Will Thyroid Hormone Help Me If I Have Hypothyroid Symptoms But Normal Thyroid Hormone Levels
Some people with normal thyroid blood tests have symptoms that are similar to symptoms of hypothyroidism. Several scientific studies have looked at whether T4 therapy would be of benefit to patients with symptoms that overlap with hypothyroid symptoms and normal thyroid function. There has been no proven benefit in taking T4 for improving symptoms if thyroid hormone levels are normal. If thyroid lab values are normal, symptoms are not likely to be due to a thyroid problem and patients should discuss other potential causes or treatment with their physician.
How Well Are You Absorbing Your Thyroid Medication
Certain foods, medications, or health conditions can cause you to absorb your thyroid hormone poorly, effectively lowering your dose.
According to a 2017 research review, the following can decrease your ability to absorb the thyroid hormone levothyroxine :
- Gastrointestinal disorders, such as celiac disease, lactose intolerance, and H. pylori infection.
- Certain medications: cholestyramine, colesevelam, ciprofloxacin, aluminum hydroxide, sevelamer, or proton pump inhibitors
- Certain supplements: calcium carbonate, calcium citrate, calcium acetate, and iron sulfate
Vitamin C was found to increase thyroid medication absorption.
The treatment of GI disorders can lead to increased absorption of thyroid medication. This can also happen when you change your medication or even your diet.
Better absorption can lead to too much thyroid hormone. If you take a medication like Synthroid and notice symptoms of hyperthyroidism , have your doctor test your thyroid hormone levels.
For patients who cannot resolve the reason for poor medication absorption, liquid T4 may be a better choice than standard T4 medication.
Assuming A Change In Medication Brand Isnt A Big Deal
Per the ATA, every brand and generic thyroid medication contains the same amount of thyroid replacement hormone. However, many endocrinologists believe that there is a variation in hormone content among the various brands, and that there are additional factors that can interfere with how the hormone is absorbed with each one, notes the ADA. Therefore, when getting a prescription filled at the pharmacy, you should not change from one brand to another, from a brand name to a generic, or from one generic to another without first checking with your doctor.
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Be Aware Of Common Drug Interactions
- Antacids Mylanta and Tums, for example
- Proton pump inhibitors Prilosec , Prevacid , and Nexium
- Diabetic medications Insulin and oral hypoglycemic drugs
- Serotonin-reuptake inhibitors Such as Zoloft and Celexa
- Tricyclic antidepressants Elavil , Sinequan , and Norpramin
- Birth control pills and hormone replacement therapy
- Certain antibioticsRifampin and Cipro
- Certain cholesterol-lowering drugs For example, Questran and Colestid
- Blood thinning medication Coumadin or Heparin
- Lithium A medication for bipolar disorder
- Activated Charcoal a binder
What Interferes With The Absorption Of Thyroid Hormone Replacement Drugs
Ideally, you should swallow your thyroid medication with water.
Suppose you’re taking levothyroxine solution like Tirosint-SOL. In that case, you can take the liquid medication directly into your mouth or add the ampule contents to a glass of water and drink all of it immediately.
One additional note: you may have seen recommendations to chew your thyroid medication or let it dissolve sublingually under the tongue. It’s not recommended for levothyroxine tablets, and there’s no evidence that this improves the effectiveness or absorption of levothyroxine. Some patients, however, anecdotally report better results when taking natural desiccated thyroid drugs this way.
If you plan to change how you take your thyroid medication, always talk to your health care provider.
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What Is The Thyroid Gland
The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroids job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working properly.
What Is Thyroid Medication
Thyroid medication, used for the treatment of hypothyroidism and Hashimotos, refers to pharmaceutical products containing thyroid hormones.
Thyroid hormone medications may include:
- The inactive form of thyroid hormone, T4, which your body is then meant to convert into the active form T3
- The active form of thyroid hormone, T3, which your body is meant to use directly
- A combination of both T3 and T4.
These are natural or synthetic versions of the hormones your body should naturally produce, but is currently not producing in a large enough quantity, is not producing them at all, or is unable to convert from the inactive to the active form that your body can then use. These products may be time released, individually compounded, or have other nuances to them. In my book, The Adrenal Thyroid Revolution, I walk you through the various thyroid medication choices that are available and commonly recommended.
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When Should You Take Your Thyroid Medication
Typically, instructions recommend taking your thyroid medication in the morning, on an empty stomach, an hour before eating or drinking coffee, milk, grapefruit juice, and three to four hours before taking supplements or medications that contain iron or calcium.
Still, the most important guideline is to take your medication consistently at the same time every dayâwhether you’re receiving treatment with levothyroxine, liothyronine , natural desiccated thyroid, or compounded medication.
