Hi, I love listening to your podcasts, I have recently been diagnosed with hashimoto's and the doctor put me on levothyroxine. I have been reading that name brand thyroid medication has much better results. Is this true and if so is it safe to switch from levothyroxine to Synthroid? Or other name brands? Are there major differences between the different brands? Thank you so much for your time and expertise! Brie
Hi Brie,
Thanks for asking this question because it can be really confusing for people especially when the internet is full of “experts”. Since I have been in school I am a bit of a convert to following what the scientific literature says in addition to going with clinical experience. First I would ask where you read that name brand thyroid medication has better results. Who wrote that or said that? Is it a blogger who has better results on Synthroid vs. Levothyroxine? Is it the makers of Synthroid saying there are better results on their product? These are the kinds of questions you want to ask yourself when you are reading something like this. Becoming a critical thinker is crucial to you taking control of your own health.
On the website for Synthroid, there is a lot of marketing telling you that this product is more effective and better for you. They don’t list the full ingredients on their website so I searched the internet via DuckDuckGo for Synthroid Package Insert. Because it is a drug there should be a full list of ingredients and side effects for it in the package insert and it should be available to you to read. You can ask your pharmacist for it. I have done this before and it totally stumps them because they often just throw it out. They sometimes don’t know what to do with me when I ask for that kind of stuff. You have a right to know what is in it so don’t be shy about asking for it.
The package insert for Synthroid aka levothyroxine sodium tablets, USP shows you the chemical equation for the product as well as the ingredients. The main ingredient is synthetic crystalline L-3,3’5,5’-tetraiodothyronine sodium salt which is levothyroxine (T4) sodium. Basically this means it is a lab made T4 only medication. The inactive ingredients are listed as Acacia (or gum Arabic which is an emulsifier, stabilizer, binder), confectioners sugar (with cornstarch), lactose monohydrate (a milk sugar used to compress the tablet- only an issue if you have a severe lactose intolerance), magnesium stearate (used to keep the drug from sticking to the equipment it is made on and can be made from plant or animal sources). There are also artificial colorings added to the medication depending on the dose: FD&C yellow #6 or 10, red #4 or #27 or 40, Blue #2 or #1.
On the Synthroid website under safety information that you should not use this medication if you have adrenal problems that have not been fixed and that taking too much of this product has been associated with increased bone loss, especially for those of us who have entered menopause. It also says that foods like soybean flour, cottonseed meal, walnuts and dietary fiber may keep you from absorbing all of your medication. If you consume a SAD diet you are likely getting a ton of soy flour because it is in everything these days- read an ingredient list for bread from your grocery store. One of the local stores near me who does their own bakery bread lists soy flour as one of the top ingredients.
Your pharmacist likely says to not take this product with food but the website says to wait 4 hours before or after eating when taking this product.
I found a study called Comparative Effectiveness of Generic vs. Brand-name Levothyroxine in Achieving Normal Thyrotropin Levels in the Journal of American Medical Association. The study included almost 18,000 thyroid patients where around 15,000 had generic prescriptions and 2200 had brand name prescriptions. The study concludes that generic levothyroxine is as effective as name brand. The conflicts of interest listed in the study are interesting and should be considered. Some researchers received funding from Blue Cross and Blue Shield, the FDA, support from the Mayo Clinic from the Centers of Medicare and Medicaid Innovation. This tells me that there was a benefit to finding that generic drugs, which are cheaper, were as effective. The listed generic drug manufacturers in the study are Mylan Pharmaceuticals, Sandoz AG, and Lannett Company, Inc.
Maybe the reason why you read better things about name brand thyroid meds is because there are many manufacturers of generics which means when you refill your prescription you could be getting a different generic each time. I would ask your pharmacist if they switch between generics as you have a right to know. They will just give you a different medication if they run out of one kind. It has happened to me before and I let my pharmacy have it. This medication is a Goldilocks drug- they can’t switch it on you or it can cause problems for you. It doesn’t for everyone so I want to be sure I say that.
I went to the FDA website and looked up FDA approved drugs for levothyroxine and came up with a whole list and it says at the top of the list: “products listed on this page may not be equivalent to one another”. There is a whole rabbit hole to go down here with each of the drugs listed but they are as follows: Euthyrox, Levo-T, Levolet, Levothyroxine Sodium, Levoxyl, Synthroid, Thyquidity, Thyro-tabs, Tirosint, Tirosint-Sol, Unithroid.
Levothyroxine Sodium alone has 8 different manufacturers listed where all others have one manufacturer listed. With one manufacturer there is less likely to be inconsistencies with the drug. Tirosint is supposed to be a hypoallergenic formula meaning there is nothing else in the medication but the same synthetic drug as Synthroid but the only other ingredients are gelatin, glycerin and water.
So there are differences and you finding which drug works best for you takes some time. Maybe you won’t feel good on any of the synthetic drugs I talked about and will do better on a natural desiccated thyroid hormone. Some people do better on the natural medication and some people don’t. It is helpful to find a doctor willing to try switching.
The natural desiccated thyroid medications are called combination therapy because they contain T4 like the synthetic drugs but also contain T3. The natural drugs available are sometimes harder to come by. The main one is Armour thyroid which is the easiest to get. Others include WP thyroid, Naturethroid, and a few more. A study comparing the long term effects of treatment with these types of drugs compared to synthetic only drugs found that people taking the natural desiccated drugs not only normalized their TSH but found improvements in mood, well-being and something called psychometric function which is hard to define in terms easy to understand but has to do with your ability to respond to certain stimuli. To be fair, some studies listed in this meta analysis showed no difference in symptoms on either type of drug. Overall though, many people find their overall quality of life on natural desiccated thyroid (NDT) hormone replacement to be better. Personally, I feel my best on a compounded NDT hormone replacement for which I pay a lot of money out of pocket. When the medication is compounded, it is made in house at the pharmacy where they mix the powder with a cellulose powder and put it in capsules. I pay around $200 for a one month supply or $450 for a 90 day supply. This is the only medication that has improved my quality of life besides WP Thyroid (I think it was this one but it’s been so long I don’t remember exactly) which was not available for a long time. So for now, I use my health savings account to pay for my meds and have a much improved quality of life.
So the bottom line here is if you don’t feel good on one medication I would suggest asking your doctor to switch you to a different one. If I had no choice but to be on synthetic medication then I would go with Tirosint first and avoid the generics since there are so many manufacturers unless you can talk to your pharmacist about ensuring that you are getting the same product every time you renew your prescription.
Other things you can do to improve quality of life are of course diet changes, figuring out which foods you are sensitive to, healing your gut, working on blood sugar balance and of course ensuring you have no adrenal issues. There will be more on this to come- my next class for my masters program is all about hormones and we will be focusing on the hypothalamus pituitary adrenal axis or HPA axis and I cannot wait to learn the latest information on this. I will give you a hint though- there is no such thing as adrenal fatigue- our glands and organs don’t get tired. Until next time. Thanks for hanging in there with me. This year has sucked and it has been a bit of a challenge for me to be motivated to do anything let alone get this podcast out. I’ve been battling a bit of depression and have been supplementing with some things that have helped a bit along with exercising and avoiding all the negativity on the news- I’ve also been trying to laugh more and it feels really good.
Ok. Take care everyone!