Dont Switch Back And Forth Between Brand
Switching from a brand-name to generic thyroid hormone, or vice-versa, could affect your TSH levelseven if the dose is the same. 7 The same goes for switching between brands of levothyroxine . the US Food and Drug Administration requires that all levothyroxine preparations deliver 95-105% of the potency on the label. But, the ATA notes, even tiny variations could make a difference. Thats why the groups guidelines recommend sticking with the same drug type to keep your TSH levels steady.
If youve made a switch and have concerns, have your doctor retest your TSH level, the ATA, American Association of Clinical Endocrinologists, and The Endocrine Society have recommended in a joint statement. 8
What Are The Different Thyroid Hormone Medications
Thyroid hormone replacement is not a one-size-fits-all process. Your thyroid test results, age, other health conditions, and symptoms will determine the type and dose of medication your thyroid doctor prescribes for you. Sometimes, your dose will need to be adjusted to reach a therapeutic level.
Ahead, some of the different kinds of thyroid medication.
T4-only thyroid medications
Levothyroxine is the first line of treatment for hypothyroidism. This medication is a synthetic or human-made form of thyroxine , one of the thyroid’s primary hormones. People taking levothyroxine may take a generic form or a name brand like Synthroid, Unithroid, or Tirosint.
T3-only thyroid medications
Triiodothyronine is the other hormone made by the thyroid. For the few patients for whom T4 alone is insufficient, the addition of T3 may be of benefit. Sometimes, a thyroid doctor may prescribe T3 replacement medication if a patient has a hard time converting T4 to T3 or if they take an interfering medication. T3 may be prescribed when a person’s TSH levels or symptoms do not improve despite an increase in T4 levels.
T4/T3 combination therapies
Natural desiccated thyroid is a medication derived from the dried thyroid glands of pigs and provides both T3 and T4. Name brands of NDT include Armour, Nature-Throid, and NP Thyroid.
Knowing When To Check Your Thyroid
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Three Reasons Why Your Thyroid Medication Isnt Working
This article is part of a special report on Thyroid Disorders. To see the other articles in this series, .
In the last post I explained that, for the vast majority of patients, hypothyroidism is an autoimmune disease. This isnt just an academic distinction. Its the reason both conventional and alternative treatments are so often ineffective.
Want to learn more about thyroid disorders?
Taking Too Much Thyroid Hormone And Thinking Its Harmless
The synthetic thyroid hormone T4 is relatively safe, and you shouldn’t worry if you accidentally take an extra dose, Bianco says. But taking an excessive amount could have side effects it can make you feel tired, affect your sleep and concentration, lead to bone loss, or cause irregular heartbeats, according to the Cleveland Clinic. If you take combination therapy, which contains both T4 and T3, the medication needs to be taken precisely as prescribed, as taking too much can be dangerous. The ATA notes that potential side effects of taking too much combination therapy include a racing pulse, anxiety, trouble sleeping, and problems with your heart and bones. Contact your healthcare provider immediately if you accidentally take more than prescribed.
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Hypothyroidism Medication Mistakes To Avoid
Taking your thyroid hormone as prescribed can help you stave off the unpleasant symptoms of low thyroid.
The goal of hypothyroidism treatment is to replace the thyroid hormone that you are not able to produce. This helps you feel more energized and back to your normal self, says Antonio Bianco, MD, PhD, a professor of medicine at the University of Chicago in Illinois.
After youre diagnosed with hypothyroidism, your healthcare provider will likely prescribe a synthetic hormone that helps stabilize your thyroid levels, Dr. Bianco says. But there are some guidelines for taking the medication that you need to know about.
Heres how to avoid the most common hypothyroidism medication mistakes.
You Have Joint And Muscle Aches/pains
General joint and muscle pains are common when hypothyroidism is not sufficiently treated, and your dosage of thyroid hormone needs to be increased. Joint and muscle weakness and pain, especially in the arms and legs, can be evidence that you need an increased dose of antithyroid drugs for your hyperthyroidism.
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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
Take Medication On An Empty Stomach
Its essential to plan the timing of your hypothyroidism medication in relation to food, supplements, and other medication, Dr. Doria-Medina says. Thyroid medication should always be taken with a full glass of water on an empty stomach for maximal absorption, she says. You should wait at least 30 minutes before a meal, and longer if your meal is high in fiber and calcium-fortified foods.
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See Your Doctor As Scheduled
When youre first diagnosed with hypothyroidism, you can expect to see your doctor about every 6 to 12 weeks to track hormone levels and determine the exact dosage you need. Its important to attend appointments as scheduled so your doctor can make an accurate assessment of how your body is responding to the treatment. If no changes in dosage are needed after a few visits, the frequency of your doctor visits can often be decreased, Doria-Medina says. Still, your dose may need to be adjusted over time, so be sure to schedule and keep all follow-up appointments with your doctor.