You may want to talk to your healthcare provider about taking levothyroxine at bedtime. has found that this enhances absorption of levothyroxine, as seen in significantly improved levels of thyroid hormone. Taking levothyroxine medication at night gives you more freedom to eat, drink, and take supplements first thing in the morning.
An important note: if you switch between taking your thyroid pills in the morning and evening, you should have your thyroid hormone levels retested, as a possible change in absorption may require an adjustment to your dose.
Some patients may be tempted to split tablets using a pill cutter, either to save money or take partial doses. You should be aware that experts don’t typically recommend splitting levothyroxine tablets or liothyronine tablets . The drug’s narrow therapeutic index and uneven distribution of the active ingredient mean that you can’t guarantee dosage consistency.
How Do I Take Thyroid Hormone
Thyroid hormone stays in your system for a long time, it is taken once a day, and this results in very stable levels of thyroid hormone in the bloodstream. When thyroid hormone is used to treat hypothyroidism, the goal of treatment is to keep thyroid function within the same range as a person without thyroid problems. This is done by keeping the TSH level in the normal range. The best time to take thyroid hormone is typically first thing in the morning on an empty stomach. This is because food in the stomach can affect the absorption of thyroid hormone. If you are taking several other medications, you should discuss the timing of your thyroid hormone dose with your physician. As an alternative, taking your thyroid hormone at bedtime can make it simpler to prevent your thyroid hormone from interacting with food or other medications. Overall, the most important thing is to be consistent, and take your thyroid hormone in the same way, every day.
Do not stop your thyroid hormone without discussing this with your physician. Most thyroid problems are permanent therefore, most patients require thyroid hormone for life. It is very important that your thyroid hormone and TSH levels are checked at least annually, even if you are feeling fine, so that your dose of thyroid hormone can be adjusted if needed.
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Thyroid Medication Is Overprescribed
A subset of people who take thyroid hormone replacement would likely be better off without this medication, as overdiagnosis of hypothyroid conditions is very common.
One study showed up to 60% of patients may be taking thyroid hormone replacement unnecessarily. In this study, 291 patients taking Levothyroxine were asked to pause their medication for 6-8 weeks. Many of these patients had been taking thyroid medication for years but did not have strong diagnostic indicators of thyroid disease.
- After going without synthetic thyroid hormone for several weeks, patients were given blood tests for thyroid function. 60.8% of patients had normal levels of thyroid hormone, meaning they did not require thyroid medication.
Warnings For Other Groups
For pregnant women: Studies of levothyroxine in pregnant women havent shown risk to the fetus. Talk to your doctor if youre pregnant or planning to become pregnant. It appears unlikely that this drug will harm a pregnancy.
Not treating hypothyroidism could cause problems for both you and your pregnancy. You should not stop taking this drug during pregnancy.
For women who are breastfeeding: Small amounts of levothyroxine may pass into breast milk, but this drug is usually safe to take while breastfeeding. Talk to your doctor about the best way to feed your child while taking levothyroxine.
For seniors: If youre older than 65 years, you may be at higher risk of developing negative heart effects while taking this drug. Your doctor may choose to start you on a lower dosage.
For children: Levothyroxine has only been approved for use in children for the treatment of hypothyroidism. The tablet can be used safely in children of all ages.
Why Is This Medication Prescribed
Levothyroxine is used to treat hypothyroidism . It is also used with surgery and radioactive iodine therapy to treat thyroid cancer. Levothyroxine is in a class of medications called hormones. It works by replacing thyroid hormone that is normally produced by the body.
Without thyroid hormone, your body cannot function properly, which may result in poor growth, slow speech, lack of energy, excessive tiredness, constipation, weight gain, hair loss, dry, thick skin, increased sensitivity to cold, joint and muscle pain, heavy or irregular menstrual periods, and depression. When taken correctly, levothyroxine reverses these symptoms.
Why People Start Taking Thyroid Medication
This topic should really be why doctors prescribe thyroid medication, but the point still remains the same.
The only real reason to start taking thyroid medication is that your body isnt able to produce enough thyroid medication on its own.
If this happens, then you will be at a deficit that must be replaced and supplemented with some amount of oral thyroid medication.
This isnt necessarily a problem, but the problem does start to arise when we talk about how doctors determine if your thyroid is functioning well or not.
The main way that doctors do this is through a test called the TSH or thyroid stimulating hormone.
If the TSH is high then you are considered to be hypothyroid and your doctor may start you on thyroid medication.
If the TSH is normal, then you are considered to be euthyroid and you dont need thyroid medication.
So, wheres the problem?
In addition, the TSH test only gives you information about what is happening RIGHT NOW.
It doesnt give you any information about your future thyroid function .
Most of the time it is an accurate measure of thyroid function, but there are times when individuals are placed on thyroid medication inappropriately or times when they may only need thyroid medication short-term.
