Thyroid disease – Hypothyroidism (low thyroid) – Part 2 of 5

The following is excerpted from my upcoming book, Armageddon Medicine.

Thyroid disease – Hypothyroidism (Low thyroid)

In Part 1 of this series we discussed different types of hypothyroidism and how the diagnosis is made.  The current installment focuses on treatment considerations.   

Diagram showing common arrangement of thyroid ...

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Current treatment of hypothyroidism centers on adjusting the dosage of hormone replacement to maintain a serum TSH in the normal range.  This is finer-tuning than is probably necessary to keep a patient asymptomatic regarding hypo- or hyperthyroidism.  However, whereas subclinical hypothyroidism may not effect health long-term, subclinical hyperthyroidism may deplete calcium from the bones and is associated with a higher likelihood of atrial fibrillation (irregular heart rate).  Patients who claim they have no evidence of hyperthyroidism may simply be unaware of milder symptoms, such as the ability to eat a little more without gaining weight, or a bit higher energy level.  

The mainstay of thyroid replacement therapy is levothyroxine (Synthroid, Levothroid, T4), one of the same hormones the human body makes.  It is the form of treatment preferred by most physicians in the U.S.  The dose is very consistent (at least in brand-name medication), which allows close monitoring of blood levels.  Of course, many patients are on generic medication, which has a +/- 20% tolerance range (vesrsus +/- %5 for brand-name drugs).  For some patients, this does not matter.  Other patients require the exact dosing only available with name-brand medication, to maintain a normal TSH level.  Generic medication costs as little as $4/month, but even brand-name Synthroid is available for $25/month or less.

thyroxine (T 4 )

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All this is fine and dandy if medication and blood testing is available, and stockpiling thyroid medication is a good idea for those who really need it.  But if civilization collapses, TSH measurements are as unlikely to be available as would be synthetic medication to treat the condition. 

However, doctors my age and older have been in medicine long enough to remember thyroid treatment before the days of readily available thyroid stimulating hormone determination.  In those days, the levels of T3 and T4 thyroid levels were assayed in the blood.  Although this was useful, it did not allow close regulation of thyroid function, and many patients were placed on thyroid medication who probably did not need it. 

Before blood tests for thyroid hormone levels were available, diagnosis and treatment were based on monitoring symptoms, a situation which is likely to recur after the end of the world as we know it.  Once stockpiles of levothyroxine run out, and if the manufacturing process has not been re-established, animal sources must once again be used. 

Of course, animal thyroid replacement therapy continues to be available (Armour thyroid), compounded from desiccated porcine thyroid tissue, and is still prescribed by some physicians.  For most patients, 60-120 mg of Armour thyroid daily is an adequate dose.  Thyroid hormone is absorbed better on an empty stomach, and so should be taken before eating, not only to maximize therapy when supplies are limited, but to obtain the most consistent treatment result. 

Until I wrote this chapter I was unaware that nutraceutical-grade thyroid compounds are available without a prescription.  These are desiccated (freeze-dried) whole thyroid tissue from cows or pigs.  The onlne sources I found stated the cows were pasture fed, thus reducing the concern for contamination with Mad Cow disease from animals fed rendered cattle remains.  I have never seen OTC dessicated thyroid preparations in local pharmacies, but I do see them online.  I’m sure no one in the medical establishment would recommend these, but at TEOTWAWKI, they are a consideration.  For those who have no other way of stocking up on medication, I suppose this might be an option. 

Classic image of a cow with BSE. A feature of ...

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 Future installments of this topic will include:

  • Figuring out what type of thyroid disease you have
  • Stockpiling medication
  • Alternative and complementary medicine 
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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
This entry was posted in Armour thyroid, Blood tests, Expired meds, Hyperthyroidism, Hypothyroidism, levothyroxine, Medical archives, Medical testing, Stockpiling medical supplies, Synthroid, T3 and T4, Thyroid disease, Thyroid preparations, Thyroid tests, TSH and tagged , , , , , , , . Bookmark the permalink.

12 Responses to Thyroid disease – Hypothyroidism (low thyroid) – Part 2 of 5

  1. Robert says:

    What is the true shelf life of the drugs COUMADIN and LEVOTHYROXINE? and after the expiration date does the drugs COUMADIN and LEVOTHYROXINE become toxic or just decrease in strength? and if so what percentage of decrease per year. Thanks

    • Doc Cindy says:

      I don’t know that these drugs have been tested specifically, but the general answer is they are probably effective years (perhaps decades) beyond their expiration dates. The so-called expiration dates are based on the length of time the drug has been studied, either in real-time or accelerated degradation studies.

      I think it is more likely that absorption properties might change than that the drugs will degrade chemically into some other compound.

      My main concern with Coumadin would not be expiration, but rather monitoring of blood thinning.

