Is Synthroid better than Levothyroxine?

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! 

What is Armour Thyroid? Episode 42.

Welcome to Episode 42. Thanks for joining me. We have a listener question today. I may have covered this in the past but we are going to discuss her question anyway. 

Before we do that I want to talk about your reviews on iTunes. I want to thank all of you who have left a review. It helps me help more people and it helps me know what I am doing well and what I can improve on. So, someone left me a 1 star review but didn’t leave any comments. Can you all help me out? If you think there is something I can do better, something to improve the podcast, please let me know. Send me an email at stephanie@outofthewoodsnutrition.com or fill out the contact form on my website. Thanks so much. 

Okay, let’s get started.  The question from a listener today is: 

What is Armour Thyroid? I have never heard of it before.  I take levothyroxine and been on it for years and I still feel awful... I'm curious if Armour is the best for Hashimoto’s. 

Shirley

Thanks for writing in Shirley. I appreciate you! 

Most doctors are going to prescribe Generic Levothyroxine or Synthroid which are T4 only medications. There are others but the only other one you are likely to hear about is Tirosint which is kind of considered a hypoallergenic medication because the ingredients are levothyroixine (T4), gelatin, glycerin and water in a gel cap. 

Synthroid ingredients are long but they start with:

• the synthetic or man made T4 along with

• acacia (binder, emulsifying agent, and a suspending or viscosity increasing agent)

• confectioner’s sugar with corn starch

• lactose monohydrate (used to keep the tablet formed)

• magnesium stearate (a water insoluble powder used as a release agent and as a lubricant or part of the production of pharmaceutical drugs and cosmetics. Hydrogenated cottonseed or palm oils are a common source for it)

• povidone (a synthetic polymer vehicle for dispersing and suspending drugs. It also acts as a binder) and

• talc (used as a binding agent). There are also a number of artificial colorings depending on the strength of your medication all of which contain aluminum and are produced from coal tar or petroleum. 

So nice for a medication you might have to take the rest of your life. 

These synthetic forms started making their way in to our lives around the 1950’s and the natural stuff was said to be unreliable and not as effective. So most doctors stopped prescribing it and started prescribing these synthetic forms. 

Synthetic means it is made in a lab. Doctors often have to go along with what their medical association says is best or face penalties. So don’t blame your doctor 100%.  Do be proactive in your own care and fight for what makes you feel best. 

Armour Thyroid seems to be the only widely available Natural Desiccated Thyroid hormone these days. 

All natural desiccated thyroid hormone pills come from a pig thyroid gland. This was the original thyroid hormone replacement back in the 1800’s. It has been around a long time and made a whole lot of us feel so much better than a synthetic T4 only medication like Synthroid or Levothyroxine.  Some people do fine on the synthetics but it sure seems like most of us do better on NDT. 

These “natural” thyroid hormones are called natural because they come from a an animal rather than a lab. They also contain all of the thyroid hormones that are available in our own tissue. 

You mostly only hear about T4 and T3 but there is also a T2, T1 and T0. There is not as much research on exactly what the other ones do for us but if they are there it must mean we need them. 

The word desiccated means that the thyroid gland removed from the pig, who is bred just for this purpose, in a special way. The pigs thyroid gland is frozen, minced, dried and turned into a powder. The fat is removed with chemicals and then many batches of thyroid powder are combined to keep the ratios of T4 to T3 more consistent. 

This means you are getting ratios more consistent with what your own body would produce. 

NDT has a naturally occurring hormone called calcitonin which is also produced by the thyroid gland and is used by the body to maintain bone health as well as blood levels of calcium. 

NDT products are often referred to in grains rather than micrograms or milligrams. This is becoming less so now but was quite common even just five or ten years ago. 

What is a thyroid grain?

One grain of NDT is 60mg in Armour Thyroid. It has 38mcg T4 and 9mcg of T3. Not all medications are the same. Every manufacturer will be different and your body will probably respond differently to each one so it is a bit of trial and error to find the one that is just right. 

Thyroid medication is often called the Goldilocks medication for this reason. 

The ingredients in Armour besides the thyroid hormones are:

• calcium stearate (a white waxy powder in lubricants, soaps and in some food products)

• dextrose (a form of sugar)

• microcrystalline cellulose ( refined wood pulp used as a texturizer, anti-caking agent, fat substitute, emulsifier, extender and bulking agent in food production most commonly used in supplements or tablets)

• sodium starch glycolate (used in pharmaceuticals to cause the tablet to disintegrate quickly or as a suspending agent)

• and lastly opadry white ( polyvinyl-alcohol film-forming polymer used to keep the pill from absorbing moisture). 

I did really well on WP Thyroid which is another NDT but it is tough to get. I cannot get it locally here in Minnesota. I also did really really well on compounded NDT which was just thyroid powder and cellulose. The one pharmacy I found her that could make it for me can no longer get the thyroid powder. 

Nature-Throid and WP Thyroid have an info page on their website about how you may be able to obtain their products through mail order pharmacies. That link is in the blog post for this episode at helpforhashimotos.com. 

getrealthyroid.com

Why is Natural Desiccated Thyroid Hormone better for so many people?

Let’s take a look at what this medication is doing for us.

