Why Thyroid Medication is Often Necessary

thyroidmedication

This article is part of a special report on Thyroid Disorders. To see the other articles in this series, click here.

If you’ve been reading this blog for a while, you might be surprised by the title of this post. I’ve been critical of pharmaceutical approaches in the past, and in general, I recommend avoiding the use of medication whenever possible.

However, I have no problem with pharmaceuticals if:

  1. they work,
  2. they do more good than harm, and;
  3. there are no non-drug alternatives with the same effect.

It turns out that thyroid medication meets these criteria in cases of hypothyroidism with chronically elevated TSH. Elevated TSH indicates that the body is not producing enough thyroid hormone to meet metabolic needs. And thyroid hormone is so important to the proper function of the body that the benefits of replacing it far outweigh any potential side effects of the medication.

Remember that every cell in the body has receptor sites for thyroid hormone. Thyroid hormones are responsible for the most basic and fundamental aspect of physiology: the basal metabolic rate. Since the basal metabolic rate affects every system of the body, low thyroid hormone causes a global decline in cellular function.

Here’s a list of things that can go wrong when thyroid hormones are low. It’s not complete, but it should give you some idea of how important the thyroid is to proper function.

  • Decreased energy production and metabolism in all cells of the body
  • Decreased bone quality and increase in fractures
  • Elevated cholesterol
  • Impaired phase II detoxification
  • Anemia
  • Decreased stomach acid production
  • Constipation, intestinal dysbiosis, malabsorption
  • Intestinal inflammation
  • Blood sugar imbalances
  • Gallstone formation
  • Vascular and arterial plaquing
  • Neurodegeneration, cognitive problems, depression
  • Weight gain
  • Hair loss
  • Dry skin
  • Cold hands and feet
  • Infertility and reproductive dysfunction
  • Weakened immune system

I could go on, but I think you get the point. If your thyroid hormones are low, you can’t be healthy. Period.

90% of people with hypothyroidism in the U.S. have Hashimoto’s disease. Hashimoto’s is an autoimmune condition that causes destruction of the thyroid gland over time. As this destruction progresses, the thyroid gland becomes less and less able to produce enough hormones to meet metabolic needs. This is reflected in an increase in thyroid-stimulating hormone (TSH).

Persistently elevated TSH is a sign that the body needs more thyroid hormone than it can produce on its own. This is one clear sign that it’s time for replacement medication. But it isn’t the only one. Some people with TSH in the normal lab range still find that they benefit from replacement.

Note that I’m not saying everyone with hypothyroid symptoms should be on medication. In a previous post, I discussed 5 different patterns of low thyroid function that present with normal TSH levels. These include underconversion of T4 to T3, problems with thyroid binding proteins, pituitary dysfunction and thyroid receptor-site resistance. In these cases, the problem isn’t with the thyroid gland itself or its ability to produce enough hormones, but is either “upstream” (in the case of pituitary dysfunction) or “downstream” (in the case of conversion problems, binding protein issues or resistance.) For these patterns, replacement hormones are often unnecessary.

There are many in my profession (natural healthcare) that vehemently oppose the use of medication under any circumstances. I think that’s foolish. I’m more concerned about the dangers of Big Pharma than most. But that doesn’t mean we should ignore the important role drugs play in treating certain conditions.

In fact, my philosophy on healthcare can be simply stated as: whatever works best and causes the least harm. It’ not often that a drug fits the bill. But in the case of hypothyroidism with elevated TSH, I believe replacement medication is a necessary part of a larger strategy that includes balancing blood sugar, adrenals and the immune system and fixing the gut.

In the next post I’ll discuss the many different considerations when choosing a thyroid medication.

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Comments Join the Conversation

  1. Claire says

    My recent blood results I believe showed poor thyroid results: serum TSH level: 4.15 mlU/L
    Serum free T4 level: 13.14 pmol/L
    Serum free triiodothyronine level: 4.2pmol/L

    My doctor said my levels are fine but I’m not so sure. Are these OK or should I be on medication. I am 10 weeks pregnant.

    3 years ago in an earlier pregnancy my TSH was 1.5.
    I have a feeling this recent increase in TSH may be due to a chronic infection/ inflammation with CRP 12.
    I would appreciate advice if I should go back to my doctor for medication or buy some natural thyroid supplement to help my body out.

  2. Edwina says

    I have half thyroid. The other half was removed because of goiter. Have been on nature thyroid for a year. Started to have anxiety and panic attacks, inside tremors, heart palpitations, weird thoughts, hot flashes, so about months ago I took myself to half a grain to eventually nothing. Finally found a dr that told me I was over medicated and possible allergic to dissicated thyroid. He said it would take 4to6 weeks fored to be out of system. I still have se symptoms but I am able to sleep better. Has anyone had this problem and what would you suggest?