Additional reporting by Jennifer Geddes
Interactions That Increase The Risk Of Side Effects
Taking levothyroxine with certain drugs may result in an increase in adverse effects. Examples of these drugs include:
- Antidepressants such as amitriptyline and maprotiline. The side effects of both of these antidepressants and levothyroxine may increase when you take these drugs together. This may put you at risk for irregular heart rhythms .
- Sympathomimetic drugs such as pseudoephedrine and albuterol. The effects of both the sympathomimetic drugs and levothyroxine may increase when you take these drugs together. This may put you at risk of serious heart problems.
- Blood thinners such as warfarin. Taking these drugs with levothyroxine may increase your risk of bleeding. Your doctor may need to decrease the dosage of your blood thinner if youre also taking levothyroxine.
- Ketamine. Taking this drug with levothyroxine may increase your risk of high blood pressure and fast heart rate.
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Sensitive Skin And Skin Discoloration
Thyroid hormones also influence the quality of your skin in a variety of ways. With hyperthyroidism, you may notice itchy and dry patches of skin.
Your face may feel softer and swollen. You may even notice swelling around your fingertips. Other symptoms include darkening of the skin, rashes, lumps, and reddish spots.
Thyroid Medications Do Not Stop The Autoimmune Process From Damaging Your Thyroid
We have already discussed how autoimmunity is the most common cause of hypothyroidism. We have also covered how the autoimmune process causes damage to your thyroid gland. So here is our fist point, thyroid hormone replacement medications do little to nothing to stop the autoimmune process from damaging your thyroid. Does this mean your endocrinologist has misguided you? No, but you may want to consider a more comprehensive approach to your thyroid condition. To your endocrinologist credit, medications do confer benefit. If someones thyroid gland is severely damaged they may need some medication indefinitely to replace what the gland can no longer produce it is very important that one ensures their thyroid levels stay within the normal lab ranges. But for many they still feel lousy when their labs are normal. Why do I say thyroid medications do little to nothing for autoimmunity? Why not just say they do nothing? Well although controversial, some studies have found thyroid hormone replacement medication may dampen autoimmunity 1, 2.
Why so much emphasis on slowing down the autoimmune process?
Well if the autoimmune process is not dampened it slowly damages your thyroid gland over time. As time progresses many are left with less and less healthy thyroid tissue and less thyroid tissue means less hormone can be produced.
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Thyroid Disease: Understanding Hypothyroidism And Hyperthyroidism
Many people diagnosed with a thyroid condition are surprised that such a small gland can have such a profound impact on overall health and well-being. But the thyroid gland plays an enormous role in human health. Throughout life, this busy gland is constantly producing hormones that influence metabolism. When disease causes your thyroid gland to slack off and underproduce thyroid hormone, or overwork and produce too much of it, you’ll know something isn’t right. Thyroid Disease: Understanding hypothyroidism and hyperthyroidism will help you recognize the symptoms and find the right treatment before you experience the long-term effects of this common condition.
- Living well with thyroid disease
Starting On Thyroid Hormone Treatment
Your doctor will decide how much to give you based on your:
- Thyroid hormone levels
If you’re older, or you have heart disease, you’ll probably start on a small dose. Your doctor will slowly raise the amount over time until you see an effect.
About 6 weeks after you start taking the medicine, you’ll go back to your doctor for a blood test to check your thyroid hormone levels. Depending on what the results are, your dosage may change.
Once your levels are stable, you’ll see your doctor for a blood test every 6 months to a year.
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You Experience New Or Worsening Symptoms
If you have lived with untreated thyroid disease for years, you may have gotten used to living with symptoms. When starting medication, your appetite may change, you may be feeling tired, or you could have a change in your bowel movements.
Some thyroid medications can also cause hair loss, which most people find frustrating and undesirable.
Talk to your doctor about these issues, as they can be the effects of your thyroid hormone levels getting back to normal. Or, you could be experiencing over-treatment, meaning that you need a dose adjustment or a different medication.
How Long Can You Go Without Thyroid Medication
However, without thyroid replacement medication, a person with overt hypothyroidism cannot function optimally and will suffer from the physical and mental symptoms of hypothyroidism. The half-life of levothyroxine is 6-7 days, which means it takes about 4-5 weeks for your body to rid itself of levothyroxine.
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Signs Your Thyroid Isn’t Working Right
Thyroid hormones affect everything from your brain to your bowels.
At least 30 million Americans have a thyroid disorder and half15 millionare silent sufferers who are undiagnosed, according to The American Association of Clinical Endocrinologists. Women are as much as 10 times as likely as men to have a thyroid problem, says integrative medicine specialist Robin Miller, MD, co-author of The Smart Woman’s Guide to MidLife & Beyond.
