TREATMENT OPTIONS
Every Patient Is Unique |
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Thyroid treatment options and dosing are as varied as the individual patient and are dependent on the severity of the imbalance. Please see the conditions below for medication and procedure options as well as our Foundational Treatment page for optimal thyroid balance.
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Hypothyroidism and Hashimoto’s
If a patient has low levels of thyroid hormone, then he/she is suffering from hypothyroidism. It is common for patients diagnosed with hypothyroidism, whether caused by Hashimoto's or not, to be prescribed levothyroxine (T4) sold under various brand names.
However, many patients continue to be symptomatic on levothyroxine-only [1-6]. Therefore, treatments such as combination methods of liothyronine/levothyroxine (T3/T4), liothyronine-only (T3-only), or natural thyroid extract medication (e.g. Armour, Nature-Throid) should be considered. |
Each patient must develop an individualized treatment plan with their doctor for optimal hormone replacement [1-11].
Interactions: Certain foods, drugs, and supplements can affect thyroid hormone absorption. Therefore, it is important to take thyroid medication one hour before meals, other medications, and four hours before any supplement containing iron, calcium, or zinc.
Switching Thyroid Medications: Use this conversion chart to help you find the available medication strengths, or to help you find an equivalent dose as you are switching from one medication to another.
Switching Thyroid Medications: Use this conversion chart to help you find the available medication strengths, or to help you find an equivalent dose as you are switching from one medication to another.
The following treatments can be used to address hypothyroidism:
Treatment Option |
Description |
Example Medication* |
Natural Thyroid Extract Derived from porcine thyroid gland and contains T1, T2, T3, T4, and sub-components like calcitonin. |
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Armour (US) Cinetic (Italy) Erfa (Canada) FegaCoren N (Germany) Nature-Throid (US) NP Thyroid (US) Thyreogland (Germany) Thyreoidum (Denmark, Netherlands) Thyrovanz (Int'l) Westhroid (US) Westminster (US) Whole Thyroid (New Zealand) WP Thyroid (US) |
Combination T4 &/or T3 Therapies which include T4 and T3. |
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Compounded T4/T3 Bitiron (Turkey) Cynoplus (Mexico) Dermocinetic (Italy) Dithyron (Greece) Ebexid (India) Euthyral (France) Jodthyrox (Austria/Russia) Levotrin (Argentina) Novothyral (Poland/Russia/Switzerland)Prothyrid (Germany) Somatoline (Italy) Thyreotom (Russia) |
Liothyronine (T3) Synthetic replication of triiodothyronine (T3), the "active" hormone. |
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Compounded T3 Cytomel (US/Canada) Cynomel (Mexico/France) Linomel (Argentina) Liothyronine (US) Liotir (Italy) Neo-Tiroimade (Portugal) Triostat - injection (US) Triyotex (Mexico) Tertroxin (Ireland/Czech Republic) Triiodothyronine - injection (UK) Tertroxin (UK/S.Africa/Australia) Tojodthyronin (Austria) |
Levothyroxine (T4) Synthetic replication of thyroxine (T4), the "storage" hormone. |
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Compounded T4 Eltroxin (various countries) Euthyrox (various countries) Eutroxsig (Australia) Evotrox (United Kingdom) Letrox (various countries) Oroxine (Australia, Singapore) Synthroid (US, various countries) Tirosint (US, various countries) Thyrax (Europe, Venezuela, Philippines) |
Nutrient Replacement and Supplements Vitamin, nutrient, and supplement therapies designed to address deficiencies and root causes associated with thyroid disease. |
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* Many brands of NTE, T3, T4, and T3/T4 medication are available internationally. There may be availability, name changes, or new research which this list cannot account for. See your provider about which options are available in your country.
