Michael Ruscio, Primal Docs
Why are so many people who are on thyroid medications, still not feeling well? Well, it is no secret that thyroid medications, in many cases, treat symptoms of disease and do not treat the cause of the disease itself. To be fair, there are certainly some medications that do treat the cause of disease, but thyroid hormone replacement medications are not one of them. The reason why so many people on thyroid hormone replacement medications still do not feel well is because thyroid hormone replacement medications should never be used without also addressing the underlying cause. There are 4 main reasons for this;
- Thyroid Medications alone may not stop the autoimmune process from damaging your thyroid.
- Thyroid Medications do not address the causes of autoimmunity.
- Thyroid Medications will fail to provide even symptomatic relief for many people.
- Your medication might not be the right medication for you.
1. Thyroid Medications do not stop the autoimmune process from damaging your thyroid.
We have already discussed how autoimmunity is the most common cause of hypothyroidism. We have also covered how the autoimmune process causes damage to your thyroid gland. So here is our fist point, thyroid hormone replacement medications do little to nothing to stop the autoimmune process from damaging your thyroid. Does this mean your endocrinologist has misguided you? No, but you may want to consider a more comprehensive approach to your thyroid condition. To your endocrinologist credit, medications do confer benefit. If someone’s’ thyroid glandis severely damaged they may need some medication indefinitely to replace what the gland can no longer produce; it is very important that one ensures their thyroid levels stay within the normal lab ranges. But for many they still feel lousy when their ‘labs are normal’. Why do I say thyroid medications do “little to nothing” for autoimmunity? Why not just say they do “nothing”? Well although controversial, some studies have found thyroid hormone replacement medication may dampen autoimmunity 1, 2.
All of this is good news and bad news. This is good news because those on thyroid hormone replacement medication are taking small steps to address autoimmunity. This is bad news because so many on medication still do not feel well. More importantly this is bad news because medication gives people a false sense that “they are doing all they can” to address their thyroid; this is far from true. As we will discuss in the chapter on autoimmunity, the causes of autoimmunitymust be addressed to ensure optimal thyroid and overall health. Not addressing these factors can leave one open for other illness in the future.
The strategy of thyroid replacement medication as a monotherapy, while easy, may not be ideal for another reason, it requires that you take medication for the rest of your life. The way I like to view thyroid hormone replacement medication is like a temporary crutch. Using thyroid hormone replacement therapy will help take some of the burden off your thyroid gland while you work to address the underlying cause. Once the cause is address, many will no longer need any medication natural or pharmaceutical and you will have taken great steps to ensure optimal, lasting health.
Why so much emphasis on slowing down the autoimmune process?
Well if the autoimmune process is not dampened it slowly damages your thyroid gland over time. As time progresses many are left with less and less healthy thyroid tissue and less thyroid tissue means less hormone can be produced.
When you have less and less hormone produced you become progressively more hypothyroidism. Over time, people generally need more medication as they lose more and more thyroid gland. This is why dosage tends to increase over time. We will explain this in more detail in my chapter on autoimmunity.
2. Thyroid Medications do not address any of our causative factors.
Remember our causes of hypothyroidism?
Low pituitary function can be caused by:
- Stress Hormone Imbalance
Low thyroid gland function (production of T4) is caused by:
- Autoimmune damage
- Nutrient deficiencies
- Low progesterone
Low conversion of t4 to t3 (activation) caused by:
- Liver toxicity
- Digestive problems
- Stress hormone imbalances
- High estrogen/low testosterone
Taking thyroid hormone replacement will do little to stop the cause of inflammation, decrease the amount of toxins in your body, balance stress hormones, fix most digestive problems, replete missing nutrients, increase your progesterone levels or balance your male and female hormones. Why is this so important? Because these causative factors can cause other symptoms, disease and illness if not addressed. For example vitamin D deficiency has not only been correlated with autoimmunity but also with everything from hypertension to heart disease 3-8.
As another example certain digestive problems have been correlated with depression as have certain toxicities 9, 10, 11. I hope this is starting to make sense.
3. Thyroid Medications will fail to provide even symptomatic relief for many people.
There are three main reasons for this;
- If someone has poor conversion of T4 into T3 and they are being given a medication that is only T4 (like Levothyroxine or Synthroid) it is very likely they will still be low in T3. See chart below for a breakdown of popular medications
- If you are producing high levels of rT3 then you will be blocking your T3 from working, even if you are being giving a medication that contains T3 (like cytomel, armor, naturthyroid).
- Some authors have speculated that patients can lose the ability for thyroid hormone to work on a cellular level. This means irrespective of the medication you may not feel well. While the data supporting this are preliminary and based mostly on animal and in vitro studies, it may partially answer the question why some do not feel any different on medications.
The good news, inflammation is the primary driver of all three of these. The most common cause of inflammation is gut issues, which Functional Medicine is exceptional at treating. The bad news, thyroid medications will do virtually nothing to correct most gut issues and the inflammation they cause.
4. Your Medication Might Not Be the Right Thyroid Medications for You
“I felt worse when I went on thyroid medication.” This is something patients will occasionally report when coming into the office. This can occur with almost any thyroid medication. We can divide reactions into two categories; patients who react to synthetics and patients who react to bioidentical/natural.
For synthetics you may be reacting to a die, filler or preservative in your medication. Patients with autoimmunity tend to be especially reactive to food and environmental triggers. The synthetic medications tend to have many dies, fillers and preservatives, while the bioidentical or natural hormones contain little to none. These patients will usually do better on bioidentical/natural hormones.
For patients reacting to bioidentical/natural it’s a little different. Patients with autoimmunity (Hashimoto’s or Grave’s) might actually form autoimmune attacks against their own T4 and T3 hormone. Bioidentical hormone medications, being near exact replicas of human T4 and T3, might fuel this autoimmune process. These patients may notice they feel worse when switching to Armour, Nuture-Thyroid or Westhyroid. In this case, using synthetics is usually a better choice. This is because the synthetic T4 and T3 are different than the T4 and T3 found in your body and therefore won’t cause a reaction. There is a test available to identify this 12, but I recommend determining this through trial and error as this test may not always be an accurate predictor.
Bioidentical/natural medications also contain a balance of T4/T3 which will be helpful for many, however for some people the T3 in these medications might be more T3 than they need, causing them to be overdosed on T3 and therefore not feeling well.
The bottom line regarding medications is they often need to be individualized and they should only be used when in conjunction with addressing the underlying cause. Please remember there are 4 main reasons why only using medication may not be ideal;
- Medications alone may not stop the autoimmune process from damaging your thyroid
- Medications do not address the causes of autoimmunity
- Medications will fail to provide even symptomatic relief for many people
- Your medication might not be the right medication for you
Giving a thyroid patient solely a medication is like giving someone in a sinking ship a bucket; they may stay afloat for a while, but until the hole in the hull is fixed they are going to continue to struggle.