Should I take thyroid hormone?

Our read is that thyroid hormone supplementation is often beneficial for individuals with hypothyroidism, addressing symptoms like low energy, reduced metabolism, and cognitive dysfunction.

Our read is that while synthetic T4 is a standard treatment, desiccated thyroid or T4/T3 combination therapies are often preferred due to the active nature of free T3 and can be more effective for some patients.

Our read is that careful dosing and monitoring, including reverse T3 levels, are crucial, as excessive T3 can lead to hypermetabolic states, and TSH alone is an insufficient marker for thyroid health.

Our read is that a doctor may prescribe a high initial dose of T3 therapy for dispensing purposes, allowing adjustment to a lower effective dose, as noted by Paul Saladino. For patients who cannot tolerate immediate-release T3 above 5 mcg, Peter Attia suggests that 15 mcg of a controlled-release T3 formulation may be tolerable. Paul Saladino also suggests that lowering T4, increasing T3 in the morning, and administering T3 later can be an alternative to T3-only therapy for Reverse T3 issues. Bryan Johnson indicates that Armour Thyroid can help manage T3 and free T4 levels when Levothyroxine alone is insufficient for TSH.

• 01Peter Attia claims that some patients who cannot tolerate immediate-release T3 above 5 mcg can tolerate 15 mcg of a controlled-release T3 formulation.
• 02Peter Attia claims that patients with hypothyroidism who had their thyroids removed and were not receiving replacement therapy experienced a fundamental change in cognitive function.
• 03Peter Attia claims that high sex hormone-binding globulin (SHBG) can be caused by insulin, thyroid hormone, estrogen, or genetics.
• 04Andrew Huberman claims that twenty percent of individuals with major depression have low thyroid hormone levels, which can cause low energy and reduced metabolism.
• 05Paul Saladino claims that a doctor may prescribe a high initial dose of T3 therapy for dispensing purposes, allowing adjustment to a lower effective dose.
• 06Paul Saladino claims that a T4/T3 combination therapy can be effective for hypothyroidism and bypass issues with NDT purity or religious objections.
• 07Peter Attia claims that propensity score matching showed no significant differences in sickness between patients treated with levothyroxine alone versus combination T4/T3 therapy.
• 08Paul Saladino claims that lowering T4, increasing T3 in the morning, and administering T3 later can be an alternative to T3-only therapy for Reverse T3 issues.
• 09Peter Attia claims that desiccated thyroid extract compounds may be a viable alternative for patients not responding to levothyroxine.
• 10Peter Attia and Paul Saladino claim that desiccated thyroid, containing T4 and T3, is often preferred over synthetic T4 because free T3 is the most active thyroid hormone.
• 11Peter Attia claims that a small dose of T3 can overcome deficits caused by a reverse T3 spike in subjects with 10-20% weight reduction.
• 12Paul Saladino claims that hypothyroidism can cause insulin resistance and may require thyroid hormone supplementation.
• 13Bryan Johnson claims that Armour Thyroid can help manage T3 and free T4 levels when Levothyroxine alone is insufficient for TSH.
• 14Peter Attia claims that T4 has a long half-life, so missing a dose is not critical and patients should not double up the next day.

Our read is that Peter Attia advises that during pregnancy, women should generally avoid all medications and supplements except for essential ones like prenatal vitamins or thyroid hormone, and withholding thyroid hormone from a hypothyroid woman during pregnancy would pose significant risks to both her and the child. Peter Attia also notes that adding immediate-release T3 alone for patients not responding to T4 often does not go well due to excessively large dose increases, and compounding pharmacies are not recommended for T3 preparation due to potential variability. Peter Attia suggests that the emphasis on branded levothyroxine may stem from marketing pressure by manufacturers, influencing guidelines without sufficient evidence. Paul Saladino warns that taking excessive T3 can lead to exhaustion and a hypermetabolic state, and that treating hypothyroidism solely with T4-only medication can fail some patients. Paul Saladino also states that taking thyroid hormones before a blood test can lead to false results, and that TSH alone is a poor marker for thyroid health. Paul Saladino emphasizes that doctors who do not test reverse T3 may miss T4 conversion issues, and that continuing with an outdated diet and lifestyle paradigm, even while taking thyroid hormone, can lead to problems. Peter Attia recounts a patient who felt worse on levothyroxine at 50-75 micrograms, which lowered TSH but caused symptoms, leading to discontinuation. Paul Saladino notes that conventional medical treatment for Hashimoto's thyroiditis, such as immune suppressants and Synthroid, does not address the root cause.

Our read is that the verdict could change if new evidence emerges demonstrating significant adverse effects of thyroid hormone supplementation not currently recognized, or if more robust studies indicate that alternative treatments are consistently superior without the associated risks. Additionally, if the effectiveness of controlled-release T3 formulations is definitively proven to be pharmacy-specific, as Peter Attia suggests is uncertain, this could alter recommendations regarding their use.