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Hyperthyroidism and Graves’ Disease
Hyperthyroidism occurs when too much thyroid hormone is produced for proper functioning. The treatment of hyperthyroidism depends on the cause and severity of the disease, as well as on the patient’s age, possible goiter size, other conditions, and patient preference. The main treatment goals for hyperthyroidism, whether caused by Graves' disease or not, are:
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The following treatments options are currently available: radioactive iodine (RAI), antithyroid drugs (ATD), or thyroidectomy [12-14]. In the U.S., radioactive iodine ablation (RAI) is often recommended as a first-line treatment. In Japan and Europe, physicians generally prefer to start with antithyroid drugs (ATDs) in the hope that the disease will remit [15-16]. Surgery, rather than RAI, is most often chosen when a patient continues to fight hyperthyroidism after being on ATDs for at least two years [18]. The long-term quality of life following treatment was found to be the same in patients randomly allocated to one of the three treatment options listed below [17].
The following treatments can be used to address hyperthyroidism:
The following treatments can be used to address hyperthyroidism:
Treatment Option |
Description |
Example Medication* |
Beta Blockers NOTE: Beta blockers are not typically prescribed for patients with asthma because the drugs may trigger an asthma attack. They may also complicate the management of diabetes and may lower blood pressure. |
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Acebutolol (Sectral) Atenolol (Tenormin) Bisoprolol (Zebeta) Metoprolol (Lopressor/Toprol-XL) Nadolol (Corgard) Nebivolol (Bystolic) Propranolol (Inderal LA, InnoPran XL) |
Anti-thyroid Medication (thionamides) NOTE: Best used for patients with less severe cases of hyperthyroidism. A small number of people who are allergic to these drugs may develop skin rashes, hives, fever or joint pain. Increased infection may also occur. |
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Methimazole Propylthiouracil (PTU) Carbimazole |
Radioactive Iodine Therapy (RAI-131 or RAI) NOTE: Graves’ opthalmopathy can develop or be worsened by the use of radioactive iodine in 15 percent of patients and corticosterioids have been found to greatly reduce this incidence [20]. |
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Administered orally via capsule or liquid form. NOTE: Patients need to be in isolation for at least 72 hours after treatment is administered since they are emitting radiation. Individuals and/or animals exposed to this ambient radiation are susceptible to thyroid destruction [28]. |
Thyroidectomy NOTE: Partial or total removal of the thyroid gland; considered for the small percentage of patients who are allergic to antithyroid medications, who are resistant to radioactive iodine, or who have a hot nodule. |
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NOTE: It is highly recommended to investigate multiple surgeons skilled in thyroid gland removal to minimize possible complications such as collateral damage to parathyroid glands. |
Nutrient Replacement and Supplements Vitamin, nutrient, and supplement therapies designed to address deficiencies and root causes associated with thyroid disease. |
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* Many brands of beta-blockers and anti-thyroid medication are available internationally. There may be availability changes, name changes, or new research which this list cannot account for. Procedure options may also differ. See your provider about which options are available in your country.
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Thyroid Cancer Treatment
Thyroid cancer has various forms and treatment is dependent on the individual case. The most common form of thyroid cancer in the United States is papillary thyroid cancer, followed by follicular thyroid cancer. The least common are medullary and anaplastic thyroid cancer. Each name indicates where the cancer is located within the thyroid gland [19]. If diagnosed and treated early, thyroid cancer treatment can be effective and usually includes the options listed below.
Due to the individual nature of cancer staging and treatment, patients must work closely with their doctors to create a personalized treatment plan. |
The effectiveness of thyroid cancer treatment lends itself to the reputation of being a “good cancer” to have, however, any cancer should not be minimized. Thyroid cancer needs effective treatment and on-going monitoring. For more information about the how the thyroid works and the specifics of thyroid disorders, including thyroid cancer, please see our About Thyroid Disease page.
