When you are sick, getting medication should be a relatively simple process. If a drug is over the counter, just go pick one off the aisles. If a drug needs a prescription, showing the pharmacist your doctor’s note should be all you need to do. But many times we are bombarded with too many choices and every pharmacy seems to have their own generic version of brand names.
So when you have a chronic condition like hypothyroidism, you wonder, what sort of treatment do you need? Brand name drugs? Generics? Natural remedies?
Let’s break it down so you can make the most informed decision about your health.
Chris Kresser, a recognized leader in health and expert in alternative medicine explains basic thyroid physiology in an easy to understand way:
“Regulation of thyroid metabolism can be broken down into the following five steps:
- The hypothalamus (a pea-sized gland in the brain) monitors the levels of thyroid hormone in the body and produces thyrotropin releasing hormone (TRH).
- TRH acts on the anterior pituitary (directly below the hypothalamus, but outside of the blood-brain barrier) to produce thyrotropin, a.k.a. thyroid stimulating hormone (TSH).
- TSH acts on the thyroid gland, which produces thyroxine (T4) and triiodothyronine (T3), the primary circulating thyroid hormones. The thyroid produces T4 in significantly greater quantities (in a ratio of 17:1) than T3, which is approximately 5x more biologically active than T4.
- T4 is converted into the more active T3 by the deiodinase system (D1, D2, D3) in multiple tissues and organs, but especially in the liver, gut, skeletal muscle, brain and the thyroid gland itself. D3 converts T3 into an inactive form of thyroid hormone in the liver.
- Transport proteins produced by the liver – thyroid binding globulin (TBG), transthretin and albumin – carry T4 and T3 to the tissues, where they are cleaved from their protein-carriers to become free T4 and free T3 and bind to thyroid hormone receptors (THRs) and exert their metabolic effect.”
What is hypothyroidism?
Hypothyroidism is a condition where the body doesn’t produce enough thyroid hormones and is also referred to as an underactive thyroid. Hypothyroidism can be caused by a number of factors: an autoimmune disease, high levels of estrogen, your inability to convert T4 to T3, and more. It is a condition that you will likely have to manage for life.
Hypothyroidism is treated with drugs that work by replacing the hormones that are missing. The main ingredient in hypothyroidism medication is levothyroxine sodium, which is identical to the natural thyroid hormone produced by the body. However there are many different kinds of medication that may work better for your particular hypothyroidism.
A doctor may recommend a brand because...
- The brand has been around for longer and is the standard. Some hypothyroidism drugs have been around for over 40 years and have gone through strict FDA requirements.
- They have determined your body may respond better to the filler ingredients in the brand.
- They are mostly formulated with T4 in mind, which may work better for your case of hypothyroidism
A doctor may recommend a generic because...
- Your body may have a problem converting T4 to T3
- Generics essentially have the same ingredients and are subjected to the same FDA requirements but may cost less
- Your body may respond negatively to the filler ingredients in the brand – like if you cannot digest gluten or cornstarch.
- Debates still exist over whether generics are as effective as brands in treating hypothyroidism
Importance of sticking to one drug
Your doctor may have originally prescribed you to a brand name and your health may have gotten significantly better since then. But recently, you may have noticed your pharmacy giving you a generic version and shrug it off. This may be dangerous to your health. Medication changes from brand to generic could cause dosage problems, which could cause serious health problems. If you’re not sure if your medication has changed, it’s important to consult your doctor. It’s also important to consult your doctor to closely monitor your dosing as well as your thyroid stimulating hormone levels.
The FDA’s Q&A about Hypothyroidism Medications states:
“Patients should talk with their doctors about which drug is right for them. Approved generic thyroid medications are as effective as brand name medications. There have been concerns raised from physicians and patients about varying product performance of levothyroxine sodium, particularly after refills that may involve different products from different manufacturers. But we've found that this may not be related to generic versus brand. Recently, manufacturers (brand and generic) have provided FDA with data revealing that some products lose their potency over time. This loss in potency may account for some of the variable effects with certain products, whether brand or generic.”
Any sort of change requires additional testing of thyroid hormone levels. If a brand or generic has been working for you, it’s important to stick with that regimen, since potency often varies from one drug to the next.
Trial and error
In order to manage your hypothyroidism, a discussion with your doctor about your body and what medication might work for you is necessary. Everybody will react uniquely to different medications, but when you find the one, you will know, and it’s important you stick with it.