Healthy Hormones

The Best Treatments for Hypothyroidism

Have you been diagnosed with hypothyroidism?

Have you been prescribed a medication?  If so, do you feel any better?

Are you wondering if there is a better treatment than what you are taking?

Are there any dietary changes or supplements that would help you feel better?

I will try to answer these and other questions in this article.

Here we go...


How Does the Thyroid Work?

In order to understand the different treatment options, it is vital to review what exactly the thyroid is and why it's important.  I discuss this in detail in this article.

Basically, the thyroid is vital for metabolism, growth, development, and temperature regulation in the body.

The thyroid gland by itself cannot produce thyroid hormone.

That activity is controlled by the pituitary gland in the brain which secretes thyroid stimulating hormone (TSH).  It measures the level of T4 and T3 which determines how much TSH to secrete.

Once stimulated by TSH, the thyroid will then produce mostly T4, which is the inactive form of thyroid.  

Primarily the liver and muscle cells then convert the T4 to T3, which is the active form of thyroid.

The T3 molecule then enters the cells of the body and attaches to the thyroid receptors, which activates genetic transcription and tell the cells to perform the functions that it is designed to do.

Every step of this process must work efficiently.  If any step is defective, the cell will not perform the job it was designed to do as well as it should, and the patient will develop symptoms of low thyroid (hypothyroidism).

Factors that Affect Thyroid Function

As I explained earlier, there are several steps required in order for the body to have normal thyroid levels.

  1. There must be adequate thyroid production by the thyroid gland.
  2. The body must be able to convert T4 to T3.
  3. T3 must be able to bind to the thyroid receptors in the cells
  4. The cells must be able to start gene transcription which causes it to perform the function it was intended to do.

If any of these steps is defective, the patient will develop symptoms of hypothyroidism.

Multiple things can affect each step of this process:

Decreased Production of Thyroid Hormone

  1. Stress
  2. Infection
  3. Trauma
  4. Medications
  5. Fluoride - competes with iodine in the thyroid
  6. Toxins - Pesticides, heavy metals
  7. Autoimmune conditions
  8. Iodine deficiency
  9. Iron deficiency
  10. Zinc deficiency
  11. Selenium deficiency
  12. Vitamin deficiency - E, C, D, B vitamins

Over Production of Reverse T3

This is a default hormone that competes with T3 at the cellular level.  High levels reduce thyroid function and indicate what is called thyroid resistance.

  1. Stress
  2. Infections
  3. Trauma
  4. Medications
  5. Low calorie diet
  6. Inflammation - chronic diseases such as diabetes
  7. Toxins
  8. Liver/kidney dysfunction

Decreased T4 to T3 Conversion

  1. Selenium deficiency
  2. Zinc deficiency
  3. Vitamin D deficiency

Decreased Cellular Sensitivity to T3

Decreased Cellular Sensitivity to T3 -

  1. Lack of exercise
  2. Vitamin A deficiency
  3. Zinc deficiency

Treatment of Hypothyroidism

Medication -

1. T4 only - levothyroxine, Levoxyl®, Synthroid®, Tyrosint®

This is the standard medication that is prescribed by the vast majority of physicians.  It is synthetic T4.

It is generally very well tolerated with few side effects.

If the hypothyroidism is purely due to a deficiency of thyroid hormone, these medications will be very beneficial.

However, if there is a problem with conversion of T4 to T3, or there is a thyroid receptor issue in the cells of the body, a T4 only medication will be inadequate to raise cellular levels of thyroid to the optimal level.  This is called cellular hypothyroidism.

A large percentage of patients have issues with this conversion.  As a result, many do not get complete symptom relief with a T4 only medication.

If your doctor is prescribing a T4 only medication and is monitoring your thyroid level by only checking a TSH and/or T4, there is a high likelihood that you will not have as much improvement or feel as good as you could.

2. Natural Dessicated Thyroid (NDT) - Armour Thyroid®, WP Thyroid®, NP Thyroid®, Nature-throid®

NDT is purified porcine (pig) thyroid.It contains both T4 (about 80%) and T3 (about 20%).  It also contains small amounts of T2.

Many patients will feel better on NDT compared to T4 only medication because it already has some T3, so it's not completely dependent on the body's ability to convert T4 to T3 for it to work.

However, some patients may still need more T3 than is in NDT to get complete symptom relief.

3. T3 only -

T3 medications can be broken down into 2 types -

  1. Immediate release (IR) - such as Cytomel® and Liothyronine
  2. Sustained release (SR) - this is compounded Liothyronine usually bound to methylcellulose

Immediate release T3 is rapidly absorbed in the body and peaks in the blood in about 2-3 hours.

The majority of people tolerate the immediate release form.  However, some people are very sensitive to T3, so this may cause symptoms such as jitteriness or heart palpitations.

Most cells in the body take weeks to respond to activation from T3.  The heart, however, is different.  T3 works directly on calcium channels in the heart which causes the heart to pump harder and faster, which can cause palpitations.

If you have these symptoms while taking immediate release T3, they will usually resolve by switching to sustained release T3.Sustained release T3 is bound to a substance such as methylcellulose which slows the absorption of T3 in the body.  This prevents the surge of T3 in 2-3 hours that you get with immediate release T3.

