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By Raphael Kellman, M.D., Kellman Center for Functional and Integrative Medicine NYC

A large portion of the patients I meet have some form of thyroid condition, usually low thyroid requiring medication. In most cases, patients who arrive at my office already taking a prescription will be on Synthroid or another T4 only medication.  Unfortunately many of these people don’t get better and still suffer with issues despite being on thyroid hormone replacement.  After extensive testing, I frequently find there is a need for T3 supplementation as well as T4. Patients are amazed to see how quickly they improve and want to know why their previous doctors didn’t use T3 as well.   

A very quick thyroid hormone lesson will help to understand the issues a bit better.   The thyroid secretes 2 hormones that regulate the metabolism and energy levels of the body.  T4 is the vast majority of what gets released into circulation however T3 (only about 7% of what is made) is the most biologically active form of the hormone and the one that has the real impact on function.  T4 must be converted to T3 to have any real effect.  Conventional medical wisdom tells us, T4 is the best choice as a prescription because it is the one the body itself creates in largest quantity.  Additionally, the body creates T3 from T4 so T4 is all that is required and the body will do the rest.

This model ignores the fact however that there are many very common conditions that actually block T4 from converting to T3 rendering T4 medications fairly ineffective.  So the question then becomes who is at risk for being a poor T4 to T3 converter?  The answer may surprise you.  Anyone suffering from inflammation, prolonged stress or adrenal issues, poor diet, digestive and gastrointestinal conditions, nutrient deficiencies, liver conditions and certain medications or  excessive alcohol use can interfere as well.  That is a large portion of people on thyroid medications, which explains why many people if not most do well with a combination of T4 and T3.

Additionally the type of medication used is equally as important.  I believe compounded, tailor made medications are the best, most accurate way to treat.  In this way, dosage of hormones can be precisely proportioned and formulated to your exact body condition and levels.  The result is much different than using a standard T4 pill off the shelf.  Another benefit is that they are pure.  There are no additives, coloring or fillers that people are commonly allergic to like gluten.

The bottom line is everyone is unique and has specific needs.  Finding the balance that works best for your own body can make all the difference.  Deep and accurate testing combined with a personalized medical approach, increases the chances that you will be on the road to recovery.