How to treat yourself for hypothyroidism
A controversial title, I think, but when one’s hand is forced by a stubborn doctor who is overly reliant on lab values, sometimes one has no choice.
Firstly, there is no point “treating” yourself with any other substance than thyroid hormone. I have been through the mill with fake thyroid cures. I used to take selenium and kelp (iodine) tablets until they came out of my ears. I’ve even tried potassium iodide – which makes me hyperactive and lately gives me a painful goiter. If you have a significant, long-lasting thyroid problem, there is no way it is down to iodine deficiency, unless you are living in a mountainous region of the third world, hundreds of miles from the sea, and you grow all your own food in your back yard. If you think you are iodine deficient, eat some white fish and visit the seaside.
There are a variety of “thyroid stimulating” or “metabolism boosting” herbal remedies and teas on the market. They are all rubbish. Green tea is supposed to be metabolism boosting, but like most salicylate-like substances, it actually raises the metabolism by acting as an uncoupling agent to the mitochondria, so that they “leak” or waste energy. Salicylates actually reduce thyroid hormone output and interfere with thyroid receptors. Ginger tea, cayenne and black pepper (piperine) are touted as thyroid-boosting agents that restore normal body temperature in hypothyroid patients. Don’t try them. They will likely make you feel very ill if you have hypothyroid induced food intolerances.
Coconut oil, in my opinion, will not solve your problem. As soon as I twittered the word “thyroid”, I was latched onto by coconut oil marketeers. These guys are absolute sharks. Coconut oil isn’t snake oil exactly, but it isn’t a wonder drug that will fix your thyroid either. I’ve googled myself silly, but I’ll be damned if I can’t find out how coconut oil is supposed to work its magic. There are just a lot of altie health sites out there proclaiming it as a miracle cure. I don’t personally understand how providing the mitochondria with a cheap-and-easy energy source has anything to do with thyroid hormone output. It may well rev-up the mitochondrial energy output, but it doesn’t make your thyroid produce any more T4. T4 production does more than just stimulate your body to burn energy and produce heat.
Having tried coconut oil for considerable periods of time, I found that it certainly gave me more energy, but it made a hell of a mess of my skin. Coconut oil, I’ve discovered, is quite notorious for causing eczema in apparently euthyroid individuals. This is probably because it contains a lot of salicylate-like polyphenols, and rather than supporting the thyroid, it may be working in the same mitochondrial uncoupling manner as many alleged herbal cures, and in fact lowering thyroid hormone function throughout the body while raising metabolism. When I tried coconut oil, I seemed to form a dependency on it, as it gave me the shakes if I didn’t take it at the same time every day.
The bottom line is, if you want to treat a thyroid problem, you treat it with thyroid hormone, nothing else.
Now, from the sources I have been reading, apparently thyroxine is a very safe drug, it is relatively hard to kill yourself with it from overdosing. Every drug has a risk. You can destroy your liver and kill yourself with as little as 12 grams of paracetamol, but the effective treatment dosage for paracetamol is 500mg – 1000mg. I believe the LD50 for thyroxine is something like 20mg/kg in rats – the equivalent of over a gram in a human. Thyroxine is prescribed in micrograms (1,000,000’s of a gram), so you would have a damned hard time of it getting hold of enough tablets to actually kill yourself. My prescription contains less than 1 milligram in total for the entire month. If you did manage to overdose to the extent of eating a gram of thyroid hormone, as some patients did back in the haphazard, slapdash early days of dessicated thyroid treatment, the result would be a heart attack.
Small overdoses, i.e. getting slightly hyperthyroid, are not really anything to worry about, though they undoubtedly feel very frightening at the time if one’s heart is racing or skipping. The treatment is simply to withdraw or reduce medication for several days and wait it out. Apparently most patients are very good at spotting when they are getting slightly hyper, and manage their own dosages quite effectively.
However, because initiating thyroxine treatment in a hypothyroid patient can produce side-effects apparently indicative of hyperthyroidism, doctors are very cautious to start out low and build up the dosage slowly until it falls within the ideal treatment range. The side-effects can include headaches, an increase in heart rate, and bouts of sweating. I have already experienced a few bouts of sweating, though whenever I’ve measured my body temperature, it’s still very low. This is a beautiful example of homeostasis at work, with the body being apparently so surprised by the presence of thyroid hormone that it honestly believes it’s too hot, when it isn’t.
It would be an essential part of self-management, that anyone attempting to treat themselves for hypothyroidism to familiarise themselves with the symptoms of hyperthyroidism, which include weight loss, increased appetite, palpitations, nervousness, diarrhea, abdominal cramps, sweating, tachycardia, increased pulse and blood pressure, cardiac arrhythmias, tremors, insomnia, heat intolerance, fever, and menstrual irregularities. Long term hyperthyroidism can lead to muscle and bone loss, so it is important to monitor one’s temperature, pulse, and blood pressure to ensure one isn’t getting carried away and thinks one is supergirl.
A number of open-minded thyroid doctors suggest that the danger of taking thyroxine is very low, and there is very little likelihood of any harm occurring in an apparently euthyroid patient (especially one with hypothyroid symptoms), who chooses to undertake a three month trial of thyroxine to see if it helps their symptoms.
