The Case:

Denise has Hashimoto’s and hypothyroidism and has been trying to balance her thyroid for years.
She tried Synthroid, Levothyoxine and Armour but these left her feeling ‘off’.
It seemed impossible to find something that would get her T4, T3 and TSH levels into range and give her ample energy.

I knew that while she was on the right track, we needed a slightly different type of approach to solve her health mystery. When the standard solutions don’t work, you might need to go custom.

The Investigation

I immediately thought of the work that Jim Hrncir has been doing with compounding thyroid medication. This is something he is incredibly passionate about ever since his own wife had challenges similar to Denise’s.

You may recall that Jim was on a previous episode talking about compounding hormones for treating menopause and perimenopause. It’s episode 96 if you missed it.

Typical Thyroid Treatment

I talk a lot about Hashimoto’s and hypothyroidism on this show. When we talk about treating the thyroid, the most common option is Synthroid. Synthroid is levothyroxine sodium which is synthetic levothyroxine. Tirosint is another brand of this same synthetic hormone but with no fillers. Synthroid is mostly prescribed by conventional doctors. While it replaces the T4 that the thyroid is not producing or producing enough of, the body still has to convert that T4 into T3. That’s why it’s important to test T3 levels to make sure that the T4 you are getting from Synthroid is being converted. Some people may be under converting which is why they are not getting full resolution of symptoms with T4 only medications.

Going Beyond Synthroid

Some patients aren’t happy with the synthetic hormone options either because they are looking for a more natural solution or they aren’t getting results from the synthetic hormone. This brings them to desiccated thyroid which comes under several brand names including Westhroid, Armour Thyroid, and Nature-Throid. Each option has different additional ingredients beyond the porcine desiccated thyroid and these fillers can sometimes be an issue.

Supply of these options can sometimes be threatened because of supply chain issues and heavy regulations from the FDA.

Sensitivity to Synthroid and other Thyroid Treatments

The thyroid plays a very big role in how the body functions so it’s important to pay attention to how well it is working by testing all the thyroid hormones - T4 and T3.

It is important to have enough but at the same time, not too much.

Getting too much thyroid hormone poses its own issues which include:

Heart palpitations
Nervousness
Tachycardia (racing heart)
Hot flashes
Insomnia
Brain fog
Feeling wired

Jim points out that before concluding that these issues are related to the thyroid medication, it’s important to check thyroid levels and also check for other deficiencies, in particular low iron.

The Compounding Option

Compounding thyroid is the practice of combining various thyroid treatments in a custom way. Jim was a pioneer in this field. The process allows for highly customized dosages based on patient and lab test responses to micro-tweaking the dose. This dose then comes in a natural base with no toxic fillers. Also, once the correct custom formula is found, the compound can even be provided in a time release capsule that gives you just the right amount of thyroid, all day long, especially when T3 is involved.

Accessing Compounded Thyroid Medication

Jim’s pharmacy is in Texas and he only serves his state. There are however 7000+ other compounding pharmacies across the country, but when you look for one in your area, you want to look for quality. If you are interested in finding a compounding pharmacy that can help you with a custom thyroid solution, Jim suggests you look for a compounding pharmacy that is PCAB (The Pharmacy Compounding Accreditation Board) accredited.

Compounding as a practice can have so many advantages as so much customization is available in natural forms. Unfortunately, compounding is under fire right now. Please check out compounding.com for suggestions on what you can do and how you can support the continued availability of compounded medications.

Mystery Solved

It was clear that Denise needed a custom solution to her thyroid issue. Based on the history of her blood work, it seemed that Denise needed both the T4 and T3. It also seemed like she might be reacting to some of the fillers in the commercially available T4. And, the desiccated thyroid she tried left her feeling wired and didn’t sufficiently lower her TSH.

When I looked at her labs after she took dessiccated thyroid, I could see that her T3 was high (which would explain the ‘wired’ feeling). This made it clear that she needed more T4 and less T3 than the fixed ratio in DTE’s and she would benefit from getting the T3 in a time release capsule so that it would be less jarring to her system. For her, compounding was going to be the best option.

Conclusion

We worked with her doctor to prescribe a synthetic T3 at a lower dosage and we got it in a time-released form.

She started with 5 mcg which worked well but her T3 was still a bit low. We bumped it up to 10 mcg and that brought her T3 into range and she felt better. Now she was on a combination of Tirosint 75 mcg and 10 mcg of compounded time released synthetic T3 and it is working very well.

Happy Ending

On a combination of Tirosint 75 mcg and 10 mcg of compounded, time-released synthetic T3 Denise is managing her thyroid levels. Denise was very happy to have an answer and to be feeling better.

Eliminating Health Mysteries

For Denise we were able to find that missing piece of the health puzzle and help her regain her health. Could this be the missing clue for you or someone in your life?

Links:

Resources mentioned

Thanks to my guest Dr. Jim Hrncir. You can learn more about the movement to ensure women continue to have access to compounded bioidentical hormones, visit compounding.com.

Related Podcast Episodes:

096 Demystifying Hormones for Perimenopause and Menopause [Ask Inna] Answers to Your Questions about Hypothyroidism and Hashimoto’s Are you Missing this Important Evaluation Method for Thyroid Assessment? Navigating the Thyroid Treatment Mystery with Inna Topiler Solving the Thyroid Mystery w/ Inna Topiler

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