From the Research
For patients experiencing bloating with levothyroxine (T4) therapy, switching to natural desiccated thyroid (NDT) products like Armour Thyroid or Nature-Throid may be a viable alternative, as some patients tolerate these better than T4 alone, with significant symptomatic benefit and improvement in quality of life, as seen in a study published in 2021 1. When considering alternative treatment options, several factors come into play, including the patient's specific symptoms, medical history, and tolerance to different formulations.
- Switching to a different levothyroxine brand or formulation can help, as inactive ingredients may cause digestive symptoms in sensitive individuals.
- Taking levothyroxine on an empty stomach at least 30-60 minutes before breakfast or 3-4 hours after the last meal of the day can minimize gastrointestinal side effects.
- Trying a gel cap formulation like Tirosint, which contains fewer inactive ingredients, may also be beneficial.
- Combination therapy with both T4 and T3 (liothyronine) medications is another option, with typical approaches including adding 5-25 mcg of liothyronine daily to a reduced levothyroxine dose, as recommended in a study published in 2020 2. However, the most recent and highest quality study, published in 2021 1, suggests that NDT products may be a better option for some patients, with significant improvements in quality of life and symptomatic benefit. It's essential to monitor any medication change with thyroid function tests 6-8 weeks after adjustment to ensure proper dosing.
- A study published in 2023 3 also supports the potential benefit of NDT in patients who are symptomatically unresponsive to levothyroxine.
- Another study published in 2013 4 found that nearly half of the patients preferred DTE over L-T₄, with modest weight loss and improved subjective symptoms.
- A consensus document published in 2021 5 highlights the need for further evaluation of combination therapy with LT4 and LT3, with areas of agreement including the use of patient-reported outcomes as a primary outcome and patient preference as a secondary outcome.