As patients, we trust doctors and the medical community as a whole to provide the best treatment possible for any given condition. Unfortunately, thyroid patients frequently do not get the care they need.
For many years, hypothyroidism has been underdiagnosed and sub-optimally treated due to a firmly established but inaccurate understanding of what constitutes proper thyroid care. However, there may be hope for us yet. Recent research suggests that doctors in North America are increasingly likely to prescribe more effective treatments for hypothyroidism.
What is Hypothyroidism?
Hypothyroidism is a condition wherein there is not an adequate supply of thyroid hormone. This is typically caused by a decline in thyroid function, which may be triggered by a wide range of factors including poor nutrition, hormone malfunction, autoimmune disease, exposure to environmental toxins, or other patient-specific factors. The condition is deceptively common with experts estimating the upwards of 40 percent of Americans are suffering from some degree of thyroid dysfunction with a large percentage of this group going undiagnosed or untreated.
Sadly, even if a patient is fortunate enough to be diagnosed and receive treatment, it is not assured that their condition will improve. Many patients with hypothyroidism continue to experience hypothyroid symptoms including fatigue, brain fog, depression, hair loss, weight gain, loss of libido, and physical discomforts even after treatment. Experts argue that the continuation of symptoms is frequently due to the inadequacy of current treatment standards.
The Issues with Standard T4-Only Thyroid Care
Typically, hypothyroidism is treated through hormone replacement therapy. This involves supplying the body with additional thyroid hormone to make up for the deficit in production due to reduced thyroid activity. Although the theory is sound, the current approach often does not improve hypothyroidism or alleviate its symptoms. This is primarily because standard therapies focus on supplying the wrong hormone.
The most commonly prescribed type of thyroid hormone replacement therapy is a synthetic formulation of T4. T4 is the inactive or storage form of thyroid hormone called thyroxine. Patients who are already being treated for hypothyroidism may be familiar with major brands of synthetic T4, also called Levothyroxine, such as Synthroid, Levoxyl, Eltroxin, Tirosint, and Levothroid. Although there are differences between each product, their defining quality of being a T4-only formulation is perhaps the greatest inhibitor to their efficacy.
Many hypothyroid patients treated with T4-only therapies do not see an improvement of their condition. There are multiple reasons why this may be the case. Perhaps the most likely being issues of conversion. Before it has any positive impact on the body, T4 must first be converted to T3. Standard practice of thyroid therapy assumes that the patient will be able to convert T4 to T3. However, in many cases, the thyroid is incapable of doing so meaning that the treatment is simply creating an unnecessary stockpile of T4, which can actually exacerbate the condition rather than improving it.
When a surplus of T4 is available, it is likely to be converted to the mirrored and inhibitory version of T3 known as Reverse T3. Increased prevalence and production of Reverse T3 can further impede thyroid activity. This is one of the leading reasons why typical T4 therapies can actually be detrimental to a patient’s recovery. Fortunately, by utilizing hormone therapies containing T3 it is possible to avoid the issues of excess T4 while still supporting thyroid function.
Why Treatment with T3 is Superior to T4 Only Therapies
Therapies that include T3 have a distinct advantage over those that don’t because the hormone does not have to be converted before it is utilized by the body. Because T3 formulations are less likely to be inhibited by conversion malfunction, patients are more likely to experience an increase in thyroid activity and subsequent resolution of hypothyroid symptoms.
Another benefit of T3 formulations is that they tend to be more customizable to a patient’s specific needs. Depending on individual patient factors treatment with time released T3, combination T4/T3, T3-only formulations, or natural desiccated thyroid (NDT) may provide better results. Being able to effectively design treatment to suit individual patient needs allows for more efficient recovery and a better-established state of wellness.
Are Prescriptions for T3 on the Rise?
Clearly there are benefits to prescribing T3 formulations instead of or in addition to traditional T4 therapies. But has this information lead to meaningful change in the medical field?
In a survey published in 2018 in the journal Thyroid, it was found that North American physicians are more likely to prescribe T3 medications in conjunction with T4 therapies as well as utilize natural desiccated thyroid (NDT) drugs. This is an exciting development as it shows an acknowledgement that the American Thyroid Association guidelines for treating hypothyroidism (recommending T4 only treatments) are not ideal.
The outcome of the 2018 survey found that nearly a third of the 389 participants were willing to prescribe a treatment other than T4-only therapy. This contrasts previous data from a 2013 survey of 900 endocrinologists finding that less than one percent were willing to prescribe combination T4/T3 treatments with only 3.6 percent willing to even consider the option.
A lead researcher for the 2018 survey believes that the greatest factor in this change of practice is the increased occurrence of patient requests for T3 coupled with reports of improved symptoms. It is common for patients who make the switch from T4-only to a therapy including T3 to see notable improvement of their condition. Patients who report these positive outcomes may be helping their physicians realize that T3 treatments are not only valid, but highly effective.
The outcomes of this study and others like it appear to be a hopeful. But some doctors contest that the results more effectively show that we still have a long way to go when it comes to effectively treating hypothyroidism. And they are not wrong.
A Long Journey to Improve Thyroid Care
Hypothyroidism is a common condition that unfortunately has gone underdiagnosed and sub-optimally treated for many years. Part of the problem is reliance on an antiquated standardized approach dictating that T4 therapy is the best and only treatment needed to resolve hypothyroidism. However, multiple studies and patient reports strongly suggest that treatment with some form of T3 hormone replacement therapy is highly beneficial and oftentimes more effective than a T4-only method. Fortunately, it seems that practitioners are beginning to adapt their practice to reflect this information. That being said, there is still much work to be done regarding awareness and implementation of proper thyroid testing and practice if we are to achieve effective widespread thyroid care.
Resources1. Kent Holtorf, MD. “Thyroid Hormone Transport.” https://www.nahypothyroidism.org/thyroid-hormone-transport/.
2. Henry B. Burch et al. “A 2013 Survey of Clinical Practice Patterns in the Management of Primary Hypothyroidism.” The Journal of Clinical Endocrinology & Metabolism, Volume 99, Issue 6, 1 June 2014, Pages 2077–2085.
3. Mary Shomon. “More US Doctors Prescribing T3 for Hypothyroidism.” HealthCentral.