    • Victot says

      Take a beta blocker if synthroid or the generic give you anxiety (elevated pulse or blood pressure). A beta blocker would control those symptoms until your body gets use to the artificial t4.

  3. Liz says

    I just found out I have hashimotos. I went in for a TSH level a week ago and it was 3.6, so my doctor tested me for antibodies and TSH again. My TSH a week later was 2.5 so she doesn’t want to put me on medicine. I’m trying to get pregnant with no luck and I’m wondering if it would be helpful to be on medication while I’m trying to get pregnant. I think my TSH might have been highly the week before because I was pregnant and now this week I’m not (I’m 3 days late but pregnancy test is negative). I’m just not getting clear answers from anyone and I’m concerned about my test results.

  4. andrea brueckner says

    i no longer have a thyroid, radioacive iodine,i have b een on synthroide for almost 30 years. should i have the amount adjusted if im not feeling right. i never have had changes to the amont i take. is there alternatives to synthroid, i htink im allergic to it now

  5. keith says

    i have taken synthroid for about 9 months and gained 20 pounds. so i switched to 90mg (i think it is 1.5 gr) and have stopped gaining but i can’t loose the weight. i eat and exercise the same as i did before i started synthroid. my tsh was 2.06 when i started this and the tsh is now .20 and the t3 level is 4.0 on armour. whats going on, i thought i was supposed to loose weight on this treatment. i do feel better in a lot of ways otherwise. have a great day keith

  6. Sylvia says

    My TSH result was 9.8 after I had a BUPA health assessment last September. Advised to test 3 months later (NHS) and now shows TSH 6.3 BUT tested positive for antibodies. Doctor says don’t need medication. i have requested another test in 6 months (she wanted to wait a year!). I am 64 year old female. Don’t have any extreme symptoms just usual aches and pains of old age!

  7. Toh Annie says

    I have normal thyroid readings but the Dr said I have thyroid, However he did not prescribed any medication. Please advise

  8. Mandy says

    My tsh is 0.01 and have a swelling on face and puffy hands weight going up what should I do I am replacing my medicine I am taking low dose but my face is puffy what cause

  9. johnna says

    I’m wondering if anyone has felt horrible on the thyroid mediciation? Im only 24, (found out when I was about 14 I was hypo) I’ve had some endos tell me I was born with hypothyroid, but not until this week did a new endo tell me I actually have hasimotos… he said my anti bodies broke the chart they were so high…I’ve had tsh levels over 100 in the past and most recently they’re about 27…I have no symptoms that I feel though,i actually feel fine.. but my endo says I HAVE to take the synthroid, even though it makes me feel awful..ive tried it over and over again and each time.. I get extremeee anxiety, I get body tremours, heart palps.. I mean this is every time I go on the medicine with all different doses…I feel far worse on it to the point I feel the need to stop taking it . and its so discouraging because I want normal levels. I DONT eat a healthy diet, im thin, but I eat way too much pizza haha.. does anyone have ANY recommendations for me.. Im getting my script filled today to try this once again but im already nervous about it

  10. Dave says

    Chris, are there any cases where people were able to heal their Hashimotos and regenerate their thyroid by permanently rebalancing, healing the gut, and changing their lives? The thought that I am permanently going to have to take medication because my thyroid is toast no matter what is very depressing :-/

    • Anna says

      I agree with you Dave, and would love to know this myself. I have tried the Vitality Herbs and Clay supplements approach…they speak much about the thyroid and healing, not sure if you are familiar with them. Just something I came across. But this forum is much more robust and realistic, since folks actually post what works for them and what the symptoms are…
      Anyhow, just stuff I was looking at and wanted to share, since I also, do not want to have to take the meds.

  11. bernardette says

    Hi, what if the problem is from the pituatary instead of the thyroid? what treatment is there for regulating the pituitary to function well?

  12. Edyta says

    Hi Chris it is a very old post but I have found it now, so I am trying my luck.
    My TSH lowered from 13 to 7.6 within a month and without medications. My t4 remained at low point within the range- 11 and t3 in the middle – 4.9 as far as I can remember. I have a few worrying symptoms such as low body temperature, ibs, fatigue and occasional brain fog, with worsening memory. I do not want to take thyroid medications because I think that my low Sex hormone binding globulin leave me with an excessive amount of estrogens which affect thyroxine binding globuline. What’s the best method of correcting excessive estrogen in this situation? I came of birth control pill and that’s when the thyroid problems started.

