Bottom Line/Health: I have a question from a reader. She’s taking Synthroid for her Hashimoto’s disease. Is that safe?

Dr. Brooke Kalanick, ND: All medications have risks, so the question of whether or not it’s safe is only a piece of the issue that she’s probably really wondering. She’s probably also wondering, is this the best medication for her particular condition?

Synthroid is the most common thyroid prescription, and as practitioners, we get a little bit married to our particular way of doing it. Many doctors, they prescribe Synthroid. Many natural practitioners want to prescribe Armour. Someone else might think that the compounded, made-by-your-pharmacist T3 combination is the best.

And the truth is that there’s no perfect medication for every person with Hashimoto’s. Especially with Hashimoto’s, you get people sensitive to different binders and fillers, so they might do fine on a particular generic of Synthroid, they might not. They might need more of the T3, which is where things like Armour come in handy.

Bottom Line: Millions of women have thyroid issues – hypothyroid, underactive, Hashimoto’s – and they’re just given Synthroid and told to have a nice life. Is it really as simple as that?

Dr. Kalanick: It’s definitely not as simple as that. Some women do really great on Synthroid. What Synthroid is, is synthetic T4. What your thyroid gland makes is T4, but you also have to convert that to T3. Some people have a hard time with that, so a different medication might be better for them. So it’s not necessarily that Synthroid is bad; it’s just that it may not be the perfect answer for you if you’re someone that has a hard time conversion.

You may do better on a combination medication such as Armour Thyroid or Cytomel, where they’re adding some T3 in. Armour is a combination of both T3 and T4. Some docs prefer that; some people like to keep the Synthroid and then add in just the T3. So it really depends on so much more than just your T4 levels and replacing those. It’s how well are you doing everything else that flows from that in the thyroid metabolism?

Bottom Line: Are there side effects of the different hormones? Because hormones always have effects on your body.

Dr. Kalanick: Yeah, when someone has too much Synthroid, they’re going to feel a little amped up. They can see changes in their cycle, just feeling sweaty or racing heart. All of those are signs that your dose might be a little bit too high.

But many women are told when they look at their labs that everything looks okay, and they still don’t feel well. So that’s where looking at some of these other options – or is there anything else they should be doing to help manage the T4 conversion and all these other things that have to happen.

And another thing to think about is especially if the patient has Hashimoto’s, each individual company that makes their version of Synthroid or their generic of the T4 or their generic of the T3 uses different binders and fillers, and some patients with Hashimoto’s are really sensitive to those different ingredients, and they might do better on just a different generic.

Bottom Line: Oh, that’s interesting. So if someone has a hard time with their hormones, it might actually be the binder that they’re not tolerating.

Dr. Kalanick: It could be. There are so many things to think about, especially if the patient has Hashimoto’s. They are quite often told their labs are okay, but they still feel not great, so there are really a lot of things to look at. And if your doctor’s not willing to look at some of those other options, you might need to get someone else to help answer your questions.

Bottom Line: Are there any supplements that somebody should be taking to help the T4 work better, to break it down better?

Dr. Kalanick: This is where we talk about zinc and selenium as being good nutrients for the thyroid. They actually help convert that T4 into T3. This happens mostly in someone’s liver, and those are great micronutrients that a lot of us are deficient in. So absolutely, those are really important.

Bottom Line: Great. All right, thank you, Dr. Brooke Kalanick.