Compounding Medications for Hypothyroid & Adrenal Fatigue

The adrenal glands secrete hormones such as cortisol, estrogen, and testosterone that are essential to health and vitality and significantly affect total body function. After mid-life, the adrenal glands gradually become the major endogenous source of sex hormones in both men and women. Intense or prolonged physical or emotional stress commonly associated with modern lifestyles or chronic illness can lead to Adrenal Fatigue, which is an important contributing factor in health conditions ranging from allergies to obesity.

Anti-inflammatory and anti-oxidant adrenal hormones like cortisol help to minimize allergic and negative reactions, such as cancer and autoimmune disorders. These hormones closely affect the utilization of carbohydrates and fats, the conversion of fats and proteins into energy, and cardiovascular and gastrointestinal function. Proper adrenal support is essential to complete the hormonal pathway to optimal health, and includes proper nutrition, getting plenty of sleep, regular moderate exercise, stress management, slowing down to regain a proper perspective on life, and replacement of deficient hormones.

Symptoms of hypothyroidism (low levels of thyroid hormone) include fatigue, cold and heat intolerance, hypotension, fluid retention, dry skin and/or hair, constipation, headaches, low sexual desire, infertility, irregular menstrual periods, aching muscles and joints, depression, anxiety, slowed metabolism and decreased heart rate, memory impairment, enlarged tongue, deep voice, swollen neck, PMS, weight gain, hypoglycemia, and high cholesterol and triglycerides. Yet, more than half of all people with thyroid disease are unaware of their condition.

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 synthetic 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 is 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
Levothyroxine therapy and serum free thyroxine and free triiodothyronine concentrations.
Click here to access the PubMed abstract of this article.

N Engl J Med 1999 Feb 11;340(6):424-9
Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism.
Click here to access the PubMed abstract of this article.
Also, the FREE full text of this article is available online.

People with Mild Thyroid Failure (“subclinical hypothyroidism”) have symptoms of thyroid deficiency, although lab tests may indicate their thyroid function is “normal”. In 2003, the normal range for Thyroid Stimulating Hormone (TSH) was adjusted from 0.5-5.0 to 0.3-3.0 as the American Academy of Clinical Endocrinologists acknowledged that symptoms of hypothyroidism frequently occurred in patients with “normal” lab values. Many patients with thyroid dysfunction have tried synthetic thyroid hormones, such as levothyroxine and liothyronine, and have found that natural thyroid is the only form that works adequately for them. Compounded Natural Thyroid is an option when commercial products are unavailable.
The Division of Endocrinology and Metabolism, Beth Israel Medical Centre, University Hospital and Manhattan Campus for the Albert Einstein College of Medicine, reported the successful management of thyrotoxicosis in a seriously ill 47-year-old man with a perforated gastric ulcer in whom oral intake was contraindicated. Specially prepared suppositories containing 400 mg of propylthiouracil (PTU) were administered rectally every 6 hours. PTU was substantially absorbed from the rectal suppositories, with serum levels of PTU maintained within the high therapeutic range for 5 days until the patient was able to tolerate orally administered therapy. The patient improved clinically during this treatment. They concluded that this case strongly supports the rectal administration of PTU in suppository form as an appropriate alternative route in any patient with thyrotoxicosis, including the critically ill patient, when oral administration is not possible.

Endocr Pract. 2006 Jan-Feb;12(1):43-7.
Rectal administration of propylthiouracil in suppository form in patients with thyrotoxicosis and critical illness: case report and review of literature.
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(CFS, Chronic Fatigue and Immuno-Deficiency Syndrome, CFIDS) andFibromyalgia (FM, formerly called fibrositis) may manifest as hypothalamic, pituitary, and immune dysfunction.

A study in the Annals of Allergy, Asthma and Immunology [2000 Jun;84(6):639-40] demonstrated that supplementation with NADH for one month resulted in significant improvement, and other studies have shown some minimal improvement with magnesium.

Ann Allergy Asthma Immunol. 1999 Feb;82(2):185-91
Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome.
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The combination of pituitary dysfunction, high reverse T3, and thyroid resistance, leads to inadequate thyroid effect in most, if not all, CFIDS/FM patients. T4 (levothyroxine) preparations are often ineffective for CFIDS/FM patients. A T4/T3 combination preparation or straight T3 (triiodothyronine) may be preferable. T3 works the best for many of these patients, but Cytomel, a very short acting T3 available at retail pharmacies, is also a poor choice because the varying blood levels cause problems such as heart palpitations. Compounded, sustained-release T3 may be the best treatment. However, standard blood tests may lead one to dose incorrectly and not obtain significant benefits. Ultimately, it is the expertise and dosing of the T3 or T4/T3 combinations and the makeup of the medications that determines the success of treatment.

Natural Therapies for CFIDS/FM: Proper nutritional supplements, proteins, and hormones can protect and enhance the immune system. Antioxidants may also be beneficial because free radicals play a role in causing damage to the immune system.

Vitamin B-12 levels are often low in patients with CFIDS/FM. A malfunctioning thyroid or adrenal gland can decrease the ability of the body to absorb and utilize vitamin B-12. Vitamin B-12 is necessary for a healthy nervous system; it has been known for many years that depression and fatigue can be caused by low B-12 levels.

D-ribose significantly reduced clinical symptoms in patients suffering from fibromyalgia and chronic fatigue syndrome, with an average increase in energy on the VAS of 45% and an average improvement in overall well-being of 30%.

J Altern Complement Med. 2006 Nov;12(9):857-62
The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study. 
Click here to access the PubMed abstract of this article.