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Show 1196: What to Do If Thyroid Treatment Doesn't Work for You

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People who find that the standard thyroid treatment doesn't resolve all their symptoms of hypothyroidism may wish to discuss combination therapy with their doctors.
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Low thyroid function is a very common problem, affecting an estimated 20 million Americans. That is nearly 12 percent of the population. Most doctors are convinced that all they need is one lab test–TSH–and one medication–levothyroxine–to treat hypothyroidism. Why don’t all patients agree?

The Problem with Thyroid Treatment:

The thyroid gland produces at least two essential hormones that your body needs every day. The primary hormone is T4, also known as levothyroxine. This hormone contains four atoms of iodine as part of its molecular make-up. The thyroid also makes small amounts of T3, or tri-iodothyronine. There are three iodine atoms in this molecule, which serves as the active form of the hormone in body tissues.

In the early 1970s, when doctors first realized that the body could convert T4 to T3 by knocking one atom of iodine off the molecule, they embraced synthetic levothyroxine (Synthroid). Around the same time, the radio-immunoassay for TSH (thyroid stimulating hormone) became available. This laboratory test soon gained prominence as the main and sometimes the only measure of how well the thyroid gland was working.

Genetic Differences:

Only recently have investigators identified the genetic basis for some variation in how well different people convert T4 to T3. These variations may help explain why a proportion of hypothyroid patients complain that they are still suffering symptoms despite taking their levothyroxine. Dr. Antonio Bianco, one of the leaders of this research program, discusses when and why certain individuals might feel better with combination therapy.

An Ayurvedic Approach to Thyroid Treatment:

Symptoms of thyroid dysfunction are, unfortunately, common and not very specific. Problems such as fatigue, constipation and muscle weakness could signal a number of illnesses. Even dry skin, weight gain and sensitivity to cold are not completely diagnostic for hypothyroidism. Nonetheless, the ancient Indian medical tradition of Ayurveda has been treating people with symptoms suggestive of hypothyroidism for centuries if not millennia.

Dr. Marianne Teitelbaum, a chiropractor who has been studying the use of Ayurvedic principles for decades, describes how she has adapted them for thyroid treatment. Ayurveda emphasizes the use of diet and herbs for treating imbalances. The Ayurvedic approach also calls for individualizing thyroid treatment for each patient, since the source of an imbalance are unique to every person.

This Week's Guests:

Antonio Bianco, MD, PhD, is a Professor in the Section of Endocrinology, Diabetes and Metabolism at the University of Chicago Department of Medicine. The review he co-authored of combination therapy in thyroid treatment was published in Frontiers in Endocrinology (July 9, 2019)

Marianne Teitelbaum, DC, has been incorporating the principles of Ayurveda, a 5,000-year-old tradition of holistic medicine that comes from India, in her practice for over 30 years. Dr. Teitelbaum lectures and writes extensively about Ayurvedic treatments for all diseases. Her latest book is Healing the Thyroid with Ayurveda: Natural Treatments for Hashimoto’s, Hypothyroidism, and Hyperthyroidism. Her website is http://drmteitelbaum.com/

You may find our eGuide to Thyroid Hormones of interest.

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