BLOGS Ask the Pharmacist Ask the Pharmacist: February 2017

Q: Is there anything I can do about my medication for under active thyroid from Hashimoto’s Thyroiditis (HT)?

A: One in five Americans have HT, yet only half of them know it. Generally the symptoms of HT usually develop long before an official diagnosis is determined. Thyroid antibodies cause a fluctuation of thyroid hormone levels which in turn causes a host of symptoms that can be mistaken for other illnesses. A roller coaster of hyper and hypo thyroid states become a confusing array of misdiagnoses. Anxiety, cold hands and feet, weight gain then loss, depression, fatigue, pain, sleeplessness, thinning hair, IBS, nausea/vomiting, brain fog, bipolar behavior are a few of the presentations.

Since the thyroid affects every cell in the body and is responsible for your basal metabolic rate, extracting vitamins and energy from food, as well as the production of other hormones, you can understand the seriousness of correcting an imbalance. Because HT causes the immune system to produce antibodies against the thyroid, and this attack eventually is the cause of hypothyroidism, many practitioners do not treat the autoimmune illness and may treat the symptoms with thyroid medications, usually levothyroxine (T4). Without going into detail about how the thyroid functions, suffice it to say, prescribing T4 alone may not be enough.

Getting your health practitioners to order a comprehensive test panel, instead of simply a TSH (thyroid stimulating hormone measures whether your pituitary in your brain thinks your thyroid is producing enough T4) can be difficult. If you have symptoms and your TSH is “normal”, ask for a more complete evaluation. TPO and TG antibodies, free T3, free T4, a thyroid ultrasound and reverse T3 if indicated.

Getting the right kind of medication, at the right dose, at the right time and in the right way can make all the difference in the world when it comes to reducing the symptoms associated with thyroid disease.

There is controversy in the medical community on when to start thyroid medications. When appropriate, they can be the quickest and most effective way to reduce symptoms and an autoimmune attack on the thyroid gland, reduce goiter size and give the ability to work toward improving ones health by clearing up foggy thinking. More progressive endocrinologists and physicians have seen results when starting patients on thyroid medications before the lab values catch up with the symptoms. Some studies have shown value in reducing the thyroid antibodies when beginning medications.

Certain conditions like heart disease, pregnancy, Addison’s Disease and diabetes may create challenges to thyroid medication dosing.

Because thyroid medications have a narrow therapeutic window, doses that are off can cause over treatment – rapid heart rate, irritability, sweating, and fever or under treatment- fatigue, joint pain, hair loss and depression.

Usually a practitioner will prescribe T4, T3, a combination T4/T3 in ratios that can be tailored to specific patient’s needs by compounding pharmacists or natural desiccated thyroid. If T4 alone is the preferred medication, it will be effective only when it is converted by the body to the more metabolically active T3. If that conversion is impaired, the dose of T4 may continually need to be increased or symptoms will return.

It is important to note that proper micronutrients such as zinc and selenium are needed for the conversion of T4 to T3 and that under stressful conditions, T4 may be converted to the inactive molecule reverse T3. It may be prudent to discuss the combination.

T4/T3 products with your practitioner and be very aware of their response to your request.

Many conventional physicians do not recommend and many insurance companies are refusing to cover animal organ-derived thyroid medication (T4/T3 combo with trace amounts of T1 and T2). This was due to some manufacturing difficulties in the past which have been eliminated. Also, be aware that if stable on natural desiccated thyroid medication, but autoimmune antibodies increase, a compounded version or a combination of synthetic T4 and T3 tablets may be prescribed.

There are a few other ways to reduce autoimmune antibodies. Eliminating some food triggers like gluten, dairy and soy, eradicating infectious agents like H. Pylori (implicated in stomach ulcers), viruses, yeasts or parasites and making sure your home is free of toxic exposure are a few examples. Supplements, low dose naltrexone, low level laser treatments are worth looking at as well.

So much about thyroid health can be related to overall stress reduction, food choice, sleep quality and toxic exposure. Look to changes in lifestyle to improve your overall health and vitality.

Deidre (Dee) Kohley, Rph, works at Watkins Pharmacy, is a graduate of Ferris University and has lived all her life in Muskegon. She continues to find ways to reach women who genuinely want to get well or live an optimal life. Dee loves digging into research to find new ways to help people. She is married and has seven children and nine grandchildren who keep her busy. She loves the beach and spending time outside enjoying the seasons. You can contact her by going to her website or

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