

 Is Armour Thyroid better than Levothyroxine?

While Levothyroxine gives you only T4, Armour Thyroid or dessicated thyroid comes from pig thyroid and contains both T4 and T3. So it can be better if taken in the right amount and in a way that you do not have too much T3 in your system if you take Armour Thyroid so that both T4 and T3 are perfectly well-balanced in your body then you can get significant benefits with respect to the way you feel. T4 T3 combination treatment can help you energizing your metabolism, reversing fatigue and depressive symptoms. Taking Armour Thyroid can be problematic if you require a high dose and you take the full amount as a single daily dose. The absorption of T4 and T3 is different and beware of T3 overdose from Armour Thyroid. Also beware of taking Armour Thyroid in high doses prescribed for non-specific symptoms that sound like thyroid symptoms and you do not have a thyroid condition. Also do not accept to take Armour Thyroid in high doses and increase medication without monitoring and testing. This can be a reason for major over-medication and health problems.

T4/T3 treatment may be the solution

Thyroid dysfunction is often a nuanced condition, and finding the best treatment option for a patient is not always easy. Hypothyroid patients may continue to exhibit symptoms after thyroid hormone levels return to normal ranges with Levothyroxine. Researchers have hypothesized that some people may suffer from impaired conversion of T4 to T3 in the body. A deficiency of T3, which is the most active form of thyroid hormone can result in fatigue, depression symptoms and slow metabolism. Such a condition, independent from or perhaps in addition to impaired thyroid gland dysfunction, could explain why some patients ultimately find relief with T4/T3 combination therapy adjusted specially for their individual needs.

What are the possible side effects of thyroid hormone treatment?

So many people are misinformed about potential side effects of thyroid hormone and believe that taking thyroid medication at the right dose can cause bone loss and other problems. However, when you are treated with the right medication at the right dose and your thyroid levels are perfect and are kept in an excellent range there is no potential effect on the bone or on any other organ. In fact, your health will be much better when your thyroid levels are consistently in a good range. The main side effect of thyroid hormone is actually when you are under-medicated or over-medicated


Over-medication with thyroid hormone is actually viewed as a major problem because excessive thyroid hormone from taking too much Levothyroxine or Armour Thyroid or T3 will lead to major consequences including:


  • *Anxiety
  • *Weight issues
  • *Muscle and joint pains and aches
  • *Hair loss
  • *Muscle weakness
  • *Fatigue
  • *Heart and blood pressure problems including cardiac rhythm problems such as Atrial Fibrillation and premature heart contractions


With too much thyroid hormone, you may even experience diarrhea. If you are overdosed with thyroid medications for a long period of time, you will be losing bone to the extent that you can develop Osteopenia and Osteoporosis. Many people taking thyroid medication who experience fatigue believe that the fatigue is caused by a lack of thyroid hormone while they may be actually taking too much of it. Too much thyroid medication in your system can also cause weight gain. You can be overdosed with thyroid medication as a result of a pharmacy error or because your doctor has inadvertently prescribed a higher dose of medication than he or she intended to or unfortunately as a result of your doctor prescribing a dose of thyroid medication way higher than what your body needs. Another common reason is a batch potency or switching from a brand name to a generic which would have a much higher thyroid hormone content.

You could also be over-medicated as a result of taking supplements that contain thyroid glandular over the counter for weight loss or as adrenal supplements (can be very dangerous). If you have Celiac disease and you are taking thyroid medication and start a gluten free diet, the absorption of thyroid hormone may become higher and that can lead to over-medication as well. Another reason is not adjusting the dose of thyroid medication after you have successfully lost weight as a result of dieting.


Another commonly overlooked overdose with thyroid hormone is the T3 overdose caused by taking high doses of Armour Thyroid as a single daily dose. Your random thyroid test may look normal; however, because Armour Thyroid comes from pigs and is much richer in T3 than human thyroid, the T3 levels can be elevated for hours after you take your morning dose of Armour Thyroid. That is why it is important to find a doctor who know s how to prescribe Armour Thyroid the right way.

If you have Hashimoto’s Thyroiditis as a cause of your underactive thyroid, remember the activity of the gland can change abruptly and the gland can become stimulated by the immune system to produce more thyroid hormone than before and that can result in over-medication and instability of thyroid levels while taking thyroid hormone medication.

Thyroid hormone interference

It is well established that foods, certain medications, calcium, iron and other minerals can trap thyroid hormone and interfere with its absorption in the gastrointestinal tract. With respect to calcium, most research published had focused on calcium carbonate, demonstrating that thyroid hormone absorption was reduced when calcium carbonate was taken concomitantly with thyroid hormone. However, a recent research study compared the effects of calcium carbonate, calcium citrate and calcium acetate on thyroid hormone absorption and showed that the absorption of thyroid hormone can be reduced by 25%. So it appears that regardless of the form of calcium supplement taken it does interfere with thyroid hormone absorption when taken simultaneously.


It is always recommended for thyroid patients to take their calcium supplements at lunch and dinner time if taking thyroid hormone medication before breakfast. Make sure you do not take over the counter multivitamins in the morning as most of them contain calcium, iron and other ingredients that can affect thyroid hormone absorption.

Is taking the right thyroid treatment enough for Hypothyroidism?

