Dr. Izabella Wentz, PharmD

Thyroid Pharmacist

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Questions Medications & Your Thyroid

Common Questions About Medications and Your Thyroid

Medically reviewed and written by Izabella Wentz, PharmD, FASCP

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Should I take my thyroid medication on the morning of my thyroid blood work?

It depends! If you are taking a T4 only medication, you can go ahead and take your medication in the morning before the test. T4 medication has a long half-life, and your levels will be stable regardless of when you take it. If you take a T3 medication on the other hand, or a combination of T3/T4, T3 has a shorter half-life so your blood work may not be reflected accurately. It will appear that you have more thyroid hormone on board than you do.  Thus it may be helpful to delay your morning dose of a T3/T4 medication until after you do the test to see (try to schedule the test in the morning).

What could cause a suppressed TSH (0.01) and low normal Free T4 (0.9) & Free T3 (2.9)?  I’m feeling good and am taking Levothyroxine and Cytomel.

Sometimes this can be due to pituitary suppression. It can be due to adrenal support, steroids, or glandulars taken at bedtime. This effect may also be seen with T3 medications in some people.

Which thyroid medication is Best?

There are quite a few options for thyroid medications for hypothyroidism. Some people report feeling better on Armour Thyroid®*, while others may feel better taking Synthroid® or another version of synthetic T4 or compounded thyroid medications. Check out this article on thyroid medications for further insight.

*Note: While Armour Thyroid does not have any gluten-containing ingredients, it is not tested for gluten content, and cannot be certified as gluten-free. Armour does contain sodium starch glycolate, which can be derived from wheat or corn.

Do you recommend gluten free thyroid medications?

The benefits of following a gluten free diet with Hashimoto’s have been well described.

Many people have taken the plunge of going gluten free and are carefully checking labels to ensure that their foods do not contain any gluten ingredients, but gluten can also be found in medications and can sabotage your healing.

There are no current laws that require medication manufacturers to specify if their products contain gluten. Many progressive manufacturers have started labeling their products, but not all. I wrote this article on gluten-free thyroid medications for further insight.

What about other fillers such as dairy, soy, etc.?

Many people with Hashimoto’s are sensitive to multiple ingredients like dairy, soy, corn, eggs. Tirosint and Nature-Throid have the fewest additives as far as thyroid medications go. You can also work with a compounding pharmacist to have a special thyroid medication made for you without any ingredients that are going to sabotage your health.

Do you have any suggestions on switching thyroid medications?

Thyroid hormones are known to have a very narrow therapeutic index, they are “Goldilocks” medications, in that have to be dosed just right to ensure effectiveness and prevent adverse drug events. Thyroid hormones are dosed in micrograms; that is just 1/1000th of a milligram! When the dose is a teensy bit too high, we may have symptoms of hyperthyroidism, and when the dose is a teensy bit too low, we have symptoms of hypothyroidism!

This is why switching back and forth between different brands of thyroid medications is not recommended. Even a teensy bit difference in the formulation can make a profound impact on our well-being! Here are some helpful hints for switching thyroid medications.

Do my thyroid medications have other drug interactions?

Thyroid medications are notorious for drug interactions with other medications. This means that some medications can cause alterations in thyroid hormone levels and side effects, and in turn, thyroid medications can impact the effectiveness and toxicity profiles of other medications. Always be sure to check with your pharmacist when taking new medications or over the counter drugs. Ideally, you should fill all of your prescriptions at the same pharmacy so your pharmacist can do a check of your drug interactions every time you fill a prescription.

Are thyroid medications safe for pregnancy?

Thyroid medications are Pregnancy Category A, which means that they are considered to be safe medications for using during pregnancy. Being on a correct dose of thyroid medication can help women conceive as well as prevent miscarriage. If you get pregnant while taking thyroid hormones, be sure to see your doctor ASAP to test your levels. You will very likely need to increase your dose, as pregnancy increases the requirement of thyroid hormones. If you are thinking about pregnancy, be sure to read this guest post-Hashimoto’s and Pregnancy

When should I take my thyroid medication?

Thyroid medication absorption can be impacted by many things, including food, other medications, and supplements. Thyroid medication should be taken on an empty stomach, 30 minutes to one hour before eating, taking other medications, supplements or coffee to ensure appropriate absorption. Antacids such as Tums, iron and calcium supplements can impair the absorption of thyroid medications. Thus, you need to have at least 4 hours of time in between your thyroid medications and these agents.

Are thyroid medications lifelong?

Thyroid medications are considered lifelong for most cases of hypothyroidism, but spontaneous remission has been reported to occur in up to 20% of patients… however addressing root causes can help increase the rates of remission. If you do not address the underlying root causes of your condition, your own thyroid’s hormone production may deteriorate over time, meaning that you may require dose increases over time. Symptoms of worsening thyroid function can sometimes be subtle (such as gaining a little extra weight every year or being just a tad bit more tired), so you will need to test your thyroid function labs at least every 6-12 months to monitor your thyroid hormone levels.

For more information see the following articles:

6 Hashimoto’s Root Causes & Are Thyroid Medications Lifelong?

To learn more about getting the most out of your thyroid medication, download my free Optimizing Thyroid Medications Guide below!

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Disclaimer: The information contained herein is for informational purposes only and should not be construed as medical advice. Please consult your physician for any health problems and before making any medical or lifestyle changes.

