Dr. Amy Nett: Yeah, it varies a lot. That’s a great question. I would say if a patient comes to me and they’re already on a thyroid medication, then I try not to mess with it unless people are really unhappy with it. I would say, in general, I most often start with Nature-Throid or WP Thyroid. Nature-Throid and WP Thyroid, I believe those are both made by the same company, but WP Thyroid basically has, like, two active ingredients. WP Thyroid has the T4/T3 natural thyroid replacement hormones, and then the only inactive ingredients are inulin from chicory root and then the medium-chain triglycerides from coconut. Nature-Throid also has the same T4/T3 natural thyroid replacement, but then it has, I think, maybe five ingredients, something like that. It’s still hypoallergenic, but if patients are really, really sensitive to things, then I would go with WP Thyroid.
In general, I start with Nature-Throid probably just because I’m most familiar with it and just use it most frequently, so that’s my go-to. But if someone comes to me on something else, whether it’s Synthroid and Cytomel or compounded T4/T3, then I’ll stick with that. If someone feels like they’re not doing well on whatever thyroid medication they’re on, whether you started them on it or someone else did, I think it is worth experimenting with some other thyroid medications.
The other thyroid medication option that you didn’t mention here … I want to say it’s Tirosint, I think, and it’s the probably most well tolerated. Yeah, Tirosint. This is a levothyroxine, but I’ve had a few patients who have come to me on this Tirosint and this is another one that I have started using, again, in patients who are just incredibly sensitive to medications, fillers, supplements. Tirosint is another one that is sort of a go-to option or when you need to think about switching to a different option. Tirosint is tolerated really well.
So when people aren’t tolerating one well, try another one. For whatever reason, I have some people who do great on Nature-Throid but terrible on levothyroxine, and vice versa. I don’t think you can predict, necessarily, a good one to start with, so I would say whatever you’re most comfortable with, start there, and then make adjustments as needed if people don’t seem to tolerate it well for whatever reason. Compounded, though, to be honest, that one’s my least favorite because figuring out the ratios, the T4-to-T3 ratio, for whatever reason, I see a lot of variation when people come to me on compounded T4/T3. I’m not always sure who those are calculated and decided upon.