The following options can be used to address thyroid cancer:
The following options can be used to address thyroid cancer:
Treatment Option* |
Description |
Notes |
Radioactive Iodine Therapy (RAI-131 or RAI) NOTE: Graves’ opthalmopathy can develop or be worsened by the use of radioactive iodine in 15 percent of patients and corticosterioids have been found to greatly reduce this incidence [20]. |
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Administered orally via capsule or liquid form. NOTE: Patients need to be in isolation for at least 72 hours after treatment is administered since they are emitting radiation. Individuals and/or animals exposed to this ambient radiation are susceptible to thyroid destruction. |
Thyroidectomy NOTE: Partial or total removal of the thyroid gland; considered for the small percentage of patients who are allergic to antithyroid medications, who are resistant to radioactive iodine, or who have a hot nodule. |
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NOTE: It is highly recommended that the patient find a surgeon skilled in thyroid gland removal to minimize complications such as collateral damage to your parathyroid glands. |
External Beam Radiation |
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NOTE: To reduce the risk of side effects, doctors carefully calculate the placement of the beam on the target area and the least amount of radiation needed to be effective. |
* Treatment options may differ from country to country. There may be availability or name changes, new research, or additional treatment options which this list cannot account for. See your provider about which options are available in your country.
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References:
1. Appelhof, Bente C., et al. Combined therapy with levothyroxine and liothyronine in two ratios, compared with levothyroxine monotherapy in primary hypothyroidism: a double-blind, randomized, controlled clinical trial. The Journal of Clinical Endocrinology & Metabolism 90.5 (2005): 2666-2674.
2. Baisier, W. V., J. Hertoghe, and W. Eeckhaut. Thyroid insufficiency. Is thyroxine the only valuable drug?. Journal of Nutritional and Environmental Medicine 11.3 (2001): 159-166.
3. Chakera, Ali J., Simon HS Pearce, and Bijay Vaidya. Treatment for primary hypothyroidism: Current approaches and future possibilities. Drug design, development and therapy 6 (2012): 1.
4. Escobar-Morreale, Héctor F., et al. Only the combined treatment with thyroxine and triiodothyronine ensures euthyroidism in all tissues of the thyroidectomized rat. Endocrinology 137.6 (1996): 2490-2502.
5. Das, Gautam, and Shweta Anand. Does synthetic thyroid extract work for everybody?. Endocrine Abstracts. (2007) 13 P316.
6. Pritchard, Eric K. Reducing the Scope of Guidelines and Policy Statements in Hypothyroidism. Journal of Orthomolecular Medicine 28.2 (2013).
7. Cooper-Kazaz, Rena, et al. Combined treatment with sertraline and liothyronine in major depression: a randomized, double-blind, placebo-controlled trial. Archives of general psychiatry 64.6 (2007): 679-688.
8. Bunevičius, Robertas, et al. Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. New England Journal of Medicine 340.6 (1999): 424-429.
9. Nygaard, Birte, et al. Effect of combination therapy with thyroxine (T4) and 3, 5, 3′-triiodothyronine versus T4 monotherapy in patients with hypothyroidism, a double-blind, randomised cross-over study."European Journal of Endocrinology 161.6 (2009): 895-902.
10. Acosta, Brenda M., and Antonio C. Bianco. New insights into thyroid hormone replacement therapy. F1000 Medicine Reports 2 (2010).
11. Celi, Francesco S., et al. Metabolic effects of liothyronine therapy in hypothyroidism: a randomized, double-blind, crossover trial of liothyronine versus levothyroxine. The Journal of Clinical Endocrinology & Metabolism96.11 (2011): 3466-3474.
12. Antithyroid Medicine for Hypothyroidism. Web MD. Updated November 4, 2011 http://www.webmd.com/women/antithyroid-medications-for-hyperthyroidism.
13. Why do physicians prefer to use propanolol in patients who are experiencing thyrotoxicois, or thyroid storm versus other beta blockers? Pharmacology Weekly. http://www.pharmacologyweekly.com/articles/propranolol-preferred-thyroid-storm-thyrotoxicosis.