Lifestyle changes can result in improved thyroid function and/or an increased absorption of thyroid hormone medications, leading to a lower required dose and possible symptoms of hyperthyroidism at a dose that was previously stable. Please discuss lifestyle changes with your physician and ensure that your thyroid function is monitored every 6-8 weeks while making lifestyle changes. Symptoms of overmedication include, but are not limited to: rapid or irregular heartbeat, nervousness, irritability or mood swings, muscle weakness or tremors, diarrhea, menstrual irregularities, hair loss, weight loss, insomnia, chest pain, and excessive sweating. Do not start, change, increase, decrease or discontinue your medications without consulting with your physician.

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Comments

  1. Could you be so kind to tell me if I don’t have a thyroid will all these symtoms occur. I have been tested and get told there is no necessity of being put on medication. Looking forward to your reply plse. Regards Lynette

    Reply

    • Lynette – Most thyroid conditions result from the immune system attacking the thyroid because the immune system is out of balance. Even when the thyroid is taken out surgically, is ‘dead’, or treated with radioactive iodine the autoimmunity still persists in most cases. Many people will have their thyroids removed, and will develop new autoimmune disorders such as Lupus, Rheumatoid arthritis, etc. The immune system just finds a different target. We need to re-balance the immune system to prevent this (sometimes the autoimmunity can be reversed as well). The gut determines your immune system. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition.

      Hashimoto’s Root Cause
      http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20

      Hashimoto’s Protocol
      thyroidpharmacist.com/protocol

      Reply

  2. I have been watching the 9-series and must admit it is extremely helpful. About 10 years ago, I had the right lobe and isthmus removed from my thyroid. I have many nodules in my left lobe. About two years ago I gradually gained 45 pounds, size 10 to size 16. My endocrinologist has me on 100 mg of Synthroid and compound of Liothyroxine 7.5 mcg. Before that he had me on Amour. He could not get my T3 in range, so he made the change. I immediately gained 10 lbs and not sleeping well. I am very frustrated, but your series has given me hope. I want to thank you so much for the thyroid series. It has taught me so much and given me some hope.

    Reply

  3. I was diagnosed with hypothyroidism in the 90’s put on synthroid and when I changed doctors, I was taken off . Why would a doctor not prescribe a medication for a person diagnosed with a disorder and say, and I quote ” I’m not prescribing you something just so you can lose weight”. The diagnosis is in my medical records…

    Reply

  4. Thank you Dr. Wentz for your book and all your help!
    I have a question about my medications. I switched from Levothyroxine to Nature Throid because my fT3 was always below the optimum level. I started taking NT January this year. My TSH now is 0.007 and my FT3 and FT4 are still not optimum but in normal range. Does this mean that Nature Throid is not my medication? Or I need to increase the dose of NT? I still feel very tired, depressed and my hair falls a lot. I’m fighting helocobacter with your non antibiotic protocol. I have very low ferritin and I’m taking opti- fertinC. I’m very concerned about my medications because doctors tell me to lower my dose of NT because TSH is very suppressed. Can you please give me any advice? Thank you!

    Reply

    • Tonya – thank you for following this page. Most thyroid conditions result from the immune system attacking the thyroid because the immune system is out of balance. Even when the thyroid is taken out surgically, is ‘dead’, or treated with radioactive iodine the autoimmunity still persists in most cases. Many people will have their thyroids removed, and will develop new autoimmune disorders such as Lupus, Rheumatoid arthritis, etc. The immune system just finds a different target. We need to re-balance the immune system to prevent this (sometimes the autoimmunity can be reversed as well). The gut determines your immune system. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition.

      Hashimoto’s Protocol
      thyroidpharmacist.com/protocol

      Hashimoto’s Root Cause
      http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20

      Reply

  6. Hi, your articles and comments are very informative. I appreciate your research and personal journey to find answers. My story started with a graves disease diagnosis, so the doctor did radio active iodine treatment…much to my regret. This was over 40 years ago. I have been hypo for years and stuggle with many symptoms. I went again to my doctor for blood work according to your list of labs. She looked over some of your pages and is very open to whatever works for me. I will start over again thanks to your articles and inspiration.
    Sincerely,
    Cindee

    Reply

    • Cindee – thank you so much for sharing! I am happy you have found a clinician to be a part of your own health care team. I’m looking forward to seeing your progress here. <3

      Reply

  7. Hi and thank you for such wonderful resources you provide. I’ve been diagnosed with hashimotos for 9 years and been on Armour for the past 2. I like it a bit better than synthetic thyroid but it’s not a huge difference to me. However I am 7 weeks pregnant. My endo is comfortable keeping me on Armour and adjusting the dosage but I’m a bit concerned about all that I’m reading online that Armour is not recommended during pregnancy. It concerns me to think about switching meds mid pregnancy but I want to have peace of mind that my treatment won’t harm the baby. Any recommendations or can you share your medication regime during pregnancy?
    Thank you so much
    Estefania

    Reply

  8. Hi -I’ve been loving all your books, website and info you have on Hashimoto and Thyroid. I have a TSH – .03, FT4- 1.08ng/dL,
    FT3- 2.8pg/ml. I still feel a little hypothyroid symptoms- hair dry and loss, weight gain, low heart rate, etc. I don’t have any hyperthyroid symptoms. My FT4 did decrease from 1.17 to 1.08 in less than 2 months. With my TSH being suppressed, do I need to be concerned? I was thinking to increase my NDT to my FT4 and FT3 can increase? I currently take 81.25mg of naturethroid. What are your thoughts?

    Reply

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