Treating an underactive thyroid with thyroid medication is an important component of the Arem Thyroid Program. However, having perfectly normal thyroid levels in your blood is not necessarily enough. For optimal wellness, you need to make sure that thyroid hormone is working efficiently in your body and you need to do everything that helps support the health of the remaining thyroid gland and to support the immune system since your thyroid condition is likely to be immune mediated and related to an immune attack on the thyroid. There are additional things that need to be done:


  • *Healthy nutrition and avoiding saturated fats. The best diet for thyroid health is a higher protein, low-glycemic, high fiber, Mediterranean diet. 
  • *Stress management, practicing relaxation techniques and regular exercise.
  • *A comprehensive supplementation program which includes:
  • *A well-balanced mix of trace minerals, vitamins, antioxidants and other ingredients that support the health of your thyroid gland, thyroid hormone efficiency, immune system health and metabolism (i.e. ThyroLife Optima).
  • *Omega 3 fatty acids
  • *Probiotics
  • *Calcium (at least 4 hours after taking thyroid medication)
  • *Vitamin D in the right amount




How to select the best thyroid supplement to optimize thyroid health and thyroid hormone efficiency

There are many thyroid supplements out there that you can get over the counter or online. Some of them contain herbs of unknown efficacy or safety, others have incomplete or imbalanced compositions and many of them have been designed by people who lack knowledge in thyroid and metabolism. Ideally you should select a thyroid supplement that will provide you with a complete spectrum of ingredients that will help your metabolism and that will reduce free radicals and inflammation in your body for optimal weight loss if you are overweight. You need to know that the best thyroid helpers are thyroid supplements that should be clean mixes that have to include well balanced amounts of the following:


  • Minerals and trace elements (iodine, selenium, zinc, copper, manganese, chromium, molybdenum, magnesium, vanadium-all important for optimal thyroid health, for optimal metabolism)
  • Vitamin A, vitamin E and vitamin C (uniquely beneficial for thyroid health)
  • Adequate and appropriate amounts of B vitamins (Thiamine, Riboflavin, Niacin, Pyrodoxine, Folic Acid, vitamin B12 and PABA, Biotin, Pantothenic Acid)
  • Other potent antioxidants such as: Co-Enzyme Q10, Lycopene, Turmeric, Alpha Lipoic Acid, L-Glutathione and Quercetin
  • Vitamin D (so important for thyroid autoimmunity and metabolism)
  • Inositol (important for TSH signaling)


ThyroLife Optima is viewed by many health professionals as one of the best supplements for thyroid patients and multivitamin, antioxidant mix because it includes, in a balanced way, all of the micronutrients mentioned above that help thyroid gland health, the immune system, thyroid hormone efficiency and metabolism. This supplement will also make weight loss easier when a person follows the right diet. It is calcium-free, gluten-free and iron-free and you can take it right at the end of breakfast, even if you are taking thyroid medication. To learn more, click here.


You need to know that thyroid supplements, including ThyroLife Optima, are not intended to treat or cure your thyroid condition but to provide you with the ingredients necessary to maintain a healthy thyroid system and metabolism. Do not be misled, there are no supplements on the market that will replace your thyroid treatment or that will treat or cure your thyroid condition.

Treatment for Hyperthyroidism

There are three types of treatments available for patients with Graves’ disease: Radioactive Iodine, medications, (PTU or methimazole) and surgical removal of a big portion of the gland. The treatment choice offered by your doctor should be tailored according to your specific clinical situation. Do not follow stereotypic recommendations!
Anti-thyroid Medications
The two most widely used medications used to treat Graves’ Disease are PTU (propyl- thiouracil) and methimazole. These medications block the manufacture of thyroid hormone. The doses needed depend on how severe the hyperthyroidism is, and typically the doses are adjusted based on symptoms and thyroid testing to maintain normal thyroid levels. These medications are generally used until remission of Graves’ Disease is achieved, and this could happen in a few months to a few years. However, most physicians decide to stop these medications after 1-2 years if remission is not achieved and advise the patient to be treated with radioactive iodine to destroy a portion of the thyroid gland. The major adverse effect to watch for while taking these medications is low white blood cell count, a dangerous but uncommon adverse effect that can lead to serious infections. For this reason, you need to have your blood count monitored on a regular basis. Another rare but serious side effect of medication is liver damage. For this reason, you need to have your liver function test monitored while receiving these medications. More common side effects are itching, urticaria (hives), skin rash, joint pains, fever, upset stomach, and metallic taste. Before starting methimazole or PTU, please become acquainted with these side effects and others. The overall remission rate of hyperthyroidism with the use of these medications is roughly 30-50%.
Radioactive Iodine
Radioactive iodine treatment is by far the most favored form of treatment of hyperthyroidism because it is more definitive and will eventually lead to hypothyroidism as a result of the gradual destruction of the thyroid gland. Most patients require one treatment; however, some patients may remain hyperthyroid after a few months and they may require a second or even a third dose of radioactive iodine. If you have an active Graves’ eye disease, be aware that radioactive iodine treatment can make your eye problems worse. If this is the case, it is better to be treated with anti-thyroid medications until the eye issues improve or resolve. Make sure you are not pregnant when you get radioactive iodine treatment, and that you are not going to conceive for the next 6 months to a year.
Subtotal Thyroidectomy (surgical removal of a big portion of the thyroid gland)
This method of treatment is not recommended as often as medications or radioactive iodine. It could be the best option if you have a very enlarged thyroid gland or if you have experienced side effects from medications and you are reluctant to receive radioactive iodine treatment. Always select a surgeon who has a great deal of experience with thyroid surgeries.