14. Reid, Jeri R., Wheeler, Stephen F. Hyperthyroidism: Diagnosis and Treatment. American Family Physician. 2005 Aug 15; 72(4): 623-630. http://www.aafp.org/afp/2005/0815/p623.html.
15. Graves’ Disease. Mayo Clinic. Updated July 1, 2014. http://www.mayoclinic.org/diseases-conditions/graves-disease/basics/treatment/con-20025811.
16. American Thyroid Association. FAQ: Radioactive Iodine. June 6, 2012. http://www.thyroid.org/faq-radioactive-iodine/.
17. Milas, Kresmira. Radioactive Iodine for Hyperthyroidism: The Most Common Hyperthyroid Treatment in the US. EndocrineWeb. May 27, 2014. Retrieved from www.endocrineweb.com/conditions/hyperthyroidism/radioactive-iodine-hyperthyroidism
18. Milas, Kresmira. Surgery for Hyperthyroidism: Are You a Candidate for a Thyroidectomy? EndocrineWeb. May 27, 2014. http://www.endocrineweb.com/conditions/hyperthyroidism/surgery-hyperthyroidism.
19. National Cancer Institute: What you need to know about thyroid cancer. May 7, 2012. http://www.cancer.gov/cancertopics/wyntk/thyroid/page4.
20. Walsh, John P., Colin M. Dayan, and Michael J. Potts. Radioiodine and thyroid eye disease. BMJ 319.7202 (1999): 68-69.
21. Pepper, GM, Casanova-Romero, PY. Conversion to armour thyroid from levothyroxine improved patient satisfaction in the treatment of hypothyroidism. J Endocrinol Diabetes Obes. 2014;2(3):1055.
22. Holtorf Medical Group. Is Natural Desiccated Thyroid Safe? May 31, 2018. https://www.holtorfmed.com/is-natural-desiccated-thyroid-ndt-safe/.
23. Holtorf K. Peripheral thyroid hormone conversion and its impact on TSH and metabolic activity. Journal of Restorative medicine. 2014 Apr 1;3(1):30-52.
24. Holtorf Medical Group. Treating Thyroid Conversion Disorders With T3. May 31, 2018. https://www.holtorfmed.com/treating-thyroid-conversion-disorders-with-t3/.
25. Izabella Wentz, PharmD. 6 Different Hashimoto's Root Causes. https://thyroidpharmacist.com/articles/6-different-hashimotos-root-causes/.
26. Dr. Westin Childs. 9 Thyroid Supplements Every Patient Should Consider. https://www.restartmed.com/thyroid-supplements/.
27. Amy Myers, MD. The Autoimmune Solutions Supplements Guide. https://www.amymyersmd.com/2015/04/the-autoimmune-solution-supplements/.
28. Kresmira Milas, MD. Radioactive Iodine for Hyperthyroidism. https://www.endocrineweb.com/conditions/hyperthyroidism/radioactive-iodine-hyperthyroidism.
29. ThyCa: Thyroid Cancer Survivor's Association. Radioactive Iodine (RAI). Retrieved from http://www.thyca.org/pap-fol/rai/.
30. American Cancer Society. Treatment of Thyroid Cancer by Type and Stage. https://www.cancer.org/cancer/thyroid-cancer/treating/by-stage.html.
31. American Cancer Society. External Beam Radiation Therapy for Thyroid Cancer. June 1, 2018. https://www.cancer.org/cancer/thyroid-cancer/treating/external-beam-radiation.html.
32. Appelhof, BC, Fliers, E, Wekking, EM, et al. Combined Therapy with Levothyroxine and Liothyronine in two ratios, compared with levothyroxine monotherapy in primary hypothyroidism: a double-blind, randomized, controlled clinical trial. JCEM. June 4, 2018. https://www.ncbi.nlm.nih.gov/pubmed/15705921?dopt=Abstract.
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