  13. heather says

    Hello Chris,
    Do you have any evidence of being able to control hypothyrodism without medication ie with a mixture of homeopathy, acupuncture and diet and supplements, stress management etc. I have just been diagnosed with high tsh, normal T3 and lowT4.
    I eat a very healthy virtually paleo diet but have had huge amounts of stress over the years and suffer from adrenal fatigue. I am also in Menopause and have a lot of joint pain.
    I would really like to try and tackle it naturally before I go down the medication route. I am just about functioning at present but have quite a few symptoms.
    I would really appreciate your opinion on this.

    • Anna says

      HI Heather, and Chris and other posters on this forum-
      Wow, I started reading this — and have not been able to tear myself away from the computer. It is like I found a revolution. I have been stumbling over the last few years, and now months with gut issues, bouts of rashes (eczema)– but I have had that since a child, and now constipation and a polyp removed, and most recently irregular periods, a cyst on my ovary (it disappeared 6 weeks later), and waking up every single night. I had my labs done, (I finally went to an integrative doctor) and she told me I may have thyroid issues. I could not make much sense of what she told me about T3, and T4. TSH, etc…My numbers were TSH 2.13 on a scale of 0.450-4.500, UI/mL, and the T3 at 12.3 ng/dL on a scale of 9.2 – 24.1, and then T4, 0.97 ng/dL on a scale of 0.82 -1.77.
      And I do know my glucose is high, because even with fasting, I as at 91 on a 65-99 scale.
      So my TSH seems normal but my T3 is low?
      All this stuff was overwhelming. And reading the posts here, I am getting the hang of it, but still is overwhelming. It’s like you need to heal your gut, to heal your thyroid, but you need to heal your thyroid to heal your gut.. AAAHHHHH. And I have been reading for years and trying to adapt my diet with things like the Maker’s Diet and the Body Ecology Diet.
      Anyhow here try any of those? I am not gluten free completely (but I don’t eat breads ans such). I never made the association with gluten, and I did not have the poop test done, but maybe I should. But all things point to me avoiding gluten full time.
      I stopped with the dairy, and only do almond milk, or raw goat milk kefir.
      Anyhow, having read all this and seen my symptoms I seem to have the thyroid issues.

      And as Heather said above, can I use homeopathy and not take hormone replacements to regulate my thyroid and gut into balance?
      And also why Paleo? The reason I ask, is that I still need/want the fiber since that has greatly alleviated my constipation. What can help with my sleeplessness? I am taking magnesium now.

      And it seems there are so many systems working together and all at once in our bodies, that it is hard to regulate one, and not affect others, and get the exact right combination (diet, meds, homeopathy etc..).
      I started taking Vitality Herbs and Clay as my only form of supplement. Based on the premise that our bodies produce whatever they need, we just need to detox, and get them into balance. The body will produce what it needs, and there is no one single drug or answer that can fix the complexity of what our bodies are.
      Amazing how we are created as human beings, with all our hormones and systems, and how we are designed to have all these things work to keep us functioning.
      I am very happy to see folks on this post who have found relief and hope.
      Best to all, and I will continue my quest for wellness. Thanks so much for this great website and its knowledge.

  14. Anne says

    Thank you for this article, it really IS spot on. I had Graves’ and it was treated in the 80’s with PTU. That was un-fun. I have been on a rollercoaster since. TSH as high as 120, now it’s 12 thank goodness. But still not good enough. What a frustrating disease this is.

  15. Alice says

    to answer about thyroid meds and high antibodies I would be a perfect example. I’ve had antibodies over 13,000 and at last check they were 7640 but thyroid meds have never worked for me and i’ve tried different types. I have addressed underlying conditions and gone gluten free having worked with a dr. trained by Dr. Kharazian and since doing so i’m off thyroid meds completely and my thyroid labs are just fine. I use coconut oil in place of them which has taken care of any lingering hypothyroid symptoms. On my thyroid group we have a few members who’ve also been able to go off meds or greatly reduce their dose since going gluten free and doing the protocol and I see a few more positive results from others going gluten free every few days.

    • Gretel says

      I have antibodies at 286, all my other numbers for my thyroid are great. Doctor put me on 45mg of Armour Thyroid meds. I don’t see any change in how I feel/look etc. She now only takes the TSH test…I took the test through an online med company and paid for it myself. Why doesn’t she take this same test (antibodies)? Should I ask and see if I can stop taking my meds? I thought it might help with my asthma. Is Glueten free that helpful?

