13 Oct The Thyroid Gland

Available dosage forms:
T3 MR/Fast Release | Capsules | Up to 120 mcg |
T3/T4 MR | Capsules | 10 (up to 40) mcg / 25 (up to 250) mcg |
Thyroid Extract | Capsules | Up to 240 mg |
Dear valued customer
Where is it?
The Thyroid Gland is located at the front of the neck just below the larynx and just above the windpipe. It is shaped like a butterfly and is generally not palpable unless it has become enlarged.
What does it do?
The Thyroid Gland is an endocrine gland because it secretes hormones called T1, T2, T3 and T4, the numbers relate to the number of iodine molecules attached to the hormone. The most commonly talked about hormones are Thyroxine (tetraiodothyronine) T4 and triiodothyronine T3. These hormones are responsible for regulating metabolic functions which influence almost every cell and tissue in the body. The secretion of these thyroid hormones is controlled by a feedback system between the brain and the thyroid gland.
Insufficient production of the thyroid hormones causes the metabolic functions within the cells to slow down and energy levels drop, this is known as hypothyroidism. Overproduction of the thyroid hormones has the opposite effect where the metabolic rate speeds up and is known as hyperthyroidism.
Hypothyroidism
Hypothyroidism is the most commonly found problem with the thyroid. There are many factors attributing to the underproduction of thyroid hormones.
- Stress
- Iodine deficiency
- Heavy metals
- Hormone imbalance
- Pollution, and other environmental factors
There are many symptoms of hypothyroidism:
- Tiredness, fatigue
- Weight gain
- Slow heart rate (bradycardia)
- Goitre (enlarged thyroid)
- Depression
- Decreased appetite
- Increased sensitivity to cold
- Poor concentration and memory
- Poor libido
- Dry skin and hair
symptoms of hypothyroidism continued:
- Hair loss
- Muscle weakness
- Constipation
- Aches and pains in the muscles and bones
- Fluid retention
Causes of Hypothyroidism
Aside from Hashimoto’s Thyroiditis, Iodine deficiency is one of the biggest causes of hypothyroidism. Iodine is required to synthesize thyroid hormones. According the WHO (World Health Organisation), almost 50 million people in the world suffer from some degree of iodine deficiency. Generally people who do not eat fish, seaweed or use iodised salt are at most risk of developing iodine deficiency.
Hypothyroidism can also be caused by treatments for Hyperthyroidism such as the removal of the gland itself of via treatment with radioactive iodine which then destroys the gland.
The thyroid gland can also become underactive due to failure of the pituitary gland to produce Thyroid Stimulating Hormone (TSH) and is not a common condition. There are also cases where the thyroid gland cannot manufacture enough T3 and T4 due to environmental factors mentioned earlier.
Treatment for Hypothyroidism
Your doctor will probably do a thyroid function test to assess the levels of TSH, free T3 and free T4 in the body. They may then prescribe either vitamin supplementation and/or T3, T4, Thyroid Extract or a combined T3/T4 capsule. All of which can be made by us here at the Green Dispensary Compounding Pharmacy.
What are they?
The medications used to treat Thyroid issues such as Hypothyroidism are T3 (liothyronine), T4 (Thyroxine), combined T3/T4 and Thyroid Extract. T3 and T4 are synthesised in a lab from the amino acid tyrosine which is the same protein which our own thyroid gland uses to make hormones. Thyroid Extract is a powder made from the thyroid glands of specially bred pigs and is the closest to what our thyroid naturally produces.
How do they work?
T3 and T4 are responsible for regulating metabolic functions and influence almost every cell and tissue in the body. The secretion of these thyroid hormones is controlled by a negative feedback system between the brain and the thyroid gland.
Insufficient production of the thyroid hormones causes the metabolic functions within the cells to slow down and energy levels drop, this is known as hypothyroidism.
Hypothyroidism
Hypothyroidism is the most commonly found problem with the thyroid. There are many factors attributing to the underproduction of thyroid hormones.
- Stress
- Heavy metals
- Hormone imbalance
- Autoimmune disorders
- Pollution, and other environmental factors
Aside from Hashimoto’s Thyroiditis, Iodine deficiency is one of the biggest causes of hypothyroidism. Iodine is required to synthesize thyroid hormones. According the WHO (World Health Organisation), almost 50 million people in the world suffer from some degree of iodine deficiency. Generally people who do not eat fish, seaweed or use iodised salt are at most risk of developing iodine deficiency.
When thyroid hormone levels are low body’s processes start slowing down. People notice feeling cold more than usual, becoming forgetful, tire easily, drier skin and constipation. Symptoms are so variable and non-specific the only way to know for sure is to see a doctor.
