Podcast about health, wellness, autoimmune disease, Hashimoto's, Psoriasis, hormones, adrenals, nutritional therapy, nutrient dense foods and ways to bring wellness back to a body in dis-ease. Holistic and functional medicine ideals.
Is Synthroid better than Levothyroxine?
What is the difference between synthroid and Levothyroxine? Does it matter which one you take?
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!
Why do I still feel horrible on my thyroid medication?
Thyroid patient and patient advocate, Paul Robinson, talks about what he has learned in his own research (he read 4 or 5 medical endocrinology textbooks and then some) to help himself recover from hypothyroidism.
Endocrinologists, medication, and first steps to take when diagnosed. Episode 9.
We go to the doctor and they tell us to take the medicine and come back in three months or so to be tested to see if we are at the right dosage. I personally got nothing at all from an endocrinologist. You have a right to find someone who will listen. Unfortunately I realize that some of you have horrible health insurance and don’t have the ability to look around much so I have a plan for you! Join me for this episode as we explore the diagnosis and what comes next.
So today I had my 3rd consultant appointment to tell me I have hashimotos disease. (I got told this by the doctor 3 months ago) all he said was, its fine, Nothing to worry about and its very common in women, thyroid is fine, no need for anything else other than ill see you in 9 months time......now i feel like an idiot for having bad days of constant tiredness and pain.
After receiving the results from my full thyroid panel that was ran by my gynecologist, she referred me back to my regular doctor. She spent 10 minutes confirming that I do have Hashimoto thyroiditis and hypothyroidism. She said that I need synthroid and I should follow-up in 3 months. Nothing was explained to me. No recommendations for supplements. No recommendations for diet. I had to request an endocrinologist referral, which will take weeks. So my question here is should I begin the synthroid, figure out what supplements I need, diet, etc or wait to start synthroid until I meet with endo? I’m lost. Also, the closest functional medicine doc is 2 hours from me and doesn’t take insurance.
It seems this is quite common for a lot of us. We go to the doctor and they tell us to take the medicine and come back in three months or so to be tested to see if we are at the right dosage. I personally got nothing at all from an endocrinologist. I had to pay out of pocket to see him and he was worthless to me. Just because your thyroid is a part of the endocrine system does not mean you will get the proper care from an endocrinologist. I am sure there are great ones out there but I have found they are particularly difficult to work with you on treating symptoms and not just your labs. Plus they have a standard for their labs and they will go by that and nothing else. If you are lucky to find an endocrinologist who will work with, great. If not, fire them and keep looking. You are the customer in this situation. You have a right to find someone who will listen. Unfortunately I realize that some of you have horrible health insurance and don’t have the ability to look around much so I have a plan for you!
First of all, you have to remove any triggers for the disease. This will be different for each of you. Once you find our what your triggers are then you will have to repair that which brought your body out of balance and led you to your autoimmune condition. Why is your immune system out of balance? Why did this happen. These are questions you need to ask yourself and do a little digging.
Make a timeline of your health. Look back to as far as you can remember and write it all down in a timeline. Infections, times where you were severely stressed out, antibiotic use or other medications you took, were you on oral contraceptives? Any accidents? Have you ever been exposed to any toxins? How about heavy metals? Do you have amalgam fillings? Once you make a timeline you can see where things might have started to go wrong and then how to fix them. Obviously you can’t do anything about an accident or the fact that you took antibiotics but you can manage stress, take probiotics and other nutrients such as b-vitamins. i strongly recommend working with a practitioner on this to get it right. You don’t and shouldn’t just take any old supplement just because someone says you should. Don’t waste your money on things you may not need.
Next, know that synthetic T4 only medication is not the only one on the market and it doesn’t work well for some people. Ask your doctor to let you try natural desiccated thyroid hormone like Armour or WP thyroid or any one of the other ones on the market.
Also, you must take a look at your diet. This is always the very first place you should start. What are you eating?
A gluten free diet is a must in my book. There is so much research now on the effects of gluten and what is now believed to be the glyphosate in the wheat products that is destroying our health. Gluten also affects our gut health in that it plays a role in leaky gut or intestinal permeability which allows undigested foods or proteins to exit our intestines and go in to our blood stream setting off an immune reaction which can lead to food allergies or sensitivities.
You may have to eliminate other foods too. Most people also have to eliminate dairy products and some of us don’t tolerate a whole bunch of foods. An elimination diet is a good first step really but if that seems overwhelming to you then start with gluten free and work your way there. Removing these foods that are causing inflammation in your body will allow your body to calm down and begin to repair itself. It will also provide your body with a chance to properly react to a food that is harming you so when you reintroduce foods you should be able to tell if something is working well for you. Foods can affect our mood, our energy levels, our digestion, our skin, our brain and more. Keeping a food journal is a good way to really pinpoint what foods are not working for you when you reintroduce them.