  16. Lynn says

    I have spent a LOT of time on thyroid boards during the past two years. During that time I have seen many people come and go. Many will turn up desperately hoping that if their sex hormones optimise, their adrenals heal or they go off gluten, they will be ‘cured’. Experience has shown me however that this just does not happen. Optimising sex hormones often means people need less thyroid and going off gluten really makes a MASSIVE difference (I never got properly well until I went off gluten) but it is the rare person whose thyroid starts to function properly after they have taken these steps. Instead, they waste years trying to ‘heal’ and ‘cure’ themselves, when they could have had proper thyroid function restored instead.
    I think eliminating gluten would PREVENT hypothyroidism. I also think optimising adrenal and sex hormone status could also play a preventative role. However, experience with people who have gotten well has shown me that once the antibodies get high enough and the frees low enough; the thyroid will rarely come back online. Even if it does, should a person really have to waste years of their life being miserable and waiting for it to do so?

  17. Chris Kresser says

    I don’t agree with that statement, because I don’t believe that everyone with high antibodies needs to be on replacement.  Antibodies fluctuate throughout the course of disease and aren’t necessarily indicative of the autoimmune attack.  Antibodies simply mark a tissue for destruction themselves; they don’t do the destroying.  Nor do I necessarily believe replacement is necessary for people with low FT3 or FT4.  It’s possible they may have elevated TBG secondary to estrogen dominance.  In that case, correcting the estrogen dominance may be sufficient to reverse the symptoms without replacement.

  18. lynn says

    I’m getting very checky here, but how about:
    “It turns out that thyroid medication meets these criteria in cases of hypothyroidism with chronically elevated TSH, low free thyroid hormone levels or high antibodies. These markers indicate that the body is not producing enough thyroid hormone to meet metabolic needs. And thyroid hormone is so important to the proper function of the body that the benefits of replacing it far outweigh any potential side effects of the medication”.
     
     

  19. Chris Kresser says

    I changed this paragraph:

    Persistently elevated TSH is a sign that the body needs more thyroid hormone than it can produce on its own. This is one clear sign that it’s time for replacement medication. But it isn’t the only one. Some people with TSH in the normal lab range still find that they benefit from replacement.

  20. Chris Kresser says

    I see what you’re saying now.  Perhaps I should have been more clear.  I didn’t mean to imply that high TSH is the only time meds may be helpful.  Just that it’s a clear indicator that they’re necessary.  I’m aware that many people with TSH in the normal lab range will benefit from thyroid meds.

  21. lynn says

    I know you have because I read all these great articles. Which is mainly why I am confused by your high TSH = thyroid meds stance. I have always had a ‘normal’ TSH, yet my antibodies were through the roof. I balance my blood sugar, am gluten free and low carb, and treat my adrenals. Yet I still am sick as a dog without my thyroid medicine. So, I really don’t get the emphasis on TSH in this post. It is a dangerous lab, which leaves people very ill for decades, as it takes so long to rise if the thyroid is not functioning correctly.

  22. Rachel says

    Thanks so much for this series on thyroid issues.  Your blog is one that I regularly follow as I try to learn all I can about allergies, asthma, and autoimmune disease.  I just started a Paleo diet about 2 months ago, and while I feel great, I still need to be on medication for all three problems.  In fact, I’ve been on Synthroid for 20 years, Allegra for about 4 years (just seasonally), and Advair for 8 months.  While I’m very hopeful that someday I will be able to get off the allergy and asthma medications, I wonder whether it’s even possible to do without Synthroid.  Do you have any experience with this?  How long does it take for the body to heal?

    • Chris Kresser says

      As I said in the article, it may never be possible (or desirable) to stop taking Synthroid – presuming it’s the right medication for you. To answer that question, you need to know what the underlying mechanism is. There’s no “one-size fits all” approach to thyroid medication, as I’ll explain in the next post. But if you have chronically high TSH without medication, and/or Hashimoto’s, it’s likely that you’ll always need replacement.

  23. says

    I’ve just recently been diagnosed as hypothyroid and very likely with Hashimoto’s (I tested positive for antibodies). My TSH was not very elevated – always hung around in the middle of the range but on a couple of tests went to the higher end of the range. Unfortunately I live in British Columbia where the range is very wide for TSH – .3 to 5.5. I finally found out about testing for Free T3 and Free T4 and that’s when the FT3 came back very slightly below the range. My FT4 is nothing to write home about either. I’ve since found out that TSH fluctuations are par for the course with Hashi’s, so it’s possible that I’ve had a TSH out of range in the past but just didn’t luck out enough to get tested that day.
    I will tell everyone I know who is having symptoms of hypo to get all three (plus antibodies) tested and to not give up until they do. I’ve been very likely dealing with this since I was 12 and I got unexplained hives on my legs for 2 years and developed pompholyx on my hands, which persists seasonally to this day. Hives are often a sign that Hashi’s is developing. I’m 38 now and have suffered fatigue and weight gain, infertility and a bunch of other issues my whole adult life. I’m super happy to finally have a diagnosis but I know it’s just the beginning of things now. Thanks for your site, I’ve learned a ton since I stumbled across it!

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