Treatment for Hypothyroidism
Your doctor will probably do a thyroid function test to assess the levels of TSH, free T3 and free T4 in the body. They may then prescribe either vitamin supplementation and/or T3, T4, Thyroid Extract or a combined T3/T4 capsule. All of which can be made by us here at the Green Dispensary Compounding Pharmacy. We can make different strengths of each medication.
The T3 is usually done as a Modified Release capsule. These capsules contain hypromellose as the modified release agent and microcrystalline cellulose as the filler. This formulation allows the hormone to release slowly into your body, approximately over 12 hours. This results in better tolerability and steady T3 blood concentration.
How to take the medication
Thyroid medication should be taken on empty stomach with water as calcium, iron and food will impair absorption.
Interactions
Please inform your doctor of your medication history and all medications you are currently taking
Adverse Effects
Please inform your doctor if you experience any of the following:
- headache
- cardiac arrhythmia
- anginal pain
- excessive loss of weight
- muscle weakness
- cramps in skeletal muscle
- diarrhoea
- restlessness
- flushing
- sweating
Periodic assessment of thyroid status should be conducted by means of appropriate laboratory tests and clinical observation.
References
Cabot, S & Jasinksa, M. (2006). Your Thyroid Problems Solved, Camden, NSW: WHAS Pty Ltd
Further Reading
General Information
Desiccated thyroid is a naturally occurring thyroid hormone derived from porcine thyroid glands. Thyroid hormone is used to treat hypothyroidism that results from primary atrophy of the gland, functional thyroid deficiency, or decreased thyroid function secondary to surgery, radiation, or antithyroid agents. The preparation is also used to treat pituitary hypothyroidism, hypothalamic hypothyroidism, and cretinism. Because of considerable variations in levothyroxine (T4) and liothyronine (T3) content, porcine thyroid hormone has been largely replaced in clinical medicine by synthetic levothyroxine, which has a more reliable hormonal content. Various thyroid extracts have received FDA approval since 1939.
Mechanism of Action
Desiccated thyroid contains both levothyroxine and liothyronine; these two hormones possess all the actions of endogenous thyroid hormones. Liothyronine (T3) is the principal hormone that exhibits these actions whereas levothyroxine (T4) is the major hormone secreted by the thyroid gland and is metabolically deiodinated to T3 in peripheral tissues. Serum concentrations of T4 and TSH are typically used as the primary monitoring parameters for determining thyroid function.
Pharmacokinetics
Desiccated thyroid is administered orally. The distribution of thyroid hormone into the body tissues has not been fully established, but it is believed that desiccated thyroid hormone distributes predominantly into the liver and kidney tissues. It does not appear to cross the placenta, and only minimal amounts are distributed into breast milk.
Route-Specific Pharmacokinetics
Oral Route: Desiccated thyroid is absorbed erratically and incompletely when administered orally, particularly in the presence of food. The average bioavailability of an oral dose is about 50—75%. Absorption of T4 can be reduced in patients with malabsorption syndrome, congestive heart failure, or diarrhea. Soybean infant formulas and anionic exchange resins (e.g., cholestyramine) can also decrease absorption of T4. Liothyronine (T3) is almost completely absorbed with 95% being absorbed within 4 hours. The full therapeutic effects of thyroid hormone may not be evident for 1—3 weeks following oral administration and persist for the same amount of time following cessation of therapy.
Indications
Thyroid Capsules are indicated in the treatment of hypothyroidism, especially in improving the symptoms of thyroid deficiency such as lack of energy, weight gain, hair loss, dry skin, feeling cold, and goiter.
Contraindications and Precautions
Your health care provider needs to know if you have any of these conditions: angina; diabetes; dieting or on a weight loss program; fertility problems; heart disease; high levels of thyroid hormone; pituitary gland problem; previous heart attack; an unusual or allergic reaction to thyroid hormones, other medicines, foods, dyes, or preservatives. You will need regular monitoring and blood tests. It may be several weeks before you notice an improvement: do not stop using this medication unless directed otherwise by your healthcare provider. This medicine can affect blood sugar levels. This medicine may have a strong odor: this does not mean that the drug is spoiled. You may lose some of your hair when you first start treatment: with time, this usually corrects itself.
