A Look at the Issue with Drs. Richard and Karilee Shames
You might arrive at your very best "dose" of thyroid medication, but still be taking the wrong brand of pills. A great many thyroid sufferers, who have consulted with me as a 30-year medical expert, eventually did much better after simply switching from one name brand to another. Amber, for example, came to our office a couple of years ago on Valentine's Day. Her appointment was part of a special present to herself. She was a bright, 32-year old legal secretary, who for the last several months had been saying to herself, "I need to see someone else about my thyroid. I think I should be taking something different."
Amber had been taking 112 micrograms of Levothroid for 4 years. Neither more nor less was as good as this exact dose. It had indeed helped relieve some of her original symptoms. Nevertheless, she had never come close to feeling like her old self, before she had a thyroid problem. When she discussed this with her doctor at her yearly checkup, she received this typical response: "It's not good to switch around with different thyroid medicines. There is nothing wrong with the brand you're on, and we saw that more of it didn't help. You've got to accept the fact that this is as good as it gets." When Amber talked during our second-opinion telephone consult, I explained that her doctor's words, although possibly true as a general statement, might easily be false for her individually. When she convinced her doctor to switch the prescription to Levoxyl, she soon experienced major improvement. Eventually, she did indeed once again feel like her old self.
As we mention in a prior article, a simple increase in the dose of your present brand of thyroxine (T4) may make all the difference you need. Many people, however, do not have such good results with their first-tried brand of thyroxine. (This can occur regardless of whether the first brand tried is Synthroid, or Levoxyl, or Levothroid, or the new Uniythroid.) Basically, these people deserve a trial of different brands. Neither doctors nor pharmacists know why one person does best with one brand of thyroxine, and another person does best with a different brand. It is, however, a frequently-observed phenomenon. Amber's doctor was not incorrect – IF the person is doing well. However, if the person is not doing all that well, or believes she could feel better, it might be a fine idea to switch brands. In Amber's case, she clearly deserved a clinical trial of another brand.
Some people can begin to have difficulty with their original brand of thyroxine after taking it successfully for many years. Others can have a problem with it after only a few months. Still others respond to it poorly from the very beginning, or experience no response at all. Sadly, if the patient's blood test looks better on the medicine than it did before treatment, the doctor may say, "Well, this is as good as it gets." We disagree.
In fact, we emphatically reiterate that there are numerous people already on thyroxine who should be treated with something other than their current first brand tried. They might simply need a different brand of thyroxine, in order to feel much better. Perhaps thyroxine mixed with thyronine (T3) would work well, if simply switching brands does not. Perhaps taking straight T-3 with no thyroxine at all would be even better still. It is even possible that a nonsynthetic, animal derived, desiccated thyroid medication, such as Armour thyroid, would be a more effective choice.
For the present article, let's consider how to best determine the exact brand of thyroxine that most completely answers your needs. Of the four supposedly-equivalent brands of thyroxine sold in the United States (Synthroid, Levothroid, Levoxyl, Unithroid), each is the special favorite for many thousands of people. It's certainly understandable why a patient might have a favorite brand. Individual response to some of the pill's ingredients could easily result in a person doing slightly better with Levothroid than with Tirosint. That same patient might also have a terrible time with Levoxyl. Synthroid, of course, has a continually unfolding controversy, well discussed elsewhere.
Often people come into our clinic saying, "Here's the brand that works best for me." We've seen this happen so many times that we tend to believe people when they say it. We feel that they should have the brand that feels best for them, for whatever reason. We know of a number of doctors, not to mention entire HMOs, who have a "favorite" brand of thyroxine. However, it may not be YOUR body's favorite brand. You may have to assert yourself to secure the right brand for you. The PATIENT should have a personally-favorite brand –not the doctor. So where does this commonly-encountered doctor bias come from? It may be a result of either drug company advertising, or the doctor's years of experience, or directly from research studies.
Keep in mind that research studies are often funded by the company that stands to profit most from a favorable result. For example, what might research study results mean to you? It could mean that a doctor might say, "Well, the researchers finally got this straightened out, after many years of not knowing for sure. Several big studies have recently shown that Brand X is the best, so I want you on it. It's been working great for most of the other patients." We submit to you that Brand X may or may not be better for you. Here's why.
The research that yielded this result almost certainly did not find that every person tested did better with Brand X. That is not what happens in even the best research studies. What happens is that some people do better on Brand X, some on Brand Y, some on Brand Z. Some evidently do better on natural thyroid, and others may even do better on various combinations of natural and synthetic medication. Suppose the conclusion of the research study was that 67% of the people did best on Brand X.
Okay, that's fairly compelling. How about the other 33 percent who did better on something else? How does your doctor know that you're not one of the 33 percent who would do better on something other than Brand X? How does the doctor know that you may not be like "most of the other patients"? You won't know until you try it for yourself. Even if many studies confirm that Brand X is best for 67% of the population, that doesn't mean that it will ever be the best for you. This simple fact, which seems so obvious to us, is evidently lost on many of our colleagues. We are not talking about slipshod application of anecdotal evidence here. We are talking about what can be proven true for one particular person on the planet -- you. Tell your doctor whether or not you feel good on the brand he or she has selected for you. If you're not doing well with your current brand of thyroid, ask to switch to a different brand. If you are on a generic product, and are not doing as well as you would like, ask for one or more of anoher manufacturer's generic.
Before you draw any conclusion about its effectiveness, realize that each 'try' should be given at least five or six weeks. (…unless the trial of the new medication is making you feel terrible. In that case, don't "stick it out" for six weeks. Instead, switch to something else sooner.) You and your doctor may be quite pleasantly surprised to find significant improvement in simply switching brand names. Our best wishes to you both.
PS - A significant number of people might not do well, no matter what brand or dose of thyroxine they take. As we mentioned briefly above, there are many good alternatives to simple straight thyroxine (T-4). We will be sharing more about each of these in upcoming articles.
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