Located above the Adam’s apple, your thyroid produces thyroid hormone , which regulates, among other things, your body’s temperature, metabolism, and heartbeat. Things can start to go wrong when your thyroid is under- or over-active. If it’s sluggish, it produces too little TH amped-up and it produces too much. What causes your thyroid to go haywire? It could be genetics, an autoimmune attack, pregnancy, stress, nutritional deficiencies, or toxins in the environment, but experts aren’t entirely sure. Because of thyroid hormones far reach in the bodyfrom brain to bowelsdiagnosing a disorder can be challenging. Here’s how to tell if your thyroid could be on the blink.
Too little thyroid hormone coursing through your bloodstream and cells means your muscles aren’t getting that get-going signal.
“Fatigue is the number one symptom I see,” says Dr. Miller. “It’s the kind of fatigue where you’re still tired in the morning after a full night’s sleepthat’s a clue that you’re not simply sleep deprived your thyroid may be underactive.”
What Are Some Common Signs Of Hypothyroidism
This is the tricky part. Its easy to attribute the signs of hypothyroidism to something else. Stress, aging, not enough sleep, not drinking enough water. Typically, the effects creep up on you over months to years. Heres what to look out for:
Low energy level, even when you get enough sleep
Weight gain, even when you are not overeating
Skin, hair, and nail changes
Listen to your body. Report your symptoms to your primary care doctor. They will take your history, examine you, and decide if you need testing.
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Weight Loss Or Weight Gain
Because your thyroid controls your metabolism, there is a direct connection between how hard or easy it is to maintain a healthy weight and the health of your thyroid. If your thyroid is overactive you may burn calories too quickly and find it hard to keep weight on. On the other hand, if your thyroid does not produce enough thyroid hormone naturally , a slower metabolism may make it hard to keep the pounds from piling up.
Treatment for hypothyroidism should allow you to lose weight similarly to others without a thyroid issue. However, bear in mind most weight gain as a result of hypothyroidism is due to water and salt, which is only about five to 10 pounds, says Maria Villamil Jarauta, M.D., an endocrinologist at NYU Langone Health in Lake Success, NY. This means even if your thyroid treatment is working perfectly, you will not lose 20 to 30 pounds as the result of medication.
Still, if you have hypothyroidism and your weight is going up despite an initial drop after starting treatment, its possible your doctor needs to adjust your dosage. Its also possible something else is going on. Your thyroid may not be the reason, says Dr. Jarauta. Either way, its time to check in with your doctor.
Signs That Your Thyroid Medication Is Not Working
If you are on thyroid medication for an underactive thyroid, it is routine procedure to have your blood work done every 2-3 months to monitor your thyroid hormone levels. Most practitioners will measure TSH and T4. TSH is a pituitary hormone that signals the thyroid to increase production of both T4 and T3. Thyroid medication such as Synthroid is a synthetic version of T4 . When T4 is administered, TSH level decrease. This is what leads to your labs appearing normal. Unfortunately, this is not where the tale of thyroid hormone ends. This article will discuss some important concepts with respect to thyroid hormone conversion.
A healthy thyroid mostly makes T4. In fact, the thyroid makes 90-95% T4 and 5-10% T3. T3 is the metabolically active thyroid hormone. It has a much shorter half life and is used up within a few hours. T4, on the other hand, has to be converted into T3 in the liver, kidneys, and by the gut bacteria. One iodine molecule is removed from T4 to convert it into T3. The enzyme requires both zinc and selenium to function optimally. Zinc is one of the most common nutrient depletions we see clinically in thyroid patients. In fact, taking thyroid medication , can further deplete both zinc and selenium levels since it calls for increased activity of the converting enzyme .
Your doctor swears everything is fine and life goes on. Sadly, many women trust that everything is okay and this is as good as it gets. This could not be further from the truth.
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You Are Anxious And/or Depressed
If you are experiencing increasing anxiety and/or depression, this could be a sign that you need more thyroid hormone or antithyroid drugs. Anxiety can also be a sign of medication-induced hyperthyroidism, indicating that you may be on too high a dosage of thyroid hormone replacement medication. If you are taking a thyroid drug with T3, such as natural desiccated thyroid or liothyronine, you may need to reduce the dosage.
How To Treat Thyroid Problems
Now that you know more about the problems that indicate thyroid problems, what should you do? Of course, the first thing you should do is ask your doctor about your symptoms. Depending on your symptoms, you may have another condition that needs to be treated.
However, if you are experiencing several of these symptoms at a time, you most likely have a thyroid condition.
Before you start receiving treatments, first youll need to work with your doctor to get tested. Typically this will include blood tests to check the levels of T4 and T3 in your blood. When the tests come back, your doctor will help you know that to do next.
Usually, treatments include hormone replacement therapy. Iodine supplements may be prescribed in order to treat goiters.
However, if your symptoms are severe, it can be a sign of thyroid cancer. In which case youll need to visit a thyroid surgeon to remove the cancerous cells. Chemotherapy and radiation oncology are also viable options.
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