      Likewise, with levothyroxine, we monitor blood levels, which would not be easy at TEOTWAWKI. I have written a self-study course on “Hypothyroidism” which you can purchase here:

  2. J.J. P says:

    Dr. Cindy-
    I have been taking 62.5 mg of Levothyroxine for about 2 yrs now. However, I cannot seem to get my weight down with normal diet/exercise methods. (I would like to lose about 15 pds.) A friend suggested taking a medication – Ionomin, which is a legal weight lose product. Does this sound like a good suggestion?? Thnx for your info. J.J.

    [Doc Cindy replies: Ionomin is a brand of phentermine, and available only by prescription. It has a mild amphetamine-like effect. In Ohio it can only be prescribed for 3 months, and only after a trial of diet and exercise, with inability to lose. It is generally safe for young, otherwise healthy individuals. Your doctor would likely monitor your thyroid closely if you were taking it. Some doctors will not prescribe this medication at all, though it is effective, at least short-term.]

  3. Camille says:

    While I understand that no herb replaces the thyroid itself can we not use herbs to support the heart, mind, etc., to slow down the effect of having no thyroid medicine available? My daughter is young, had her thyroid removed and we worry about things such as this. I am an trained herbalist, so I understand what you are saying but I also see that perhaps we can use herbs to support the affected areas from the missing thyroids? I’m just not sure where to start.

    [Anyone who’s had their thyroid completely removed will need thyroid replacement therapy, and I am unaware of any herb that will make a significant difference. However, I am going to write another post on use of animal thyroid tissue soon, having come across a few more options. – Doc Cindy]

  4. Jason says:

    Dr. Koelker,
    Thanks so much for starting this series. My wife has hypothyroidism and I’ve been very worried about the issue.

    I’ve read in several places that Synthroid was unstable and unlikely to be good much past the expiration date, so I was looking into Armour for stockpiling purposes. I suppose that both need a prescription. 🙁


    • Doc Cindy says:

      Please refer to for questions on expired medications.

      I expect either preparation might lose some potency over several years, but the dosage could be increased to compensate. In any event, in an Armageddon-scenario, dosage adjustment would need to be managed according to symptoms, as outlined in the series on hypothyroidism (Parts 1-5). Likewise, new sources of thyroid replacement therapy would need to be established by the time stockpiles have been depleted, as discussed.

      Reading the entire series should answer most questions on thyroid replacement therapy.

  5. Christine L. says:

    The doctor never mentioned Hashimoto’s disease which is a form of autoimmune disease whereby the immune system attacks the thyroid and [ultimately destroys it].

    1) I would like to know if the thyroid can ever regenerate itself.
    2) How do you know if your thyroid is TOTALLY DEAD?
    3) If all has collapsed, how could you even get the Armour Thyroid??


    • Doc Cindy says:

      Good questions, Christine. I have a few more articles to add on thyroid disease, just haven’t yet had the time, so stay-tuned. Also, I’m working on more articles about stockpiling medicine.

      But a few quick answers: I have seen thyroid function vary in Hashimoto’s patients, though probably not totally revert to normal. Can it ever regenerate itself? Maybe – interesting research going on regarding regenerating body parts using adult stem cells (not too likely to be helpful, though, if civilization collapses.)

      For now I suggest working with your doctor to determine if your thyroid is “totally dead.” It’s not that hard to determine, but does require close monitoring to determine, which any doctor treating hypothyroidism should be able to do. More on that in a later post.

      Neither Armour thyroid nor Synthroid would be available if all collapses. Stockpiling one would be as difficult as the other. Whether one preparation is more stable than another is unproven, but my vote would go to Synthroid, since it was more standardized and contains only one thyroid hormone (the Armour thyroid is a mixture). Animal supplies would, however, be easier to re-establish. More on that later, too.

      How long does Synthroid remain potent? Keep an eye open for my next article on expired medications. The short answer is, extrapolating from medications that have been tested for extended shelf-life, probably at least a few years beyond the printed expiration date. Certain meds have been stable for as much as 30 years. Also, the Shelf Life Extension Program data did not demonstrate dangerous degeneration of the compounds tested. If I had a low thyroid condition, I imagine I’d be willing to take Synthroid for a decade or two beyond the printed expiration date, though I don’t have scientific proof to support this.

  6. Greg says:

    Thank you for this article… 6 years ago now I was diagnosed with Hashimoto’s – my TSH was 118.40. I could tell you some stories about my symptoms including 3rd stage renal failure…slurred speech etc… It took 4 years once on Synthroid to feel balanced with most symtoms reversed… I NEVER want to go back to how I felt so I thank you for your research and hope that you can inform me on how to go about receiving some sort of treatment in case of a interrupted medicine supply…

  7. Robert says:

    Thank you so much for starting this serious of articles. As a user of Synthroid I have been extremely worried about what I will do when the system collapses, and, my replacement Synthroid is no longer available. Please continue your series and provide people like myself the answer to what we can do to keep ourselves alive in lieu of Synthroid. I have tested on myself what it would be like to not take my pills for 5 days and my cramping and dizziness was frightening. Thank you.

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