ThyroidWA - Treatment Options

Hypothyroidism - Treatment Options

Treatment Options for Hypothyroidism (Underactive Thyroid)

Thyroxine

Currently thyroid hormone replacement therapy, artificial thyroxine (T4), is the conventional way of treating patients with hypothyroidism and patients without a thyroid gland or a non-functioning gland. The brand name Oroxine has been on the Australian market since the 1970’s or earlier. Sigma Pharmaceuticals (Australia) Pty Ltd acquired this product from the original manufacturer in December 1999. The formulation & manufacturing process has not been changed since its launch. A second brand, Eutroxsig, was launched on 1st November 2002. Oroxine is more expensive than Eutroxsig, but Eutroxsig and Oroxine are identical products. Aspen Pharmacare Holdings Limited acquired Sigma Pharmaceuticals (Australia) Pty Ltd in 2010.

Oroxine and Eutroxsig are available in the following strengths; 50 micrograms, 75 micrograms, 100 micrograms and 200 micrograms.

A healthy thyroid produces about 80 % of thyroxine (T4) and 15 % of triiodothyronine (T3). It also produces calcitonin and some other smaller hormones such as diiodothyronine (T2) and monoiodothyronine (T1).

When you are on conventional thyroid hormone replacement therapy (thyroxine), only one of the main hormones produced by the thyroid gland is replaced. The theory is that all of the thyroxine (T4) taken is converted to T3 in your body. The cells can only use T3, so if T4 is not converted to T3 then you may still have symptoms and remain hypothyroid despite having normal blood test results. The blood test does not show you what happens at tissue level.

Thyroxine works well for people with mild hypothyroidism and for people who are treated early. If treatment is delayed (especially if you had longstanding hypothyroidism or severe hypothyroidism) then thyroxine alone may not be as successful. Not all patients on full replacement therapy are symptom free when thyroxine is taken alone, either because the dose is not optimal or they may simply need the small amount of T3 which is produced by a healthy thyroid gland. How well thyroxine works for you also depends on your overall health or whether you have other underlying conditions, such as other autoimmune disorders, adrenal insufficiency, food intolerances, mineral/vitamin deficiencies and or allergies.

Tertroxin

Tertroxin (artificial T3) is manufactured by Aspen Pharmacare Holdings Limited and comes in a 20 mcg tablet. Twenty mcg of T3 is equivalent to about fifty mcg of thyroxine. Tertroxin can be taken in combination with thyroxine. This combination therapy is helpful for people who are on full replacement therapy, but still experience symptoms of an underactive thyroid, such as depression, anxiety, weight gain, poor memory and concentration etc.

A healthy thyroid only produces a relatively small amount of triiodothyronine (T3) per hour. If Tertroxin is taken in addition to thyroxine, then it is best to take only 5 mcg at a time to avoid wide fluctuations. The tablet can be cut up into quarters very easily with a pill cutter. Tertroxin is best taken 3 times a day (every 5 hours). A typical dose for patients without a thyroid gland or non functioning thyroid gland would be 100 mcg of thyroxine and 15 mcg of Tertroxin (3 times 5 mcg).

Tertroxin is available on the PBS, but it is an authority script which means that the doctor needs to state the following; “replacement therapy for hypothyroid patients who have documented resistance to thyroxine sodium”.

The New England Journal of Medicine reported in February 1999, that the majority of thyroid patients studied, felt better on a combination of T4 and T3. Patients will not notice any improvements if the dose of T4 and T3 is not right. In some trials thyroxine may not have been replaced with enough T3 or the thyroxine may have been reduced by too much. Unfortunately many doctors are not familiar with Tertroxin or are reluctant to prescribe it under the PBS. If Tertroxin is prescribed without an authority, it will be expensive. A huge opportunity is lost here to improve the quality of life of so many sufferers. Tertroxin can be prescribed by a GP or an endocrinologist.

Slow Release T3 Capsules

Slow release T3 capsules are made by compounding pharmacies and come in many different strengths, so prices vary. It contains liothyronine (artificial T3) and has a slow release formulation. The capsule contains hypromellose as the modified release agent and microcrystalline cellulose as the filler. The hormone is slowly released into your body over 12 to 24 hours. Hypromellose is slowly released unlike lactose found in many drugs which is released instantly. How well slow release T3 works for you will depend on your digestive system. Slow release T3 can be taken in combination with thyroxine.

