Treatment Options for Hypothyroidism

There is no one-size-fits-all treatment for hypothyroidism. It may take a few trips to the doctor to get the right remedy, and over time, your prescribed medication may change. Here’s a brief look at the possibilities:

Synthetic hormones.
Most people with hypothyroidism first receive a synthetic thyroid hormone known as levothyroxine; the brand names are Synthroid, Levoxyl, Unithroid, and Levothroid. This medication often gets you back to normal within weeks. And you’ll take it for the rest of your life. But it doesn’t work for everyone.

“About 80 percent of patients who test positive for hypothyroidism get a prescription for levothyroxine and feel better,” says endocrinologist Theodore Friedman, MD, PhD, an associate professor of medicine at Charles R. Drew University of Medicine and Science and the University of California, Los Angeles. “For the other 20 percent, we need to be flexible. I get the patients who tell me conventional treatment isn’t working. And I believe them.”

Combination therapy.
Your thyroid produces two hormones, but synthetic levothyroxine replaces only one, known as T4. The biochemistry can get complicated, but basically your body has to convert T4 into yet another hormone called T3 for your thyroid to work well.

Experts like Friedman and Baylor University’s Ridha Arem, MD, a nationally known endocrinologist, believe T4 treatment alone doesn’t do the job for some patients. For them, Friedman also prescribes a small amount of supplemental T3 (brand name Cytomel), so-called combination therapy.

Other animal-based hormones.
Some experts may even reject this approach in favor of animal-based hormone treatment (the most common brand is Armour). Manufactured in the United States for more than 100 years, this medication is made from the desiccated thyroid tissue of pigs.

The major thyroid organizations consider it outdated, but some specialists swear by it. “I clearly have patients who do better on Armour,” Friedman says. Even its strongest advocates aren’t sure why Armour would be more effective. But it contains both T3 and T4, as well as lesser-known hormones called T1 and T2 and other substances.

By Melanie Haiken