The Misunderstood, Mistreated Thyroid

We’ve slanted this month’s rant towards the pharmacy side of our business. We figured it was cool since natural practitioners are weighing in on pharmacy topics such as thyroid health and treatment.  We’re calling on pharmacy to help dispel some myths.

Ah, the thyroid… Who knew one little gland could cause so many problems. There are few other health topics that elicit such strong reactions and have so many crazy theories. Who are we kidding? With the Internet, that can mean every health topic.

So first a little background… The thyroid is a small gland wrapped around your trachea or windpipe.  It produces two main hormones:

  • T3 or tri-iodo-thyronine, which is the form that does the work
  • T4 or thyroxine, which is the major form found in the blood and eventually gets converted to T3

This tiny gland affects many of your body systems including metabolism and temperature regulation. This is why when you have a true thyroid problem it can manifest itself in so many ways.

Iodine is a building block of thyroid hormone.  The thyroid gland requires no more than 70 micrograms (mcg).  That’s a small number.  A paperclip weighs 1 million micrograms.

There are a number of thyroid conditions that fall into two main categories:

Hypothyroidism: This is where your body does not produce enough thyroid hormones. The thyroid hormone is too low.  A common cause of this is an autoimmune disease called Hashimoto’s Disease.

Hyperthyroidism: This is where the body produces too much thyroid hormone. The thyroid hormone is too high.A common cause of this is another autoimmune disease, Graves’ disease.

There is so much bad information out there on the thyroid and in particular treatment of HYPOthyroidism.  From books and the Internet to fake practitioners and supplement companies…

Let’s go through some of the bad information

  1. Iodine supplementation

This seems to be the biggest one of all.  The recommended allowance varies from 90mcg (kids up to 8) to 290mcg (lactating mothers).  The average adult should get 150mcg: just 70mcg for the thyroid and the rest for other body systems.  

In America, the average intake is between 240-300 mcg per day. That means even with our super bad diets, we’re getting well over what we need.

If you have thyroid issues, iodine is not your problem – unless you live in remote parts of the Appalachian Mountains in a hut. Taking more iodine than what’s found in your diets will do literally and figuratively nothing.

If you’re worried, eat some cranberries.  You don’t have to worry, though.

  1.   Synthroid (levothyroxine) is synthetic so it’s bad.

Technically, yes, Synthroid is synthetically made where something like Armour Thyroid is directly from a natural source.

However, the compound itself, levothyroxine, is identical to the hormone your body makes. If you put the T4 in Armour Thyroid under a microscope and then the Synthroid, you could not tell them apart.

Saying that it is inferior because it is not directly from a natural source is an appeal to the naturalistic fallacy. This states that anything natural is always better than the synthetic counterpart.  In the example of ascorbic acid (Vitamin C) from an orange versus from corn syrup, it’s the same as Synthroid – they’re identical and the source doesn’t matter.  

The reason we hate Vitamin C from corn syrup isn’t that it’s synthetic; it’s that Vitamin C (ascorbic acid) as an isolated chemical isn’t needed for your wellness – foods rich in Vitamin C are.  As for your thyroid, the isolated chemical, whether natural or synthetic, is all that’s needed so either will suffice.

  1.  Armour Thyroid contains both T3 and T4 and is therefore better.

Super controversial.  Most endocrinologists will agree in an almost overwhelming majority of cases, T4 is all that’s needed and in fact preferred.  Some people have rare conditions where they can’t convert T4 to T3.  Super rare, and there are better treatment options than natural thyroid products.

Patients who truly need T3 or T3 AND T4 have better options, which we’ll discuss why and what now…

  1.  Natural thyroid products like Armour Thyroid are better than Synthroid for XYZ reasons. 

We’ve gone through the big concerns we have with Armour vs Synthroid.  The biggest, however, is the variability of dosing.

When you take hormones, it’s essential to get consistent dosing. Day over day you want the same amount.  Unfortunately, when you use natural sources like piggy thyroid (yes, Armour Thyroid is ground up whole thyroids of pigs – how’s that for natural?), the amount of T4 and T3 can and does vary lot to lot.

Our Village Apothecary stores have an accredited compounding pharmacy in which we do compound custom doses of natural thyroid.  We’ve seen swings of over 5% on one or both T3 and T4 in both directions.  