Desiccated Thyroid Extract

Desiccated thyroid extract has been a treatment for hypothyroidism since 1891. Before the 1960’s this was the only treatment available for hypothyroidism. In the 1960’s doctors began to replace the desiccated thyroid extract with thyroxine and by the 1980’s more thyroxine was prescribed than desiccated thyroid extract. Thyroxine was marketed as more pure and consistent than the animal extract.

Desiccated thyroid extract is a natural preparation and is made from porcine (pig) thyroid glands. The extract is dried and powdered and has a strong characteristic odour.

Desiccated thyroid extract is also known as Armour Thyroid, made by Forest Laboratories Inc. in the USA. Forest Laboratories Inc. have not always been able to keep up with demand over the last few years, so there have been supply problems and there have also been some issues with variations in potency from batch to batch. Compounding pharmacists in Australia can also purchase Thyroid Extract USP powder from associate US suppliers, which is the same thyroid extract used in Armour Thyroid tablets.

The dosage of Armour Thyroid is measured in grains (1gr = 60mg) and is available in the following strengths; ¼ grain, ½ grain, 1 grain 1 ½ grain, 2 grain, 3, grain, 4 grain and 5 grain.

One grain is equivalent to 38 mcg of thyroxine (T4) and 9 mcg of liothyronine (T3). The inactive ingredients are calcium stearate, dextrose, microcrystalline cellulose, sodium starch glycolate and opadry white. The active ingredients contain T4, T3, calcitonin and small amounts of T1 and T2.

The human thyroid makes more T4 and less T3 than a pig’s thyroid gland. It may therefore be necessary to add some thyroxine to get the correct ratio of T4 and T3. The pharmacist can also supply a slow release form, but it may still be recommended to take the capsules twice a day. The tablets contain both T4 and T3, so it can be harder to make adjustments to the T3. Thyroxine (T4) is best absorbed on an empty stomach, which could be inconvenient if you tend to eat every two to three hours.

Armour Thyroid tablets are usually prescribed by integrative practitioners. Although it is considered a natural medicine, the fillers and binders which are used may not be natural.

Compounded T4/T3 Combination Treatment

Both artificial T4 and T3 are supplied by a compounding pharmacy according to the patient’s needs. If the patient is getting too much T3 then this can easily be adjusted. The downside is that it is more expensive than Oroxine/Eutroxsig with Tertroxin (if prescribed under the PBS).

What are Compounding Pharmacies?

Pharmacies customise an individualised prescription for the specific needs of the patient. Sometimes the strength needed is not manufactured by drug companies. Armour Thyroid tablets and Slow Release T3 capsules are both drugs for patients with hypothyroidism and they are only made by compounding pharmacies. Generally speaking these drugs are more expensive, because they are not listed on the PBS (pharmaceutical benefit scheme). You can claim part of the cost of a prescription drug from compounding pharmacies from some private health funds.

Side Effects of Thyroid Hormone Replacement Therapy

Getting the dose right can be especially tricky when your thyroid becomes more unstable with fluctuating thyroid hormone levels. Please be patient. It can take about 2 weeks before you notice a difference and as many as 6 to 8 weeks for thyroid hormone to take full effect if the dose is right. If you had severe hypothyroidism then it can take even longer before you feel well. The side effects that you may experience when you take thyroid hormone are usually as a result of under treatment or over treatment. If you have too little then you will have symptoms of hypothyroidism, such as; weight gain, dry skin, fatigue, anxiety or depression etc. and if you take too much then you will have symptoms of an overactive thyroid, inability to hold fingers still, feeling hot, fast resting pulse, heart palpitations, weight loss or weight gain, more frequent loose stools etc. It is very important that you know how to recognize overdose symptoms. You must monitor yourself!

Disclaimer The information provided is for educational purposes only and is not intended to be medical advice. The contents must not be relied upon in place of advice and treatment from a qualified medical practitioner. THYROID WA SUPPORT GROUP INC. and the author disclaim any liability whatsoever.