You’re not still taking levothyroxine, are you?

Because it is such a critical and commonly mismanaged issue, I’ve discussed thyroid health many times here in the Wheat Belly Blog, as well as the Undoctored Blog, the Undoctored book, and several of my Wheat Belly books. Despite all this and the large reach of my messages, SO many people continue to wonder why they have not regained full control over their health, including persistent inability to lose weight, yet continue to take levothyroxine for thyroid hormone replacement. And thyroid dysfunction, particularly hypothyroidism (i.e., low thyroid hormone status), is at epidemic levels for a variety of reasons, but especially increasing exposure to endocrine disruptive industrial chemicals.

And what is a cardiologist doing discussing thyroid issues? In my cardiology practice, I got so frustrated with the mismanagement of thyroid—essential for proper management of cardiovascular risk, minimizing risk for heart attack, improving heart failure and left ventricular systolic dysfunction, and other aspects of health—that I said “Heck with it–I’ll do it myself.” It angered a number of primary care docs and endocrinologists. But I believe my patients began to see and feel what optimal thyroid status felt like and virtually all of them continued on the path I set for them. (In fact, I can’t recall a single instance in which a patient rejected the path I advised and returned to the “solutions” offered by their primary care doc or endocrinologist.)

So let’s once again discuss this important issue. Let’s start with basic definitions of the relevant factors in this situation; for a more extended conversation, see the Wheat Belly Total Health or Undoctored books, as well as this Wheat Belly Blog discussion.

When the thyroid gland is deprived of iodine required to manufacture thyroid hormones, output of the T4 and T3 thyroid hormones drop. (The “4” and “3” refer to the number of iodine atoms per thyroid hormone molecule.) The thyroid can be damaged by autoimmune thyroid injury (most commonly Hashimoto’s thyroiditis) from, for example, antibodies directed at the gliadin protein of wheat but that cross-reacts with thyroid antigens yielding thyroid inflammation and damage, or when damaged by endocrine disruptive industrial chemicals. There are also factors that block the conversion of the T4 thyroid hormone to the active form, T3, factors such as perfluorooctanoic acid from Teflon exposure or triclosan hand sanitizer exposure or one of the dozens to hundreds of industrial compounds now known to block thyroid hormone action at one or more levels. Or you could have a situation, most commonly adrenal gland dysfunction and/or other form of ACTH/cortisol dysfunction, that yields a rise in reverse T3, the mirror image form of the T3 thyroid hormone that can cause hypothyroid symptoms even if TSH and free T3 levels are normal. Estimated conversatively, 20% of the American population now has thyroid disease or dysfunction, while less conservative estimates may put it as high as 35%—1 in 3 Americans. It is by no means uncommon.

Let’s put aside the causes for thyroid disruption and instead focus on how to deal with its various forms:

• If you have iodine deficiency, the solution is iodine; if iodine deficiency is the cause of your hypothyroidism, thyroid hormone status should be corrected within 2-3 months of supplementing iodine. (You’d be shocked at how common surgical thyroid removal, prescription levothyroxine, or other shenanigans are instituted for what is nothing more than iodine deficiency.)
• If you have autoimmune thyroid inflammation like Hashimoto’s, in addition to some of the conventional medical steps that can be taken (e.g., beta blockers instituted temporarily to block the adrenaline storm associated with this situation that can be dangerous, drugs to block thyroid hormone effects, etc.), the steps we take in our Wheat Belly and Undoctored lifestyles can help reverse autoimmune inflammation, allowing you to track this reduction by occasionally reassessing thyroid antibodies. As the levels of thyroid antibodies decline and reach the normal range, this will help limit the damage to the thyroid gland, though, once damaged, the thyroid gland rarely recovers its full potential to produce T4 and T3 thyroid hormones, thus the common and widespread need for thyroid hormone replacement.
• Damage to the thyroid by industrial compounds is typically irreversible, obliging thyroid hormone replacement.
• If the conversion of T4 to T3 is blocked, I know of no way to unblock it, so we create a simple workaround by administering T3 in some form.
• If reverse T3 is high and causing hypothyroid symptoms, addressing the adrenal dysfunction (not so easy to do in practical life, as the inciting factor is often severe emotional stress that is not easily undone) is key, but replacing T3 in the meantime can reverse the hypothyroid phenomena such as failed weight loss, fatigue, or depression.

Problem: Most conventional doctors, given the decades during which the drug company, Abbott, heavily marketed their patented and thereby much more expensive Synthroid brand of levothyroxine (T4), advised by sales representatives that T4/T3 combination preparations, usually manufactured from desiccated (dried) thyroid glands of cows and pigs, were imprecisely formulated and dangerous. (Even today with the patents on Synthroid expired, this branded preparation still typically costs five-fold more than T4/T3 combination products.) The imprecision of desiccated thyroid preparations was indeed an issue several decades ago, when content of thyroid hormone was estimated based on iodine content. However, more precise means of regulating the relative T4/T3 content have since been devised and these preparations do indeed yield consistent levels of replacement hormones.

If we took 100 people taking levothyroxine, T4, alone and replaced it with a T4/T3 combination preparation, what should they expect? In my experience in many people over the last 10+ years, about 80% of people will experience:

• Increased energy, improved mood and relief from depression
• Weight loss
• Improved metabolic measures–such as increased HDL, reduced LDL measures, reduced triglycerides, a modest reduction in insulin resistance and blood sugar
• Relief from inappropriately cold hands and feet
• Moister skin, thicker hair
• Greater relief from constipation (above and beyond that achieved with wheat/grain elimination and efforts to cultivate bowel flora)

Although not well charted, there may even be improvements in bowel flora composition, likely exerted via the acceleration of intestinal contractions (“peristalsis”) that develops with normalization/optimization of thyroid status.

That all said, not everyone experiences such benefits. Around 20% will not, perhaps even experiencing effects such as increased heart rate, anxiety, and sleeplessness, hyperthyroid-like symptoms from the addition of the T3 component. This identifies you as someone who can do fine on T4-only preparations—you’re in the minority, but you can do just fine on T4 alone without added T3.

The biggest hurdle of all if you would like to convert to a T4/T3 combined preparation such as Armour Thyroid or Naturethroid? Finding a healthcare practitioner willing to reject conventional thinking. It might be a functional medicine or integrative health practitioner, it might be naturopath who collaborates with a prescribing MD, it might be a nurse practitioner who is more open-minded than the doctor she works for. It could also be a practitioner who makes use of the services of a compounding pharmacy who custom-formulates T4/T3 combination preparations who, by using such a service, declares him/herself as more progressive and open-minded.