Foods to Avoid if you Have Thyroid Problems:
Ive found that these 10 foods cause the most problems for thyroid patients. Learn which foods you should avoid if you have thyroid disease of any type.
The Complete List of Thyroid Lab tests:
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What Medications Treat Hypothyroid
Whether your healthcare provider prescribes the generic or brand name, these medications help to replace the thyroid hormone your body isnt naturally producing in your blood.
It may take some time to find the right medication, or dosage that works for youand once youve figured out your treatment plan, certain things can mess with how the prescription works for you.
Do You Want To Get Off Of Your Thyroid Medication
If youre like most thyroid patients then youve probably been told that once you start taking thyroid medication you have to be on it for the rest of your life.
But what if I told you that this isnt the whole story?
What if I told you that there are plenty of people who can get off of their thyroid medication?
It may sound too good to be true but it doesnt have to be.
New studies suggest that as many as 30% of thyroid patients may be taking thyroid medication when they dont need it and may be able to get off of it.
Thats a huge number of people when you consider that levothyroxine is one of the most commonly prescribed drugs in the United States!
How is it possible that so many people may be able to stop taking their medication?
The reason is simple:
There are plenty of causes of reversible hypothyroidism and some of these conditions either go away on their own or can be reversed through therapies and actions that you take.
For instance, if you are someone who has been following the advice listed on my blog about how to change your diet, how to use thyroid support supplements, how to replace nutrient deficiencies, how to exercise appropriately, then theres a chance that you may fall into that group.
In addition to this group of people, there are also thyroid patients who may have been incorrectly placed on thyroid medication and have been taking it for years because no one ever stopped to ask why they were placed on it in the first place.
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What Should I Watch For While Using This Medication
Do not switch brands of this medication unless your care team agrees with the change. Ask questions if you are uncertain.
You will need regular exams and occasional blood tests to check the response to treatment. If you are receiving this medication for an underactive thyroid, it may be several weeks before you notice an improvement. Check with your care team if your symptoms do not improve.
It may be necessary for you to take this medication for the rest of your life. Do not stop using this medication unless your care team advises you to.
This medication can affect blood sugar levels. If you have diabetes, check your blood sugar as directed.
Some brands of this medication may have a strong odor. This does not mean that the medication is spoiled.
You may lose some of your hair when you first start treatment. With time, this usually corrects itself.
If you are going to have surgery, tell your care team that you are taking this medication.
Switching & Converting Between Thyroid Medications
Is it possible?
Does that mean you should avoid it?
There are a number of factors that should always be considered when you are transitioning between thyroid medications and each of these factors may influence how that transition goes.
From my own experience in treating hundreds of thyroid patients, I find that most patients do the best on a combination of both T4 and T3 medications.
Unfortunately, most patients are probably taking a T4-only medication such as levothyroxine.
While T4 medications can be helpful in many situations, they arent always enough to get patients back to the 100% that they were accustomed to prior to their thyroid disease.
This has to do with a number of issues including your own personal genetics, factors that influence thyroid conversion, and cellular receptor sensitivity of thyroid hormones.
We arent going to go into detail on these specific topics but you should be aware that they exist and they can all influence how well you transition or convert between thyroid medications.
I also think its important for you to understand that while conversion charts can be helpful, they are not always 100% accurate!
I understand why you may want to look at something like this and even though I am going to provide the information I would encourage you to not go by the charts listed below.
Because they are flawed!
It will be possible, but very unlikely, for you to be able to look at the chart to help pinpoint your dose.
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When Medication Is And Isnt Required
Standard blood tests for TSH and free T4 are very reliable indicators of who needs thyroid hormone replacement :
- TSH levels are abnormally high, and your free T4 levels are abnormally low: This means you have true hypothyroidism. T4 medication is required.
- Slightly elevated TSH levels and normal free T4: This is called subclinical hypothyroid. This is an early form of hypothyroidism and requires monitoring but not T4 medication.
- Low free T3: This is a sign of inflammation, digestive issues, or a diet too low in carbs or calories. T3 medication is not normally required.
- Elevated thyroid antibodies with normal thyroid hormone levels: In this case, you do not need thyroid hormone replacement. Hashimotos disease does not always lead to hypothyroidism.
- Low free T4 and normal TSH: This is a sign of dysfunction in the pituitary gland. Consult an endocrinologist.
Whether your thyroid condition requires medication or not, many thyroid conditions can be improved through better gut health.
Underactive Thyroid And Pregnancy
It’s important for the health of you and your baby that an underactive thyroid is treated properly before you become pregnant.
Tell a GP if you’re pregnant or trying to become pregnant and you have hypothyroidism. They may refer you to a specialist for treatment and monitoring during your pregnancy.
Page last reviewed: 10 May 2021 Next review due: 10 May 2024
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