Keep Taking Those Thyroid Pills
Q. I’m taking 120 mg of Armour thyroid for treating an underactive thyroid gland. The doctor that put me on it said I can come off it anytime. However, my family doctor said that once you start taking thyroid hormone you can never discontinue it because the thyroid gland shuts down. I want to go off the medication, but which doctor is right? - W.B., Zeeland, Mich.
A. What we’re talking about here is a sluggish thyroid gland - that double-lobed structure located in front of the Adam’s apple and windpipe. Its job is to secrete two active hormones: T4 (thyroxine) and T3 (triiodothyronine). These hormones regulate our metabolism so that we’re not snails or jackrabbits; they affect our heart rate and the strength of muscle contraction; they stimulate brain development and growth; they help us generate a normal body temperature; and they help regulate cholesterol production and breakdown.
It’s really important to have just the right amount of T4 and T3 produced. The way that’s done is via the pituitary gland in the brain sending a hormonal signal to the thyroid known as TSH (Thyroid Stimulating Hormone). It’s something like a “work order” for the thyroid. The thyroid responds to the TSH signal by making hormones. It then sends a signal back to the brain to indicate that the “work order” has been received and enough hormone is being made.
What happens if the thyroid isn’t putting out enough hormone? The TSH blood level rises, as if it’s trying to wake up a worker sleeping on the job. However, if the thyroid gland is petering out, the increased TSH message doesn’t do anything except let a doctor know that your thyroid gland needs some assistance.
In the vast majority of cases, generally being women, this underactive thyroid condition develops because of an “autoimmune” condition. It’s called Hashimoto’s thyroiditis, and we don’t know why people develop it. What we do know is that out of the blue, a person’s own body starts a slow attack of their thyroid gland as if it were a foreign invader. We’re never sure how much damage will occur or when the attack will stop or start again. It’s anyone’s guess what’ll happen over time.
That’s why we need to monitor the thyroid gland’s activity at least yearly. Hashimoto’s thyroiditis is actually fairly common, with as much as 10 percent of the adult population having it. In women over the age of 75, 1 in 5 have an underactive gland.
It’s 10 times more common in women than in men.
One thing about this disorder is that it’s permanent. Your doctor told you that you could stop the thyroid hormone replacement anytime. Of course you can, but your body will surely miss the supplemental thyroid. Your gland never shuts down; you’re just filling in the missing level of thyroid hormone. And if we check a supersensitive TSH blood level, it’ll let you know whether or not you’re taking enough(or too much) thyroid replacement.
The next thing we need to address is how to replace the hormone. The vast majority of folks with hypothyroidism take thyroxine(T4) alone as Synthroid or Levothyroxine.
The body then converts the T4 into T3. The dosage prescribed is very precise, measured in micrograms(that’s 1/1000 of a milligram; 1/1,000,000 of a gram). What you’re taking is purified ground-up whole thyroid gland from a pig. It’s dosed in milligrams. It’s rarely used by today’s physicians, and generally viewed as imprecise and old-fashioned. Some folks who have normal TSH values don’t find that T4 makes them feel any better, and prefer a T4/T3 combination like ground-up thyroid. I don’t recommend it because it’s less precise in its milligram dosing than the microgram dosing of T4 and T3. Some docs prescribe T3(Cytomel) in addition to T4 to those patients who don’t respond well to T4 alone. If combination therapy is deemed necessary, I feel this is the way to go. Dosed in micrograms rather than milligrams, precise dosing can be administered and confirmed by Free T3, Free T4, and TSH blood tests.