Ideally, if one were to do this, one should of course do it under the supervision of a doctor, or at least a naturopath, who is willing to monitor your blood levels of thyroid hormone for signs of toxicity.
When you begin treatment for hypothyroidism, the doctor will begin you on 25-50mcg of thyroxine, depending largely on what they and you both feel comfortable with. Every month to six weeks, you are supposed to go back to the doctor to have your thyroid hormone levels checked again to make sure you haven’t gone hyperthyroid. If you haven’t, and you are still complaining of symptoms, you are supposed to get an increased dosage until you begin to feel better. Most people end up on around 150mcg of thyroxine. Sometimes doctors are downright stupid, and as soon as you fall within the normal reference range, they will stop increasing your dosage regardless of how you feel, and some will even cut off your supply of hormones(!) Make sure you get a good doctor, one who is willing to tailor your dosage to your individual needs, and view your lab results as a guideline only.
In the old days, before standardised blood tests, thyroid treatment was done blind without any blood tests, and the patient would simply tell the doctor whether they were feeling any better, whether they felt well, or whether they felt as though they were going hyper. Arguably, patients were better off before blood testing, as blood tests can be deceptive. Some hypothyroid patients claim that they do not feel well until they are statistically hyperthyroid. People have different needs.
Although today, most people end up on an average dosage of around 150mcg of thyroxine, in the old days, it was more like 300mcg of thyroxine, until doctors declared that one’s TSH was the all-important number, and it must remain above zero. This seems a little silly to me, because if you have no capacity at all to produce thyroid hormone (e.g. in thyroidectomy or radioiodine treatment), much as the pancreas of a T1 diabetic has no capacity at all to produce insulin, a TSH of greater than zero suggests that the pituitary is still signalling to the missing thyroid that more T4 is required than is being served.
That said, according to the patient advocacy sites, many people claim that they feel at their best when their T4 levels are in the upper third of the reference range, and their TSH is below 1.
You’re supposed to take your thyroxine tablets first thing in the morning on an empty stomach, leaving a couple of hours before eating. You shouldn’t take them with iron or calcium, which interfere with thyroxine absorption.
Another issue is the equivalent dosage between synthetic T4 preparations (thyroxine), and natural porcine extract (e.g. Armour thyroid). Although a lot of doctors dislike Armour thyroid for a variety of (IMHO) unjustifiable reasons, a subset of patients claim an improvement on Armour that they have not seen on synthetic T4.
Synthetic T4 and natural T4 are chemically identical, but synthetic preparations do not contain T3, which Armour thyroid does. T3 is considerably more potent on the cellular level than T4. The ratio of T3:T4 in porcine extract is roughly 1:4. The smallest dosage available of Armour is 1/4 grain, or 15 milligrams, which contains 2.25 mcg of T3 and 9.5 mcg of T4. Based on clinical responses, one 25mcg tablet of synthetic thyroxine is roughly equivalent to 1/4 grain, 15mg tablet of Armour thyroid.
A number of endocrinologists believe that one should not supplement entirely with Armour or other natural thyroid extracts because they contain this T3:T4 ratio of 1:4, claiming that our bodies prefer something close to a ratio of 1:14 T3:T4. Having examined this assertion, I don’t really understand it, as according to Dr Skinner, our bodies naturally contain a ratio of 1:4.5 T3:T4, very close to that provided by Armour.
The consequence of taking tablets that contain T3 is that your T4 can go quite low. The typical blood profile of someone taking Armour, is low TSH, low T4, and high/normal T3. This makes doctors unhappy. Possibly this profile might make one slightly more prone to fluctuations in energy if one were to miss a tablet or two. T4 has a half-life of about seven days, whereas T3 has a half-life of only 1.5 days. However, some people claim that they simply did not get better until they started taking a preparation containing T3, and there is also the possibility that it might supply other unknown and unidentified hormones to the body that synthetic thyroxine does not.
Should you wish to obtain thyroid hormone without a prescription, you may be able to buy it online. Rules vary from country to country regarding this. In the UK, one does not need a prescription to purchase small amounts of prescription drugs for oneself and one’s immediate family. International Pharmacy is one website I have seen recommended on a UK thyroid forum. Be aware that you will have to pay VAT on purchases greater than £18, they may be delayed by customs, and the postman will likely ask you for a cheque on your doorstep.
Remember that finding a doctor who will listen to your symptoms regardless of your laboratory tests is always the better route, for your safety and security, and these doctors do exist, it’s just a matter of asking the right people to point you in the right direction. Start on thyroid forums and patient advocacy sites, as many have lists of sympathetic doctors who consider symptoms to be more important than lab values. Once you start down the dark path, forever will it dominate your destiny! In other words, once you have started self-treating, it will be hard for you to confront your doctor about your self-prescribing of drugs, and any future thyroid hormone test that you take will be affected by your use of thyroid hormone. Should you wish to “go straight” in the future, but do not want to confide in your doctor, you will have to undergo a wash-out period of a few weeks before taking an unbiased thyroid test.
Of course I’m not advocating any of this. I’m just saying, if is how things are, this is how I would get around the problem…