Choosing Thyroid Medication for Hashimoto’s Thyroiditis
If you have been diagnosed with Hashimoto’s, thyroid replacement medication can make a big difference in your health and well-being. It’s important to find the right medication at the right dose. Even if you are the type of person that doesn’t like to take pills, this is about replacing critical hormones that your body needs. I’d like to share some insight on choosing the right medication.
If you have Hashimoto’s and have hypothyroid symptoms, but are not on medication already, your doctor will most likely suggest thyroid hormone replacement. Studies have shown that thyroid hormone replacement not only replaces important hormones that your body needs, but can also reduce thyroid gland inflammation, and help relieve your symptoms. You will need to work closely with your doctor at this stage because prescribing the right thyroid replacement is tricky and takes expertise. It usually takes a few rounds of trial and error to find the product and dose that works best for you.
If you are on medication but still have symptoms, and your lab tests are not optimal, it may be time to explore other medication options.
In my personal experience, very few people with Hashimoto’s feel better with T4 replacement alone. This is because T4 is the relatively inactive form of the hormone that must be converted in the liver and other organs to the more active form triiodothyronine, or T3.
Unfortunately, chronic stress, acute and prolonged illness, heavy toxic body burdens and nutritional deficiencies can dramatically slow down the conversion of T4 into T3.
Studies have shown that many people’s symptoms improve with T3 replacement.[i] I know mine did, but it’s not for everyone! You’ll have to work with your doctor to find out if T3 supplementation is right for you.
Your Thyroid Replacement Options
You have a few options when choosing a thyroid hormone replacement. The most commonly prescribed treatment for Hashimoto’s is a synthetic version of the hormone thyroxin (T4) called l-thyroxin or levothyroxine. The brand names are Synthroid, Levoxyl, Levothroid and Unithroid.
T3 comes by the brand name Cytomel, and is also available in time-release and immediate release formulas from compounding pharmacies. The compounded time-release formulas are the only form worth taking though, because T3 has a relatively short half-life in the body.
Thyrolar (Liotrix) contains both T3 and T4, but also contains a ton of fillers and dyes (see below.)
Two other options are Armour Thyroid and the less allergenic Nature-Throid. These are prescription medications made from desiccated (dried) porcine (pig) thyroid, and contain both T4 and T3. They also contain T1, T2 and calcitonin, which make them closer to what your own healthy thyroid would produce. The only caveat about desiccated thyroid is that it can provoke an immune response in some people, because it’s mostly thyroid tissue, which is what your body’s antibodies are attacking in the first place.
I have personally seen antibodies go up when people make the switch to a desiccated thyroid. Since the goal of The Thyroid Cure approach is to reverse your autoimmune condition, it makes sense to avoid substances that are known to trigger an immune response. Many thyroid sufferers swear by Armour. They will tell you that nothing makes them feel as good. My personal opinion is that if you feel better and your antibodies disappear while you are on a desiccated thyroid, then you are on the right track. However, if you’re taking desiccated thyroid, you’ve removed all the other possible immune burdens (I call them splinters), and your antibodies are still elevated, it may be time to try another type of hormone replacement.
Finally, there are prescription synthetic compounded T4 / T3 time-released combinations that are made by compounding pharmacists. I feel these are superior preparations, but insurance companies rarely cover them, and they cost significantly more than the other options. I always recommend calling the compounding pharmacy first to inquire about the costs. I list the names of some reputable compounding pharmacies in the resources section of The Thyroid Cure Web site at
Like I have said before, I have noticed that everyone is different when it comes to thyroid hormone replacement. There is no one-size-fits-all medication. You and your practitioner must be willing to try different options until you find the right one.
Beware of Sensitivity to Fillers
I have observed that quite a few of my clients have not felt as well on Synthroid, Armour or Cytomel. It’s likely that many people with autoimmune conditions have sensitivities to the fillers used in these preparations. Synthroid has both cornstarch and lactose. Thyrolar contains silicon dioxide, corn starch, lactose, magnesium stearate and dyes. Cytomel has a modified food starch that contains gluten, and Armour has dextrose. It’s hard to believe that a person can react to such tiny amounts of these substances, but they definitely do.
Finding the Correct Dose
With all hormone therapy, it’s always best to start low and go slow. Your doctor will be able to find a starting dose that is appropriate for you. I agree with the approach of incrementally raising the dose until your TSH reaches 1.0 or lower while you are in the healing phase. This gives your thyroid a break, and reduces the inflammation in the gland.
Talking to you Doctor
Unfortunately not all physicians are up to speed on the latest treatment options for Hashimoto’s. It’s a good idea to bring the information in this blog post to your doctor. If you need help finding a doctor who agrees with this information, you can call my office and we’ll help you find one. I am also available as a medical advocate and certified health coach. I can work along side you and your doctor to help you get the treatment you deserve!
My office line is 575-613-4369 or you can email me: email@example.com
Don’t Stop Here!
Taking thyroid medication alone will not reverse your Hashimoto’s. Even if you feel better and some of your symptoms improve, if you want to heal completely, you must reduce your body’s toxicity and remove the splinters aggravating your condition. This requires further investigation, and in most cases, some lifestyle changes.
The next step is to follow the Sensitivity Discovery Program to discover the foods that aggravate your condition. I lay out all the details the in my book, The Thyroid Cure, but you can get the food lists and some delicious recipes from The Thyroid Cure website at
Stay tuned for my next blog where I’ll talk about the causes of Low T3, Low T3 Syndrome and how functional medicine treats these complicated conditions!
In the mean time, wish you success on your healing journey and in finding the thyroid medication that works for you!
[i] Nygaard B, et al. Effect of combination therapy with thyroxine (T4) and 3,5,3′-triiodothyronine versus T4 monotherapy in patients with hypothyroidism, a double-blind, randomised cross-over study. Eur J Endocrinol. 2009;161:895–902. http://www.eje-online.org/content/161/6/895.full