Your Guide toThyroid Medication

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Paloma Health is thefirst online medicalpractice focused onhypothyroidism. Weoffer at-home bloodtest kits, live videoconsultations withthyroid specialists, andprescriptionmanagement. In this guide, you'll learneverything you need toknow about medicationfor hypothyroidism.

A notefromPalomaHealth

Located at the base of the neck, the thyroidgland produces hormones that regulate your body's energy use, along with manyother important functions. When your thyroidhormone production drops, your bodyprocesses slow down and change, affectingvirtually every system in your body.

What is hypothyroidism?

FDA Regulations

FDA approval meansthat the benefits of adrug conceivablyoutweigh the risks.A drug withoutapproval is notnecessarily harmful;and while theseunapproved drugsare sometimesallowed to be sold,they are typicallynot covered byinsurance.

All standardpharmaceuticalproducts areevaluated to makesure that they work.The role of the FDAis to protect publichealth by ensuringthe safety, efficacy,and security ofhuman andveterinary drugs,biological products,and medical devices.

There are many formulations of thyroidhormone replacement medication, andno one-size-fits-all option. We are eachunique with individual sensitivities. Our bodieswill not all react the same way to a specificmedication or dosage.

FDA Regulations

LevothyroxineSynthroidLevoxylTirosintUnithroidLevo-TLiothyronineCytomel

ArmourNature-ThroidNP ThyroidThyroid USPWesthroidWP ThyroidCompoundedmedicines

FDA Approved Not Approved

The thyroid gland produces two hormones:thyroxine (T4) and triiodothyronine (T3).Similarly, thyroid replacement medicationcomes in T4 and T3 formulations. In a healthythyroid gland, the inactive T4 hormone isreleased into circulation and then convertedby the body into the active T3 hormone.Often, treatment for thyroid replacementstarts with T4-only formulations, assumingthat the body can successfully do theconversion on its own.

T4-Only Formulations

A synthetic form of T4 that successfully treatsthe symptoms of hypothyroidism in mostpatients. Your physician may specify a brandname because the potency of genericthyroxine has a history of varying considerably. *Fillers in levothyroxine include gluten, lactose,cornstarch, sucrose, and dyes.

Levothyroxine

As of 2019, Synthroid is the most commonlyprescribed medicine in the United States, withtens of millions of prescriptions per month. *Fillers in Synthroid include lactose, cornstarch,and dyes.

Synthroid

Levoxyl is another brand-name formulation ofgeneric levothyroxine. Levoxyl uses differenttypes of binders and is gluten- and lactose-free.Some patients find this medication morecomfortable to take because of a gentler rate ofabsorption. *Levoxyl include dyes.

Levoxyl

Tirosint is yet another brand-name formulationof generic levothyroxine. It comes in a gelcapsule instead of a tablet, which may help withfaster absorption. *There are no fillers in Tirosint.

Tirosint

Other forms of levothyroxine include Unithroid,Levo-T, and compounded T4. Compoundedmedication is personalized medication in whichdrug ingredients are combined, mixed, or alteredto solve for specific patient needs. CompoundedT4 often includes cornstarch. The Food and DrugAdministration (FDA) approves all commerciallyavailable T4 medication, except compoundedT4. *Fillers in Unithroid include lactose, cornstarch,and dyes.

Other T4 Formulations

If your body has a hard time converting T4 toT3, or you take an interfering medication,standard T4 medicines may not be sufficientfor you. For the few patients who do not feelcompletely normal taking a syntheticpreparation of T4 alone, the addition of T3may be of benefit.

T3-Only Formulations

The generic formulation of thyroid hormone, T3.T3 is the active thyroid hormone that works atthe cellular level to help with the delivery ofoxygen and energy to cells, tissues, and glandsthroughout the body. Typically, liothyronine isused in combination with T4. *Fillers in liothyronine include cornstarch.

Liothyronine

The most common brand-name version ofliothyronine. It is short-acting, so it is best dosedtwice a day. *Fillers in Cytomel include gluten, cornstarch,and sucrose.

