Lethbridge Pharmacy -Martie Dick

Hypothyroidism and the Compounding Pharmacy

The thyroid system affects every bodily function by regulating energy and heat production, growth, and tissue repair and development; stimulating protein synthesis; modulating carbohydrates, protein, fat metabolism, and digestion; modulating muscle and nerve action; and helping regulate hormone excretion and oxygen utilization.

In healthy people, the thyroid makes just the right amounts of two hormones, T4 and T3. Hypothyroidism is an under production of thyroid hormones (the body produces too much TSH, and too little T3 and T4) and is quite common as we age. Other causes of hypothyroidism include Hashimoto’s disease, a condition in which your immune system attacks your thyroid, often leading to an underactive thyroid gland. Some patients can suffer from Wilson’s Syndrome, an impairment in the conversion of T4 to T3 which causes a maladaptively slow metabolism rate, resulting in a cluster of seemingly unrelated symptoms. This is often caused by significant physical, mental, or emotional stress (often persisting after the stress has passed), and characterized by routine thyroid blood tests in the normal range with a body temperature pattern that runs below normal.

Hypothyroidism may exhibit many (and multiple) symptoms that include:

  • Fatigue
  • Weakness
  • Depression
  • Constipation
  • Memory loss
  • Irritability
  • Hair loss
  • Coarse, dry hair
  • Dry, rough pale skin
  • Decreased libido
  • Extreme Intolerance to cold Temperatures
  • Muscle cramps and frequent muscle aches
  • Weight gain or increased difficulty losing weight
  • Abnormal menstrual cycles

Although both T4 (thyroxine, an inactive form that is converted to T3 in other areas of the body) and T3 (triiodothyronine, the active form) are secreted by the normal thyroid gland, many hypothyroid patients are treated only with levothyroxine (synthetic T4). Some hypothyroid patients remain symptomatic, and T3 may also be required for optimal thyroid replacement therapy. However, the only commercially available form of T3 is liothyronine sodium in an immediate release formulation which is rapidly absorbed, and may result in higher than normal T3 concentrations throughout the body causing serious side effects, including heart palpitations.

Research indicates there often times can be  a need for sustained-release T3 preparations in order to avoid adverse effects. A randomized, double-blind, crossover study found inclusion of T3 in thyroid hormone replacement improved cognitive performance, mood, physical status, and neuropsychological function in hypothyroid patients. Two-thirds of patients preferred T4 plus T3, and tended to be less depressed than after treatment with T4 alone. Patients and their physicians may wish to consider the use of sustained-release T3 in the treatment of hypothyroidism, particularly when the response to levothyroxine (T4) has not been complete. (J Endocrinol Invest 2002 Feb;25(2):106-9; N Engl J Med 1999 Feb 11;340(6):424-9).

Many patients have tried commercially available thyroid hormones, such as levothyroxine and liothyronine, and have found that a combination of T4 and T3 is the only form that works adequately for them, reporting that they simply do not feel as well when they take levothyroxine or liothyronine alone. Our pharmacy can blend T4 and T3 pure powders in a specific ratio by as prescribed by your doctor. Commercially available tablets contain fillers and excipients that may not be tolerated by all patients. When we compound customized dosages, we have the ability to omit any problem-causing inactive ingredients and substitute non-reactive fillers.

When the medications that are commercially available aren’t right for you, we can work with your doctor and prepare slow-release capsules of levothyroxine (T4) and liothyronine (T3) in any strength. Gail’s Apothecary & Compounding Pharmacy can assist in monitoring the effectiveness of your therapy and adjust your medication as directed by your doctor, to assure optimal results. Our highly trained compounding pharmacists and staff  are available to discuss individualized prescriptions, thyroid conversions, and all other considerations in therapy options.

#2, 425-13 Street N | (403) 329-4121, gailsapothecary.ca