Tending the Furnace: Compounded Hypothyroidism Medications
Living with untreated hypothyroidism is like functioning with low batteries — all of the time. You’re never really operating at full capacity, and always struggling to exert even the minimal amounts of energy it takes to keep yourself going.
Many standard treatments for thyroid issues are only so-so, and many patients manifest with a variety of interrelated problems. Compounded hypothyroidism medications and related preparations for adrenal dysfunction and thyroid disease is a fruitful area for pharmaceutical professionals because there are a large number of patients in need and many excellent solutions that are available via compounding.
Common Adrenal Dysfunctions and Thyroid Diseases
Adrenal dysfunction can cause serious complications including depression, diabetes, hypertension, and chronic fatigue. Addison’s disease and Cushing’s syndrome are both adrenal gland disorders which have the potential to be fatal if left untreated.
Addison’s disease is debilitating and difficult to detect early. It causes the adrenal cortex to progressively lose function over time. This results in deficiencies in mineralocorticoids and glucocorticoids, as well as reduced levels of androgens and DHEA. Typical symptoms include a bluish discoloration of the mouth’s mucous membrane, dehydration, fatigue, heavy skin pigmentation, low blood pressure upon standing, shock, and weakness.
Cushing’s syndrome causes high levels of cortisol in the blood and resulting characteristic changes in the body and disposition such as a rounded “moon” face, anxiety, depression, elevated blood sugar levels (hyperglycemia), hirsutism and menstrual disorders in women, muscle weakness, reduced fertility and libido in men, slender arms and legs, stretch marks, stunted growth in children, susceptibility to infection, a tendency to bruise easily, thin skin, weak bones (osteoporosis), and weight gain in the trunk area.
Thyroid cancer aside, the two most common thyroid diseases are hyperthyroidism and hypothyroidism. Thyroid hormones regulate many bodily functions such as your heart rate and how fast you burn calories. An overactive thyroid makes too many thyroid hormones, resulting in hyperthyroidism. An underactive thyroid cannot make enough thyroid hormones to sustain proper metabolism, resulting in hypothyroidism. Both hyperthyroidism and hypothyroidism are more common in people with other thyroid problems, women, and people age 60 and over.
Hyperthyroidism, also called thyrotoxicosis, may be caused by various things including Grave’s disease (an autoimmune disorder), consuming too much iodine or synthetic thyroid hormone, thyroiditis, and thyroid nodules. Symptoms vary but often include fatigue, frequent bowel movements or diarrhea, goiter (an enlarged neck and thyroid), hand tremors, heat intolerance, insomnia, irregular and rapid heartbeat, irritability, mood swings, muscle weakness, nervousness, and weight loss.
Hypothyroidism is caused by many things, including an autoimmune condition called Hashimoto’s disease, congenital hypothyroidism, some medicines, surgical removal of part or all of the thyroid, thyroiditis, radiation treatment of the thyroid, and thyroid nodules. Symptoms vary but often include cold intolerance, constipation, depression, dry skin, dry, thinning hair, fatigue, fertility problems, irregular or heavy menstrual periods, joint and muscle pain, puffiness in the face, reduced sweating, slowed heart rate, and weight gain.
Compounding for Adrenal and Thyroid Disorders
Typical treatment for Addison’s disease includes replacement hormones using synthetics. Among the most common cortisol replacement therapies is hydrocortisone, a synthetic glucocorticoid. In more serious cases, hydrocortisone and saline may be required to be delivered intravenously to prevent complications that may be life-threatening. Finding the right dosage level with hydrocortisone can be challenging because there are diurnal variations in natural cortisol levels in the body. Compounded treatments can be used to match natural circadian rhythms as closely as possible. This is particularly important because regulation of ACTH levels is difficult following the delivery of hydrocortisone, and overly high levels of ACTH over time can lead to an enlarged pituitary gland or a pituitary tumor. Compounding can help minimize this risk of overtreatment.
Treatment for Cushing’s syndrome relies upon medications that suppress the pituitary gland from releasing ACTH and prevent steroid production — and the options in terms of what drugs are FDA approved for use in this way are limited. This means that compounding is essentially the only option for many patients. Ketoconazole, an antifungal medication, is effective in inhibiting the synthesis of steroids and secretion of ACTH from the pituitary gland. However, it also carries long term adrenal risks.
Treatment for hyperthyroidism is often with medications, and sometimes with radioiodine therapy or thyroid surgery. For the many patients who undergo surgery, they are basically left in the position of the hypothyroidism patient, needing to treat a nonfunctioning thyroid since theirs has been removed. No one-size-fits-all treatment works.
Treatment for hypothyroidism is typically with synthetic thyroid hormones. These must be taken every day to maintain therapeutic levels. Typical synthetic prescriptions are levothyroxine and liothyronine. However, these don’t always work for all patients, and some report that natural thyroids are the only treatments that work for them; many of the requested strengths of these natural hormones are available only via compounding.
In addition, many patients thrive on compounded hypothyroidism medications that contain blends of triiodothyronine (the active form of the hormone, T3) and thyroxine (the inactive form of the hormone, T4) in different ratios. The only form of T3 that is commercially available is a synthetic liothyronine sodium that is rapidly absorbed because it is immediately released. This means that it can result in higher than normal T3 concentrations throughout the body. Side effects from this treatment can include heart palpitations and other serious problems. Research has also shown that more patients prefer the combined T3 and T4 treatment and show signs of improved mood and fewer thyroid-related symptoms using this course of treatment.
Compounding also offers solutions for patients with mild thyroid failure or subclinical hypothyroidism. These patients have lab results that indicate a normal thyroid function but have classic hypothyroidism symptoms. This may well be because the American Academy of Clinical Endocrinologists adjusted the standard for “normal” thyroid function in 2003, making it lower. Compounded natural thyroid replacement are an alternative for these patients and may be their one chance for relief.
It is amazing to feel energetic once again. Compounded hypothyroidism medications and other preparations for adrenal dysfunction and thyroid disease are a way pharmaceutical professionals can give patients that gift. They are also the only way that many patients feel well again. Given these facts, compounding for adrenal dysfunction and thyroid disease remains a key focus area in the field.
If your pharmacy is in need of compounding ingredients, Pharmaceutica North America would like to be your resource for high-quality compounding products for all of your compounding needs. For information about compounding for adrenal dysfunction, thyroid disease, or other areas, please contact our very knowledgeable and friendly team.