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Help for Hashimoto's and hypothyroidism

Dear Pharmacist: I listened to your Thyroid Summit last June and heard the different doctors talk about medicine, but I'm still unsure what I should be taking. I have Hashimoto's and don't do well on Armour. Can you tell me what is best for me? -- J.C., Chicago

As a pharmacist, I know about all the medications for thyroid disease, but as an individual, I insist you ask your practitioner what's best for you. I've learned that people with Hashimoto's have a peculiar sensitivity (at times) to porcine-derived medications known as natural desiccated thyroid, or NDT. Your Armour medication is in the NDT class.

NDT drugs are popular prescription medications that contain a combination of T4 and T3 that is porcine (pig)-derived, then purified. First the advantages of NDT drugs:

1. NDT drugs provide your body with a good match to your own human thyroid hormone, despite being derived from pig glands.

2. NDT drugs have been around for a long time and have a relatively safe track record.

3. The price for a month's supply is very affordable.

Here are a few disadvantages of NDT drugs:

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1. Some people develop an allergy to it or they don't want an animal-derived product.

2. This is a biggie for people with Hashimoto's: Your immune system may mistake the added thyroid glandular you are getting from the drug and make more antibodies to your thyroid.

For some of you, your immune cells cannot distinguish between pork-derived thyroid gland and your own thyroid gland, so the NDT drugs trigger your immune system. We are talking about autoimmune thyroid disease, not regular hypothyroidism. You would know because your TPO (thyroid peroxidase) TG (thyroglobulin) antibodies would increase, and symptoms would flare. This reaction does not happen to everyone, but if you do react, then one easy alternative would be to switch to a synthetic drug, such as levothyroxine. This is a synthetic T4 drug that matches your own thyroxine hormone, and because it's not glandular, it might mean fewer antibodies. Removing grains, soy and dairy can reduce antibodies; so can taking selenium.

As for levothyroxine, one disadvantage that is that some of you might not fully activate the medicine into T3 thyroid hormone, so the symptoms would persist. This poor peripheral conversion of T4 to T3 is what I call being "thyroid sick," and you can activate better if you take certain natural herbs, probiotics and vitamins. (I cover this all in my "Thyroid Healthy" book.) Levothyroxine is usually started at 50 mcg (micrograms) per day, and titrated to higher doses within a few weeks.

Thyroid medicine is always taken in the morning on an empty stomach. Your physician should be monitoring free T3 and T4 during this process. If the T4 goes up too high, then balancing it with T3 from Cytomel, or from compounded T3, which comes from a compounding pharmacy, can help.

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