There are two kinds of T4 in our body- a levo and a dextro and synthetic T4 has only the levo type. I’m not going to get deep in to science and will just leave it at that. 

Around 80-90% of T4 is made by the thyroid gland as thyroxine (so levothyroxine is from the levo type which is a left rotating isomer of the thyroxine molecule). 

T4 is converted to T3 in the thyroid a bit and in other tissues much more. About 40% of T4 is converted to T3 in the body and some is converted to reverse T3. 

T3 is more bioavailable or bioactive and is about 10% or so of thyroid hormone and most is made in tissues in the body by converting T4. 

Now Free T3 is what our cells are using and works better than free T4 according to some. We do know that Free T3 can get to our brain by crossing the blood brain barrier better than Free T4. So Free T3 gets to the brain easier and could be why so many find that our cognitive abilities and general brain function are so much better on NDT. 

What can help brain fog?

Being on NDT is a good place to start. Often synthetic T4 medications don’t convert as well to T3 in many people OR you just are not getting an adequate dose of your medication. 

I said earlier that there isn’t a lot known about the T2, T1 and T0 but what we do know is that T2 may be involved in enzyme production that helps us make T3 from T4. 

It is thought that T1 helps the thyroid function and play a role in heart health. 

I also mentioned calcitonin which helps our body regulate calcium levels in our body and particularly in our bones. It plays a role in prevention and reversal of osteoporosis.  It also helps us reabsorb calcium from bone storage and helps the gut absorb calcium from our diet. 

So gut health is pretty important for that. 

In order for our body to convert thyroid hormone we need to have this enzyme called a deiodinase. When someone is taking synthetic synthroid (T4 only) you must rely on your body (which is not functioning well if you have the need for thyroid medication) to make enough of these enzymes so your body can convert T4 to T3. 

With a NDT like Armour or one of the other brands, your body doesn’t have to do this because the medication contains the much needed T3. 

T3 is also absorbed in the small intestine much better than T4. T3 is bound by the thyroid binding globulin (TBG) which is a protein that transports the hormone through the blood. When they are no longer bound to the TBG, they are free hormones. 

Synthetic T4 does not have this type of protein bringing it through the blood and can be more affected by stomach acid, digestive enzymes or gut flora making absorption more difficult. 

The Wall Street Journal published an article bringing to light a scandal with Synthroid in 1996. The then owner of Synthroid paid a researcher to study the medication proving it was a better product than NDT. The research did not come out in their favor and the company tried to discredit the author and threatened to sue her if she published her findings. 

Synthroid has been has been recalled a couple of times by the FDA due to problems with doses and strength. It was actually sold in the US for years without FDA approval and in 2001 a new drug application for Synthroid had to be made. 

So why does your doctor or endocrinologist typically only prescribe synthetic thyroid hormone? 

Could be financial incentives due to financial ties between manufacturers and the American Association of Clinical Endocrinologists who create the guidelines under which your doctor may practice. 

A NDT like Armour or WP or Naturethroid have helped many thyroid patients feel better in a plethora of ways from fixing brain fog as mentioned earlier to being able to lose weight, better sleep, more energy and so much more. All because we are getting that missing component in something that is more biologically available to our body in its full form. 

When you take a NDT medication it can be helpful to take it in divided doses such as 2x a day with a dose in the morning and one in the afternoon. Personally when I switched to Armour I got heart palpitations (this did not happen on the compounded medication or WP thyroid for me) so I started with half a dose dissolved under my tongue in the morning then the other half a couple hours later and the second pill in the afternoon. I have to do this for a week or so until my body gets used to the medication and then I can take a whole pill in the morning without getting palpitations. 

Another recommendation is to do ⅔ of your total dose in the morning and ⅓ in the afternoon. T3 has a shorter half life and so taking that second dose in the afternoon can help keep you from feeling sluggish. Some people get too stimulated by a T3 medication and cannot take it at night, others have no problem. You just have to play around with dosing until you find what works for you. 

You also don’t want to take too much, remember I said this is a goldilocks drug and hopefully you have a doctor that will work with you on treating symptoms. You can end up with heart issues, osteoporosis, insomnia, and intolerance to heat, hyperthyroidism, tremors, too many bowel movements in one day and thinning hair. 

You will want to make sure your doctor orders a Free T3, Free T4, Reverse T3 test as well as TSH when taking NDT. TSH can be below normal but if Free T3 is in normal range and you feel great, it should not be a problem. My doctor does not prescribe to this idea but she is very good about supporting me in checking my symptoms first. 

Thanks for listening. Send my your questions at helpforhashimotos@gmail.com or fill out the contact form on my website. 

Please leave me a rating and review on iTunes, the more reviews the more people will be able to find the podcast and get help. I appreciate your help! 

You can find me at helpforhashimotos.com and you can join the facebook support group help for hashimoto’s. I’m avoiding social media still but will be checking for people who want to join the group. You can also get my ebook Five Things Your Doctor Won’t Tell You About Hypothyroidism on my website by signing up for my newsletter. 

Need help figuring out how to navigate your thyroid health? I’m here for you and am taking new clients. I can’t wait to help you! 

That is it until next week. Take care!