The Controversy of T4-only meds like Synthroid or Levothyroxine
Why does STTM state that for too many thyroid patients, T4-only, aka levothyroxine medications like Synthroid, Tirosint, & Eltroxin didn’t work well enough?
The purpose of T4 is to convert to the active T3. It’s T3 which changes lives.
But the problem, according to years of patients experiences, is that T4-only has NOT been doing the job as a sole treatment for hypothyroidism for decades, whether the cause is autoimmune Hashimoto’s, or any other reason for being hypothyroid…unless you think that an elevator that goes up to the 5th-floor-only on a 50-story building is “doing the job”.
Granted, we do hear from those who feel they are doing great on T4-only! And we applaud that! But on the other side of the coin, there are also too many who, though they feel they are doing well, report symptoms which creep up over time. Or, they have symptoms which they never thought was connected! It appears by so many reported experiences that the body is not meant to live for only one of five thyroid hormones for all too many.
**You can read a lot more interesting information about T4-only in Chapter 1 of the updated revision STTM book–the one with the girl on the front with her fists up.
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But “we’re all different” right?? What doesn’t work for one may work for another, right?
If ten people were playing in a street, and seven were run over, would you still approve of playing in the street because three didn’t get run over at that moment in time…in the name of “We’re all different” or “Whatever works” or “To each his own”?
In summary, on only one of five thyroid hormones, some never feel better; some do better but still have problems like Fibromyalgia, hair loss, depression, anxiety, low iron or b12, rising cholesterol or blood pressure, etc; some do well for years (or they thought, not realizing what was actually happening); some never needed treatment in the first place since pure and simple chronic stress can raise the TSH..aka secondary hypothyroidism that would go away in the first place once stress was relieved.
Why doesn’t T4-only work well for so many, based on their reports?
Please consider that a healthy thyroid makes five hormones: T4, T3, T2, T1 and calcitonin. T4, also called thyroxine, is simply a storage hormone meant to convert to T3, the active hormone. But a healthy thyroid doesn’t make you totally dependent on conversion alone. It also gives you direct T3 plus the other hormones above. So in other words, being on a T4-only med means you are missing out on direct T3 as well as the compliment of all five hormones.
Summary: all in the graphic can negatively affect the conversion of T4 to T3: getting older, chronic stress, taking calcium/iron/estrogen or high fiber at the same time, excess uncooked goitrogens daily, poor nutrient absorption, chronic fasting, chemotherapy or radiation, excessive intense exercise, chronic inflammation, low testosterone, certain medications, liver stress, low iron, genetics and lyme disease.
What are common symptoms or problems that happen to T4-users
They vary from individual to individual, but can include one or more of the following: easy fatigue, poor stamina, decreasing iron levels, decreasing B12, low Vitamin D, anxiety, high cortisol, low cortisol, easy weight gain, trouble losing weight, feeling cold when others are warm, having to nap in the afternoons, dry skin, dry hair, thinning eyebrows, aches and pains, rising cholesterol, rising blood pressure, heart problems, heart palps, and on and on. i.e. T4 users are still hypothyroid…whether from the beginning or the longer they stay on!!
And what do too many uninformed doctors do for the symptoms someone on T4-only might have?
What our doctors tend to do is what we call “band-aid treatments.” i.e…..
Summary: it’s just too common for doctors to bandaid continued symptoms of hypothyroidism with antidepressants, anti-anxiety meds, statins, blood pressure meds, or pain meds…or to exclaim “Exercise more, eat less, go see a therapist, your TSH is normal”.
But what about Tirosint, a newer version of T4-only?
Tirosint is a liquid version of T4 which patients have reported doing better on than Synthroid or Levo. But the clear answer is: T4-only is T4-only is T4-only. We again saw that even on Tirosint, patients have reported problems by Tirosint forcing your body to live for conversion to T3 alone. Feeling better apparently doesn’t equal getting rid of all symptoms of hypo, or avoiding the problems that too many encounter down the line from forcing their bodies to get T3 from conversion only.
So what’s a better alternative to being on T4-only?
FIRST, there’s a good chance that you’ll need to get your adrenals tested with a 24 hour adrenal saliva test, plus all four iron labs, because T4-users often see these one or both go south on T4. Not all do. But enough do. To successfully raise Natural Desiccated Thyroid (NDT), T4/T3 or T3, your levels of iron and cortisol are important!
Then, people move over to a medication that was successful from the late 1800’s onward: natural desiccated thyroid hormones (NDT). Most are made from pig glands, meet the stringent guidelines of the US Pharmacopoeia, and give patients exactly what their own thyroids give them–T4, T3, T2, T1 and calcitonin. It’s powerful and it works.
Additionally, when on NDT, patients are not dosing by the lousy TSH. Instead, they raise their desiccated thyroid (NDT) according to criteria mentioned on the NDT page on STTM, straight from the experiences of patients. Even adding synthetic T3 to your synthetic T4 is miles better than being on simply T4, report patients over the years.
**You can read a LOT more interesting information found nowhere else about natural desiccated thyroid in Chapter 2 of the updated revised STTM book.
I once tried Natural Desiccated Thyroid, or even adding T3 to my T4, and it gave me problems! Why?
In other words, read this: https//www.stopthethyroidmadness.com/ndt-doesnt-work-for-me to learn about the problem of too high or too low cortisol or inadequate levels of iron. This is why patients have found it to be so important to test their adrenals via saliva before being on, or raising NDT…as well as testing all four iron labs (i.e NOT just ferritin). Equally common as to why patients think NDT failed them? NOT RAISING HIGH ENOUGH (in the presence of good iron or cortisol(.
It’s important to test and correct iron and cortisol before raising!
As a thyroid cancer patient, my doctor wants me to suppress my TSH on my T4. Is that ok?
It does appear it can be important to suppress the TSH after cancer. But…this research implies that doing it with T4 is bad: https://www.targetedonc.com/publications/targeted-therapy-news/2017/march-2017/levothyroxine-linked-to-heart-risks-in-patients-with-thyroid-cancer i.e. it’s better to suppress the TSH with NDT, or T4/T3, or T3, patients have experienced, as it’s common to see the TSH suppressed anyway on these meds when optimal. NOTE: the TSH will be suppressed before optimal So what is optimal? A large % of patients state they have a free T3 towards the top part of the range and a free T4 midrange, both. Good iron and cortisol is important to achieve optimal without problems.
What’s the BOTTOM LINE?
Years and decades of reported patient experiences and wisdom tell us that the risk for problems is far too high with T4-only…sooner…or later, for too many. It’s not a pretty picture. So patients feel strongly: Why risk it? Work with your doctor on this.
Want to learn more? Here you go…Listen to an audio version of some of this page.
- Watch Janie talk about T4-only vs NDT
- Learn more about natural desiccated thyroid,
- Here’s a great summary of what patients have learned about all of this.
- See the different brands of desiccated thyroid
- Here’s needed labwork and places to get it on your own to share with your doctor
- Here’s how to find a good doctor. And remember: YOU need to face your doctor informed and assertive. Use the revised STTM book to take with you.