The quality of your food is also very important. People often say how expensive it is to eat healthy and I’m not gonna lie. It can be costly to eat all organic and shop only at food co-ops. I have been very fortunate to be able to do just this but I also don’t have a lot of extra money for anything else. I have made high quality foods a priority and will continue to do so because it is important to me. It may not be important to you and that is okay. You can do a lot of good for your health by shopping at a regular conventional grocery store. Just don’t shop the center aisles of the store. In other words, buy real whole foods and if you can, shop with the environmental working groups list of dirty dozen and clean fifteen. This is a list of produce that is recommended to be bought organic and a list of produce that is okay to buy conventionally grown. A big way to save money though is at farmers markets. I got a head of cauliflower for $1 and all kinds of things at much cheaper prices than were in the store. I also buy most of my meat from local farmers at a significant savings. So if you can do some of that kind of thing it is really helpful in saving money.
Next, if your adrenal glands are not working properly, you will not see improvement in your thyroid health. When we are stressed our cortisol can be low or high or fluctuate between the two. Last weeks episode was about adrenals so you can give that a listen for more details.
You also need to heal your gut where 80% of your immune system lies. Cleaning up your diet, making sure you digest your food well, maybe taking a stomach acid supplement. If your stomach is not acidic enough you will not digest your food which will start the cascade of inflammation through the digestive tract and the body. A good diet is essential here and probably some supplementation. You should work with a practitioner on this.
Lastly, removing toxins. This is big. Maybe you have a heavy metal issue. Maybe you need to clean up your personal care products and your household products. Perfumes have too many chemicals in them to count so those should be avoided. Air fresheners are full of chemicals. Anything you put on your skin will be absorbed in to your blood stream so you need to be mindful of that.
I could probably spend an hour on each of these subjects but I like to keep these episodes kind of short since many of us have brain fog and low energy.
You should take the medication that your doctor prescribed and see how you feel. Some people are sensitive to fillers in some of the medications. Synthroid contains cornstarch. Some generic brands have blue food dye in them. Many people do better on natural thyroid hormone replacements like Nature thyroid and Armour but everyone is different. It is common for people with Graves disease to do better on T4 only meds like Synthroid rather than meds with T3 in them because they will have developed antibodies to T3 and T4. Because T4 is synthetic in synthroid there is less of an autoimmune effect in those cases.
If you are taking synthroid or other synthetic T4 only medication and you show a normal TSH lab test but dont’ feel any better this might be what is happening:
If you have hashimoto’s, long term inflammation of any kind including stress you can end up not being able to convert T4 to T3. You pituitary gland wont’ communicate well with your thyroid gland and/or your cells won’t respond to the thyroid hormone that is brought to them. You may also have issues with your blood sugar, a gut infection, food intolerances and so on.
If you are taking or feel better on natural desiccated thyroid hormone then:
you probably couldn’t convert t4 to t3, you were sensitive to something in the medication, you may need t3 because those cells of yours are not taking in the t3 brought to them or the cells just like t3 better.
If you have high cortisol, low progesterone, inflammation, nutrient deficiencies- these all will play a role in your body’s ability to take in whatever medication you are taking.
Something else to consider is that if your autoimmune condition is managed you might not need medication at all. When your thyroid gland is significantly damaged then you will probably be dependent on medication and not taking it can be life threatening.
Either way, you have to manage the hashimoto’s with all that was mentioned today. It is a lifestyle folks, not a quick fix. Healing or recovering or putting hashimoto’s in to remission takes time. The better you do with diet and lifestyle the better your thyroid will perform for you.
To me, it is all worth it.
That’s it for today. Thanks for listening. Be sure to share this podcast with anyone you think could use it. My goal is to help as many of you with hashimoto’s and other autoimmune conditions as possible.
Be sure to pick up my free ebook, 5 Things Your Doctor Won’t Tell You About Hypothyroidism on my website www.outofthewoodsnutrition.com or www.helpforhashimotos.com
You can find me at Out of The Woods Nutrition on Facebook www.facebook.com/outofthewoodsnutrition and at @stephanieewalsntp on Instagram.
Please send me your questions about thyroid and hashimoto's or anything autoimmune related to helpforhashimotos@gmail.com or fill out the contact form on my website.
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Links (some are affiliate) to stuff I talked about: