What are some alternatives if you can’t tolerate standard thyroid medication?

When managing hypothyroidism (underactive thyroid), standard commercial prescription medications like levothyroxine (T4) are often the first line of treatment. However, some individuals may find that these options do not provide adequate relief or are poorly tolerated due to sensitivities to excipients (inactive ingredients) or the need for a more customised dosing approach. If you find yourself in this situation, it’s worth exploring how compounding pharmacies can offer tailored solutions in partnership with your doctor.

In this article, we’ll explore:

• Understanding Hypothyroidism Treatment
• When Commercial Medicines Fall Short
• The Compounding Solution: T3 and T4 Combinations
• Natural Thyroid Extract (NTE) as an Option
• Partnering with a Compounding Pharmacy

Understanding Hypothyroidism Treatment

Hypothyroidism, a common condition where the thyroid gland does not produce enough hormones, is typically treated by replacing the missing hormones. The main hormones are:

• Thyroxine (T4): The primary hormone secreted by the thyroid, which is converted into T3 in the body. Medications like levothyroxine provide T4.
• Triiodothyronine (T3): The active form of the hormone, responsible for metabolic functions. Medications like liothyronine provide T3.

Commercial medicines usually focus on providing T4, which is generally effective for most people.

When Commercial Medicines Fall Short

While effective for many, commercial thyroid medications might not work sufficiently for everyone. This can happen for several reasons:

• Poor Tolerability: A patient may be sensitive or allergic to the fillers, dyes, or binders used in commercial tablets.
• Incomplete Conversion: Some patients may not efficiently convert the inactive T4 hormone into the active T3 hormone, leading to persistent symptoms despite normal T4 levels.
• Dosing Limitations: Standardised commercial strengths may not precisely match an individual’s unique hormonal requirements.

In these scenarios, a compounding pharmacist, working closely with an integrative or specialist doctor, can explore highly personalised alternatives.

The Compounding Solution: T3 and T4 Combinations

Compounding pharmacies are able to create custom capsules using the active ingredients T3 (liothyronine) and T4 (levothyroxine). This allows for a precision dosing approach that commercial products cannot match:

• Unique Doses: A pharmacist can combine specific microgram amounts of T3 and T4 into a single capsule, moving beyond the fixed strengths available commercially (e.g., 50 microgram or 100 microgram tablets).
• Combination Therapy: For individuals who struggle with T4 to T3 conversion, a combination capsule ensures they receive both hormones in a precise, doctor-prescribed ratio.
• Improved Compliance: Instead of taking multiple tablets, a patient can take a single, convenient capsule containing their exact combination dose.

Furthermore, compounding allows the pharmacist to prepare the medication without common allergens or unwanted excipients, improving tolerability for sensitive patients.

Natural Thyroid Extract (NTE) as an Option

Another compounded alternative is Natural Thyroid Extract (NTE), often referred to as Desiccated Thyroid Extract (DTE).

• What is NTE? NTE is a combination of T3 and T4 extracted from an animal source (typically porcine). It contains both T3 and T4 in specific, naturally occurring ratios, along with other thyroid-related compounds.
• When is it used? NTE is an option for patients who may not have found success with synthetic T4 or T4/T3 combination therapy, particularly those who prefer a non-synthetic, natural-source product.
• Prescription Requirement: As with all thyroid hormone replacement, NTE is a prescription-only product and requires a discussion with your doctor to determine if it is a suitable treatment path for you.

It is important to note that while NTE comes from a natural source, its potency and ratios are standardised and tested to ensure consistent dosing, as detailed by regulatory pharmacopoeias.

Partnering with a Compounding Pharmacy

Thyroid treatment is highly individualised. If standard commercial medications have not helped you achieve optimal health, do not be disheartened. Compounded options provide a pathway to personalised care.

It is essential to work with a doctor, especially one who specialises in integrative or functional medicine, who can assess your specific needs through blood tests and symptom review. Your doctor can then partner with a compounding pharmacy like National Custom Compounding to design a precise formulation tailored just for you. This collaborative approach ensures you receive a prescription that is both effective and well-tolerated.

Important Disclaimer: Thyroid hormone replacement is a prescription-only treatment. Any changes to your medication regimen must be discussed with your doctor or specialist. This article provides general information and does not constitute medical advice.

Video Transcript

Hi there. It’s a question that we do have a lot of interest in at National Custom Compounding. And the question is what are some alternatives if you can’t tolerate standard thyroid medicine? And it’s a great question because again, it touches on the importance of commercial prescription medicine. And there are a couple that are available for thyroid or low thyroid and to treat low thyroid. And then there are situations where these medicines may not work sufficiently for people. And it could be it could be the fact that the medicine is not well tolerated. It could be that the tablets are not producing what they need to once swallowed, and that’s when compounding pharmacies can step in to assist. Again, thyroid medicine, whether it’s compounded or it’s commercially made, is a prescription only product. So definitely chat to your doctor about it. And in situations of working with an integrative doctor, you’ll find that there are some other thyroid options available that are not typically used commercially. So, to sort of talk about thyroid, it’s generally called hypothyroidism. And the products that you would take is generally a product called levothyroxine or the other one is liothyronine, which is a form of T3. Levothyroxine is a form of T4. So these two ingredients can be used by compounding pharmacies, and you can actually make really unique doses. So for example when one tablet is available it might be a fifty microgram, it might be one hundred microgram tablet, and that also might be other strengths. But if a patient wants a combination of these two, a compounding pharmacy can use the active ingredients, so T3 and T4, in specific doses inside the same capsule. So what it gives you is easier compliance. You’re not taking two tablets, and also you get a product that you know has got a specific dose in it specifically for you. So that can be quite beneficial. There is another product which you might have heard about before. It does come from overseas and it’s called Natural Thyroid Extract. That’s actually a combination of T3 and T4 in specific ratios extracted from an animal source. So it’s not a natural product in that it comes from animals, but it is a thyroid product because it’s tested and there is a universal reference for the ratios. And those capsules are made for people through compounding pharmacies and can definitely assist in situations where perhaps the commercial medicine did not benefit them in a certain way. Again, prescription only. So you do have to talk to your doctor about it. But I think the most important thing to keep in mind is there’s commercial medicines which are worth trying. If they fail, don’t be disheartened. There is definitely a compounded option available, and places like ourselves at National Custom Compounding are well placed with our team of pharmacists to have those discussions and then work with your prescriber to find a formulation and prescription that suits. Reach out if you’ve got any questions and have a great day.