Functional Medicine Approach to Thyroid
We see a lot of thyroid issues in our Tulsa Functional Medicine clinic. Many patients simply do not feel well with the traditional medical approach to thyroid. I’ve written about this before in another post entitled The Mismanaged Thyroid. That post has a lot of information about how to manage thyroid.
For years, I have used and recommended RLC Labs’ Nature-Throid. This is a natural desiccated thyroid (NDT) containing a combination of T4 and T3.
The problem
Basically, they take the thyroid gland from pigs (porcine), dehydrate (desiccate it), grind it up, and put it in a pill. I know that may sound gross but it is actually quite effective. It is the same thing (well, similar) as Armour throid and NP Thyroid.
Half-life
It shocks me how many physicians as well as patients have no idea how their medications work and for what duration. We’ll have patients take a pill on a regular basis then check labs to see how they are doing without understanding how the two issues can overlay and influence one another.
T3 is one of the hormones in natural desiccated thyroid. It has a very short 1/2 life and it gets in your system very quickly and only lasts a few hours. T4, on the other hand, has a very long 1/2 life.
Most physicians are only using T4 medications (Synthroid, levothyroxine, etc) so there is no need to understand the difference between T4 and T3 half lives. But when you are using combinations then this understanding is critical to appropriately managing doses.
For example, if you take your T3 containing natural desiccated thyroid and then check your serum labs you will frequently have an elevated Free T3 because the hormone gets into the blood stream quickly but doesn’t stay long. If you only take your medication once daily then you get a rush of hormone for a few hours then you may be low for the rest of the day.
Autoimmunity
Many of our patients have Hashimoto’s (autoimmune) thyroiditis. This means that their immune system is creating antibodies against thyroid tissue. It may not make good sense to give these patients additional thyroid tissue (natural desiccated thyroid) which could potentially stimulate the immune system and increase the antibody response. I’ve seen that happen in some patients.
Over the past several months I’ve been vigilant of this issue and have switched some patients over to Tirosint (T4 only) along with either Cytomel or compounded T3-SR (which I prefer).
Thyroid Ratio
Natural Desiccated Thyroid (NDT), made by any of the manufacturers, contains a thyroid hormone ratio of about 80% T4 and 20% T3. However, human thyroid is more like 90% T4 and 10% T3. Remember that T3 is the active hormone (T4 is a pro-hormone with very little effect).
It is very common for us to see higher serum levels of T3 and lower levels of T4 in patients taking Natural Desiccated Thyroid. In fact, we’ll often add synthroid or levothyroxine in addition to Natural Desiccated Thyroid (NDT) to improve these ratios.
Availability
RLC Labs has had an issue for the past couple of years and the supply of Nature-throid has been problematic. We aren’t sure why. They haven’t been very forthcoming with why this has been an issue. I’ve heard several stories but I’m not sure it really matters.
This was first an issue in 2016 and I was told that it would take them several months to get it fixed. It did take several months to say the least!
We started ordering it to dispense from the clinic because many pharmacies couldn’t get it. At least if I knew what we had in the clinic we could better manage prescriptions. The problem was we could only get a couple of doses and even those were very difficult to get. We kept running out and then it would take to long to get them.
But we were being patient because they always had a good product. Better than Armour and NP Thyroid in my experience.
However, recently we discovered that Nature-throid was in short supply again. In fact, some of the pharmacies contacted us and told us that weren’t going to be able to get it indefinitely. I may like the product but if I can’t get it for my patients then what good is it?
The Solution
I liked Nature-throid because it was incredibly inexpensive and effective. However, if you can’t get it then price and effectiveness simply don’t matter. We had to come up with something else.
Enter Revolution Thyroid SR (sustained release):
This compounded thyroid addresses all of the problems listed above.
First, it is a sustained-release thyroid. This means that it is absorbed more slowly and will, then, last longer. You don’t get the spike and drop that you get with natural desiccated thyroid and cytomel (liothyronine). Energy and lab levels should be much more consistent.
Second, these are natural T4 and T3 molecules without the other components of thyroid. That means that we aren’t exposing our Hashimoto’s (autoimmune) patients to thyroid gland which could, in theory, make their autoimmune issues worse.
Next, we have fixed the problem with the thyroid hormone ratio. T4 and T3 are set to a more physiologic level and the labs should reflect accordingly.
Finally, we have availability. Of course, this prescription is a compound so it can’t be sent to Walgreen’s or CVS pharmacies. It has to be sent to a compounding pharmacy. Price will go up a little but it is still extremely cost effective and worth every penny. The benefits on making this switch are huge!
I generally recommend NextGenRx for this prescription. I know the costs (pretty inexpensive) and their quality. They also have great customer service. However, if you want it sent to another pharmacy just let us know and we’ll be happy to accommodate.
