How hypothyroid symptoms can be treated via a private GP and specialised compounding pharmacy

Rizvan Batha, Superintendent Pharmacist at Specialist Pharmacy discusses the signs and symptoms of thyroid problems 

Thyroid hormones – thyroxine (T4) and triiodothyronine (T3) – are produced by the thyroid gland and have diverse actions, acting on nearly every cell in the body to regulate metabolism, maintain brain function and maintain heart and digestive function.

The thyroid is a small butterfly-shaped gland in the neck, just in front of the windpipe (trachea). It produces hormones that affect things such as your heart rate and body temperature.

Common signs of an underactive thyroid (hypothyroidism) are tiredness, weight gain and feeling depressed. This can be successfully treated by taking daily medication to replace the hormones your thyroid is not making. By contrast, an overactive thyroid, also known as hyperthyroidism or thyrotoxicosis, is when the thyroid gland produces too many thyroid hormones which can cause unpleasant and potentially serious problems that may need treatment.

There are many symptoms that can indicate a thyroid problem but the main one is usually feeling fatigued.

Symptoms

Signs and symptoms of thyroid problems include:

• Susceptibility to colds and infections
• Lethargy or fatigue that does not improve with rest
• Enlarged thyroid gland (goitre)
• Difficulty losing weight
• Depression
• Dry skin, hair & nails
• Hair loss
• Thinning or loss of eyebrows, especially the outer third
• Muscle weakness and joint pain
• Menstrual problems
• Infertility
• Sluggish memory and poor concentration
• Lowered stress resistance
• Recurrent infections
• Deep, hoarse voice

Testing

When testing for thyroid dysfunction most GPs check thyroid-stimulating hormone TSH and T4. It is very common for many patients who have symptoms of thyroid dysfunction to have normal or borderline results in their thyroid function blood tests within the NHS, which can be very frustrating, it is therefore important for a private practitioner to take a patients symptoms into account too and offer a solution to the debilitating symptoms.

To gain a complete picture of thyroid function it is often important to measure not just TSH but also Total T4, Free T4 and Free T3 and often thyroid antibodies.

The first line of treatment for underactive thyroid problems is Thyroxine (T4), but sometimes T4 alone is not effective, especially if someone has problems converting T4 to the active form of T3. In this scenario giving more T4 may not be enough to resolve hypothyroidism.

T3 is an active circulating thyroid hormone made from T4. Supplementing thyroxine medication with a small amount of T3 can make all the difference to energy levels and a general feeling of wellbeing. T3 is generally more readily absorbed and has a more rapid and profound effect, therefore, it needs to be monitored more closely.

Treatment

By supplementing with thyroid supportive nutrients or prescribing appropriate doses of thyroid hormones, it is possible to improve a patient’s symptoms and quality of life. Treatment plans should be tailored to an individual’s needs and progress monitored closely.

Borderline (subclinical hypothyroidism) may respond well to appropriate dietary and lifestyle advice, as well as a personalised supplement regime whereas hypothyroidism will need to be treated with thyroid hormone too.

There are various types of thyroid medication available, depending on the patient’s individual needs.

Natural Desiccated Thyroid (NDT) capsules are an effective porcine derived, compounded thyroid medication, for treating hypothyroidism. NDT naturally contains both T4 and T3. This is an alternative medication to conventional levothyroxine (T4), which isn’t effective for all patients, especially if they are having difficulty converting T4 to T3. Although there have been no randomised controlled trials using NDT, it was the most commonly used thyroid replacement treatment before levothyroxine came to the market, and there is evidence that NDT is equivalent in efficacy to levothyroxine, with some studies suggesting that patients respond better to NDT for their hypothyroidism.

An alternative to NDT would be synthetic T4 and T3. These can be given in their licensed forms or for some patients who are not able to tolerate the licensed form either due to allergies and intolerances, or to improve compliance by having them as a single capsule, then there is the option to compound these to a dose personalised to the patient. These can be prescribed in varying doses in both standard and slow-release formulations either alone or as a combined capsule.

Anyone with a thyroid problem will experience symptoms that affect their aesthetics and should seek medical help to treat the underlying problem. Not only will symptoms affect skin, hair, nails and weight, but it will also affect energy levels, quality of life and ultimately how the body functions, so obtaining treatment privately and working with a compounding pharmacy is of paramount importance.

Staff Writer