Pregnancy
Thyroid hormones are considered FDA pregnancy risk category A drugs. Desiccated thyroid hormones undergo minimal placental transfer and human experience does not indicate adverse fetal effects; do not discontinue needed replacement during pregnancy.2Also, hypothyroidism diagnosed during pregnancy should be promptly treated. Measure TSH during each trimester to gauge adequacy of thyroid replacement dosage since during pregnancy thyroid requirements may increase. Immediately after obstetric delivery, dosage should return to the pre-pregnancy dose, monitor a serum TSH or other thyroid function tests 6—8 weeks postpartum to assess for needed adjustments.
Breast-feeding
Thyroid hormones, like desiccated thyroid, are generally compatible with breast-feeding; minimal amounts of thyroid hormones are excreted in breast milk.3 Thyroid hormones do not have a known tumorigenic potential and are not associated with serious adverse reactions in nursing infants. However, use caution when administering desiccated thyroid to a nursing woman 2; changes in thyroid status in the post-partum period may require careful monitoring and maternal dosage adjustment. It should be noted that in general, adequate thyroid status is needed to maintain normal lactation, and there is no reason maternal replacement should be halted due to lactation alone. Levothyroxine is often the preferential drug to treat hypothyroidism and is considered compatible with breast feeding.3
Interactions
Possible interactions include amiodarone; antacids; anti-thyroid medicines; calcium supplements; carbamazepine; cholestyramine; colestipol; digoxin; female hormones, including contraceptive or birth control pills; iron supplements; ketamine; liquid nutrition products; medicines for colds and breathing difficulties; medicines for diabetes; medicines for mental depression; barbiturates; phenytoin; corticosteroids; rifabutin; rifampin; soy isoflavones; sucralfate; theophylline; warfarin. This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Some items may interact with your medicine.
Adverse Reactions/Side Effects
Changes in appetite; changes in menstrual periods; diarrhea; hair loss; headache; nausea, vomiting; tiredness; trouble sleeping; weight loss. Call your health care provider immediately if you are experiencing any signs of an allergic reaction: skin rash, itching or hives, swelling of the face, lips, or tongue; breathing problems; chest pain; excessive sweating or intolerance to heat; fast or irregular heartbeat; nervousness; swelling of ankles, feet, or legs; tremors.
How is this medication best taken?
Take this medicine by mouth with water. It is best to take it on an empty stomach, at least 30 minutes before or 2 hours after food. Take this medicine at the same time each day. Follow the directions on the prescription label. Talk to your pediatrician regarding the use of this medicine in children. While this drug may be prescribed for children, precautions do apply.
What do I do if I miss a dose?
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose. Take your next regularly scheduled dose. Do not take two doses at the same time.
Storage
Store this medication at 15°C to 30°C and away from heat, moisture and light. Medication containing T3 and/or T4 needs to be stored in the fridge at 2°C to 8°C . Keep all medicine out of the reach of children. Throw away any unused medicine after the expiration date. Do not flush unused medications or pour down a sink or drain.
General Statements
Do not share or take any one else’s medicine. Talk with your healthcare provider before starting any new medicine, including over-the-counter, natural products, or vitamins. This medication was compounded specifically for you. This patient information summarizes the most important information about your medication; if you would like more information, talk with your doctor.
References
1. The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012;60:616-31.
2. Armour Thyroid package insert. St. Louis, MO: Forest Pharmaceuticals Inc.; 2012 Aug.
3. American Academy of Pediatrics (AAP) Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics 2001;108:776-89.
4. Armour Thyroid® package insert. St. Louis, MO: Forest Pharmaceuticals Inc.; 2002 November.
5. Levothroid (levothyroxine sodium tablet) package insert. Shenandoah, IA: Lloyd Pharmaceutical; 2011 June.
6. Benvenga S, Bartolone L, Pappalardo MA, et al. Altered intestinal absorption of L-thyroxine caused by coffee. Thyroid 2008;18:293-301.
7. Divi RL, Chang HC, Doerge Dr. Anti-thyroid isoflavones from soybean; isolation, characterization, and mechanisms of action. Biochem Pharmacol Gericke KR. Possible interaction between warfarin and fluconazole. Pharmacotherapy 1993;13:508—9.7;54:1087—96.
8. Questran® and Questran® Light (cholestyramine) package insert. Spring Valley, NY: Par Pharmaceutical Inc; 2002 July.
9. Colestid® and Flavored Colestid® (colestipol) package insert. Kalamazoo, MI: Pharmacia & Upjohn Company; 2002 July.
10. Sperber AD, Liel Y. Evidence for interference with the intestinal absorption of levothyroxine sodium by aluminum hydroxide. Arch Int Med Gericke KR. Possible interaction between warfarin and fluconazole. Pharmacotherapy 1993;13:508—9.2;152:183.