Thyroid Management Principles

I typically recommend patients start with NDT medication.  However, if their free T3 level is in the high 3s or low 4s, it is reasonable to start with a T4 only medication.

Insurance plans also tend to prefer T4 only medications, so they may be cheaper for the patient.

However, if the patient does not get adequate symptom improvement and/or their free T3 level remains low, they should either be switched to NDT, or a T3 only medication should be added to their regimen.

If the patient continues to have a high reverse T3 and a low T3 level despite being on NDT, a T3 only medication may need to also be prescribed for a short time in order to flush out the reverse T3 and reset their system.  This usually only takes a few months.

Traditionally, thyroid medication has been taken first thing in the morning on an empty stomach.  No food or other supplements or medication should be taken for a minimum of 30 minutes to 1 hour.  However, there is now evidence that the best time to take these medications may be in the evening.

By the way, thyroid medication should be held the morning that the patient is having their thyroid labs drawn.  Otherwise, the T3 levels in the labwork could be affected.

After starting a patient on thyroid medication, I typically follow up with the patient in 2 months.  At that time I ask about symptom improvement and any possible side effects from the medication.

Once you have reached maximal symptom control and the lab results are in the optimal ranges, the labs should only be checked every 6 to 12 months.

Supplements -

As has been previously discussed, thyroid function can be adversely affected because of nutrient deficiencies.

Our food simply doesn't contain the same amount of nutrients that it had even 40 years ago.  Plus, the standard American diet is woefully short of many nutritional needs.

Therefore, it's important to eat organic as much as you can, but you may also need to include some vital supplements to get the nutrients to the levels that our body needs.

1.Selenium -

  • Selenium is essential for the conversion of T4 to T3.  A deficiency of it has been shown to increase your risk for thyroid disease.
  • Selenium has also been shown to reduce thyroid antibody levels in Hashimoto's thyroiditis.
  • Recommended dose is 200 - 400 mcg daily of selenomethionine for a few months.
  • Of note, eating 2 brazil nuts contains roughly 200mcg of selenium.
  • Fish and sunflower seeds are also good sources

2. Iodine -

  • Iodine is an essential micronutrient for normal thyroid function.
  • Iodine deficiency is common and can directly cause a suppression of thyroid hormone production.
  • Iodine supplementation by itself can actually suppress thyroid function if iron and selenium are deficient.  Therefore, it is important to add selenium if you take an iodine supplement.
  • Recommended dosages of iodine is to start at 200-300mcg per day and slowly titrate dose based off of symptoms - discontinue if you experience negative side effects and seek professional help
  • Read more about iodine here.

3. Iron -

  • Iron has been shown to be essential for normal thyroid function.
  • Not only is iron required to produce thyroid hormone, low iron levels are also associated with  low levels of free T3.
  • Also, if you are low in iron, your body will not utilize iodine even if you are supplementing it.
  • Iron levels are assessed by checking a serum iron, TIBC and ferritin level.  Ferritin should be 40-50, while iron and TIBC should be in the middle of the reference range.
  • Recommended dosage is 10ml daily of liquid iron, or 1-3 capsules daily.

4. Zinc -

  • Zinc is another nutrient that is essential for hormone function in the body, including the thyroid.
  • Zinc supplementation has been shown to improve thyroid function.
  • It helps with conversion of T4 to T3 and also helps with cellular sensitivity to thyroid hormone.
  • Recommended dosage is 30-60mg daily.

Diet -

So, what is the best diet for someone with hypothyroidism?

That is not an easy question and there is not a quick answer.  Every person is unique.  

In my opinion, you can't go wrong if you keep this simple rule - eat what God made and avoid what man made.

That means eating organic, whole foods.  You should avoid processed foods, sugar, and most grains.


Hypothyroid is an extremely common condition, affecting up to 40% of adults.

Thyroid medications include T4 only medication, natural dessicated thyroid, and T3 only medication.

Effectiveness of the thyroid medication depends on its absorption, the ability of the body to convert T4 to T3, and the sensitivity of the body's cells to the thyroid hormone.

Nutrient deficiencies are common and can affect the thyroid hormone's production and function.  

Supplementation with the appropriate nutrients may be necessary for proper thyroid function.

Eating an organic, whole food diet can also help maximize the thyroid function in the body.    

Now it's your turn...

Have you been diagnosed with hypothyroidism?

What medication were you prescribed?  Did it make you feel better?

What other things have you done that have helped?

Leave your comments below.

About the Author Dr. Jeff Whelchel

Dr. Whelchel is a family physician who specializes in functional medicine, especially hormone optimization. He has over 20 years experience in private practice managing patients with various medical issues. His passion is helping patients reach their full potential of wellness and quality of life. He grew up in the Texas Panhandle where he currently lives. He is married and has 3 awesome children.

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1 comment
Gionei Gomes da Silva says February 9, 2023

Dr. Jeff Whelchel, if time could be rolled back to the early years of my medical graduation and these pearls of yours were taught to me, then I would be a better performing physician throughout my professional career!

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