The acceptable variance is up to 10%, but the problem isn’t the small variance but the inconsistency of direction.  It’s all over the place – and is to be expected because it is difficult to control from the natural source.

If someone wanted or needed to have a custom dose of T3 and T4, we’re on board.  But even Armour will always give you a FIXED RATIO of T4 to T3.  What if you need to adjust the T3 only?  What about the T4?  

Two options that are better than natural thyroid:  use Synthroid (T4) and Cytomel (T3) together OR get a custom compound of T3 and T4 combined in a single dose.

  1. I got a blood test that said I was low in iodine.

This is not true. There is no test that can reliably diagnose iodine deficiency in individual patients.   As for who should even test, pregnant women and school-aged children are our highest priority as it pertains to iodine deficiency; they get hurt the most without good iodine levels and may have abnormal diets.

There is no blood test.   The other test that people sometimes use for iodine is to put some on their skin and based on how fast it absorbs they will know if they need iodine or not.

This is not an accurate measure; different people have different skin. The test shows how well iodine absorbs through your skin, not how much iodine you need.

Anyone claiming to test you for iodine is not being honest with you.

  1. It can’t hurt to take lots of iodine.

This is the most dangerous one of all.  The American Thyroid Association says people should not consume more than 500mcg a day.

Taking high dose iodine as we’ve heard:  5, 10, 15 and even 50 milligrams is extremely dangerous. It can cause your thyroid gland to overproduce thyroid hormone or mess up several thyroid mechanisms and eventually lead to various thyroid diseases.

Any practitioner stating otherwise should review an endocrinology textbook.  They clearly do not understand how the thyroid works, nor how well understood that gland system is. It’s not that controversial.  There’s no inside information or hidden secret.

  1. I am gaining lots of weight but my thyroid tests were normal.  Do I have a unique case that the tests aren’t sensitive enough to pick up on?

While some weight gain is possible with a thyroid condition, let’s have a little moment of honesty here. For most people with weight problems it is lifestyle choices.

You can’t confidently say that weight gain (ESPECIALLY weight gain) is a direct result of medical conditions UNLESS YOU ARE EATING WELL.  This means with complete and total discipline – good timing, portion size, and plate content.  

There will always be those rare cases where it is an underlying medical issue – including low thyroid. We’re not talking about those people.

The vast majority of the time it’s because of two reasons. First, lack of exercise. Get your butt off the couch and walk your dog. He needs to feel the sun and pee on someone’s mailbox for goodness sake.  Remember, as we age, our metabolism slows and we must increase the intensity of our activity to just maintain.  It’s the worst, but it’s the truth.

The next reason is the food we shove in our faces. Are you like Neal and eat M&M’s indiscriminately?  Be honest with yourself and face the music.

We offer free nutritional counseling with a dietician, for those of you that need some help. No more excuses.

  1.  I’m on a thyroid treatment but still having XYZ symptoms, so it’s not working.

Symptoms of thyroid gone wild are varied because of all the body systems it affects.   It could be as simple as an incorrect dose, a problem with how you are taking the medicine (remember consistency!), or that it’s not your thyroid causing the problem at all.

In order for your thyroid to function properly, you need to be eating a healthy diet. Make sure you are consuming lots of fruits and vegetables.

Here’s the point of all this:  you have to see an expert.  A specialist.  A real physician or endocrinologist. Yes, sometimes you need to get a second opinion. Not all doctors are created equal. Do not be afraid to get a second or even third opinion.

Do not, however, shop around till you find someone who just tells you what you want to hear. The best advice you can get is someone being honest with you, not sugar coating things. Sometimes it is hard to hear, but in the long run, it’s the best advice.

If you are looking for a good website for thyroid information you can go to No sales pitches or axes to grind, just all the information you could ever want about thyroid health.

Just trying to keep it real…

Neal Smoller, PharmD
Owner, Pharmacist, Big Mouth

Dr. Neal Smoller, Holistic Pharmacist

About Neal Smoller

Dr. Neal Smoller, PharmD, is a licensed pharmacist: and owner of Village Apothecary, an independent pharmacy in the most famous small town in America—Woodstock, NY. He’s also the host of the popular wellness podcast, The Big Mouth Pharmacist.”


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