In Part 1 of our examination of natural thyroid hormone replacement as the treatment for Hashimoto’s hypothyroidism, we reviewed the history of natural thyroid hormones (desiccated thyroid hormones such as Armour and NatureThroid, which include T4, T3, T2 and T1).
We then looked at the reasons for the development of synthetic thyroid hormones (T4 and T3 are separate synthetic replacement hormones; T4 converts to T3 in the body and many patients are only prescribed T4). We also reviewed their widespread adoption of synthetic thyroid hormones by many endocrinologists as a first line treatment for Hashimoto’s patients.
Here in Part 2, we look at research on the safety of long-term use of desiccated thyroid hormones and the controversy among physicians about treatment using natural vs. synthetic thyroid replacement.
Are there any studies about the safety of taking desiccated thyroid, e.g., Armour or NatureThroid, for decades?
Though the research that has been performed does indeed span decades, nothing recent was found regarding the long-term effects or safety of natural thyroid extract. There were two older papers however, both from 1951 (and thus written before synthetic hormone and modern lab techniques were available) that sought to describe the impact of giving normal patients thyroid extract; the results and conclusions are unclear because of lack of access to the original articles.
There is not much research in total related to desiccated thyroid extract, but there is some, though reliability probably varies greatly. One of the most well-known studies – often cited by advocates as proof of safety and efficacy – actually demonstrated no difference in symptom improvement or quality of life; extract patients did lose a few pounds, however. Another study examined the effect of various extracts on the intestines of rats, though its applicability to human beings is probably low, and it is not really concerned with what we are discussing.
A related study looked at appropriate versus inappropriate use of thyroid medications in an elderly population and found that inappropriate use occurred more often in men; and when it occurred, it was more commonly associated with desiccated extract than with levothyroxine.
Others investigated the actual contents of available extract pills, finding mostly positive results in terms of active hormone being present, but with too much variability in amounts and ratios. And by extrapolating from other research on bone mass and strength, we can confidently say that taking too much hormone, of any preparation – which in turn lowers thyroid-stimulating hormone (TSH) – may put patients at risk for osteoporosis and fracture. It is reasonable to assume that such a risk would increase along with the duration of inappropriate therapy.
Fortunately, for those interested in following or pursuing present and future research opportunities, there is at least one study currently recruiting participants that is seeking to compare natural to synthetic treatment, with the hypothesis being that natural extract will benefit patients more than synthetic levothyroxine.
Why is there controversy about patients taking natural desiccated thyroid pills, especially for autoimmune thyroid disease (which is sometimes harder to treat than non-autoimmune thyroid disease)?
Despite our conspiracy-driven culture today, doctors are generally not out to surreptitiously support an evil pharmaceutical agenda and counter all things natural, just for the sake of being proud, difficult or stubborn (which some certainly are). There are real reasons – many of which are the same as those that inspired the original research and development referenced above – to lean toward synthetics. Likewise, there are real concerns with not doing so and instead going the natural route.
Again, as mentioned above, many of the reasons for taking synthetics versus naturals, and for doctors being against the latter, involve the lack of precision, standardization and regulation surrounding natural thyroid extract preparations. There is frequently unacceptable uncertainty regarding the contents and amounts of hormone within each pill. In fact, occasionally the supplements contain no active hormone at all, a scenario that just doesn’t occur with proper FDA oversight. And physicians are likewise concerned with the amount of iodine per pill, which also varies quite a bit.
The practice of dosing according to symptom relief, rather than lab values, is much less precise, and thus much more likely to result in medication-induced hyperthyroidism and related problems. Proponents of natural hormones sometimes argue that you should use medicine until you feel better, regardless of what lab results say, since that’s what it’s there for. Unfortunately, this is faulty and potentially very dangerous logic: Following this line of thinking with morphine will definitely remove all of your pain eventually…but you might also very well die. Medications like thyroid hormone (and morphine), which have very narrow therapeutic windows (the desirable gap between too little and too much medicine), require accurate blood levels to direct very precise treatment, so that these same levels do not stray from the reference range, leading to avoidable problems.
Another treatment path that some health providers take is to include thyroid supplements with the treatment plan. There are good and valid reasons why physicians offer caution in treating thyroid with these supplements. Even some proponents of naturopathy and natural hormone treatment advise caution when using thyroid supplements because they include thyroid hormones, which combined with your prescription dosage, could be too much thyroid hormone replacement. This of course quickly leads to controversy for those looking, for whatever reason, to stick with natural thyroid treatments. That said, some people, whether as a result of a placebo effect or not, have reported only feeling better with natural thyroid extract and thyroid supplements. And that’s the main goal here – getting well by leaving sickness behind.
Therefore, assuming that you’re taking a confirmed and measurable extract containing the true active hormone – recommended by and under the supervision of a competent clinician (MD, DO or NP; not ND!), who can recognize signs and symptoms of too much/little hormone and other problems – I would say it’s among the safer and more legitimate remedies promoted largely by naturopathy. But please utilize it only under the above conditions, and always check with your doctor first. We as physicians have no interest in stymying your efforts to get well; but we do take issue – Hippocratically and personally – with you becoming unnecessarily sick as a result of self-medicating irresponsibly, or following the advice of people who have zero to two years of questionable education.
Naturals may very well help, but why not have someone by your side who can identify real signs of danger or ineffectiveness, and who can try to help you feel better using appropriate methods? Medicine isn’t wholly science – it’s very much an art – and some physicians are inevitably going to be better clinically than others, while all doctors make mistakes or misdiagnose occasionally, as a condition of being human. But every physician should have one identical primary intention: that of helping his or her patients get well. In whatever way that allows care to be rendered safely, effectively and under regulated, measurable standardization, backed by good science.
Please note all of the qualifications and conditions I’ve provided above. Though some people suspect that allopathic (traditional medicine) recommendations are simply the result of stubborn hubris and resentment mixed with big pharma influence – the latter of which many practitioners clearly recognize and do resent – this is just not the case. All clinicians looking to stay true to their oath should strive for one thing only: achieving your health and well being via the safest, most reliable and effective ways possible, while using their knowledge and experience to carefully monitor for potential problems. And for the vast majority of doctors and other clinicians, that is the only objective that matters. I urge you to believe me, because it’s the truth.
Questions for your doctor:
- What are your thoughts on natural versus synthetic thyroid hormone for treatment of hypothyroidism?
- Is there a place for natural hormone therapy in hypothyroidism? Can you explain what kind of potential problems using natural hormones presents?
- If I have decided to use a natural hormone supplement, are there any that you prefer and why?
- What are the specific symptoms I should be on the lookout for when using desiccated extract, to monitor for signs of hyperthyroidism?
- Where can I find more information that is accurate and reliable, as well as up-to-date?
About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians. After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time. He may be reached at [email protected].