Cytomel

Like T4, compounded T3 is an option for thosewho are sensitive to fillers or don't respond toavailable T3 formulations. Compounded T3 oftencontains cornstarch. Work with your doctor todetermine the best treatment for you. If youdecide that compounded medication is the bestoption, make sure that the pharmacy isaccredited by the Pharmacy CompoundingAccreditation Board. These pharmacies must gothrough an extensive process to achieve fullcompliance with the specified standards, andthis accreditation proves to physicians andpatients that their pharmacy meets a very highstandard.

Other T3 Formulations

You may prefer combination therapies ifyou're interested in a more natural approach.There are two main types of combinationthyroid medications - desiccated andcompounded. Like compounded T3, compounded T4/T3 iscustom-made in specializing compoundingpharmacies to provide the strength and ratiothat a patient needs. Combination therapiesgive the most flexibility for those who need aprecise dosage.

T4/T3 CombinationTherapies

Armour is the most common T4/T3 combinationtreatment. It is a brand-name of naturaldesiccated thyroid. Natural desiccated thyroid(NDT) is derived from the dried (desiccated)thyroid glands of pigs or cows and provides T3,T4, and other thyroid hormones found in thehuman thyroid. Pigs produce T4 to T3 at a 1:1ratio, which is lower than the human proportionof 4:1. Due to this difference, some patients mayhave to supplement with additional T4hormone.  Some patients love Armour Thyroid, while othersfeel better with an alternate option. As always,it's important to work with your doctor to find theright treatment for you.  *Fillers in Armour include cornstarch.

Armour

Nature-Throid is another T4/T3 combinationmedication also made of desiccated pig thyroidbut uses different binders and fillers, whichaffects how different people absorb themedicine. *Fillers in Nature-Throid include lactose.

Nature Throid

NP Thyroid, manufactured by Acella, is anotherT4/T3 combination medication. It is gluten-free,dye-free, and dissolves under the tongue, whichmay be helpful to those who have difficultyswallowing pills. *There are no fillers in NP Thyroid.

NP Thyroid

Non-active Ingredients

has consistent andreproducible quality. Both active andinactive ingredientscan cause adversereactions or allergies.It's important to knowwhich fillers are in themedication you takeso that you canavoid possiblereactions like rash,bloating, diarrhea, orheadaches.

Thyroid medicationsoften includesupplementaryingredients known asfillers. These inactiveingredients are thepart of the productthat do not increaseor affect themedicinal propertiesof the activeingredient. Thesenon-activeingredients help toensure that a drug

Fillers in T4

Fillers in T3

If taken at the rightdose, thyroidreplacement therapiesshould not cause sideeffects. Side effectsmay be an indicationthat you are taking toomuch thyroid hormone. Talk to your doctor ifyou experience any ofthese side effects.

Side Effects

Fast heartbeatDifficultysleepingDull, brittle hairHeat sensitivityHungerNervousness oranxietyShakinessSweatingTirednessWeight loss

While there is no perfect formulation,medication can help optimize thyroidfunction. We are all unique with individualsensitivities, so it's necessary to weigh thepros and cons for your specific needs.

Which one is right for you?

This type of therapy is FDA approved, leastexpensive, and includes only one pill.

T4-Only Formulations

This type of treatment relies on your body toconvert to T3 and contains many fillers & dyes.

Increase T3 levels for those with reducedability to convert T4 to T3.

T4 + T3 Therapy

Requires two pills and an experienced doctorfor dosing.

May require only one pill, and it is a morenatural approach with less fillers and dyes

T4/T3 Combination

Expensive, not regulated by the FDA, and has alower T4:T3 ratio than is needed in humans.

Take your pill at thesame time everyday. Make it part ofyour daily routine.

Thyroid hormone replacement drugs arepowerful, so it's critical to be under carefulmedical supervision, especially when startinga new brand or increasing dosage.

Tips for taking medication

Learn aboutinteractions thatmay prevent youfromabsorbingyour medication.

1

3

Swallow your pillwith any liquidother than soy milk,grapefruit juice, orcoffee.

2

Stick to one brand.Small differences informulation canmake a difference.

4

You deserve better care.Schedule a free call with a care

advisor to determine if Paloma can helpyou manage your condition.