Why Thyroid Medication Is Often Necessary | Chris Kresser

Why Thyroid Medication Is Often Necessary

by Chris Kresser

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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’s 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.

  1. The “alternative” is the nutrient most people are deficient in: iodine. Though people have been taught to fear it because of badly done research.

    Anyone interested in seeing more should take a look at Abraham’s research: http://www.optimox.com/iodine-research

    He has successfully treated a lot of patients with iodine supplementation.

  2. Hi, I’m 62 yrs old & not sure how long I have dealt with low-thyroid. But it was brought to my attention after my lab work up about 5 years ago. I am about 5’11” & weigh about 165 & have felt normal over all. I refused to take Levothyroxine for several years that was prescribed because I didn’t have any symtoms & after reading the side effects, mainly osteoperosis, which really scared me, mainly because I’m predisposed to have osteoperosis. But, my dr. brought it to my attention that I don’t have to have any noticeable symtoms, that it could be something internal, like my heart damage if I don’t take my medication. So, now I have been taking the prescribed meds,
    75 mcg. for several yrs. Several months ago I went in for my latest lab work & found that my thyroid is normal. Lately, I feel I’m loosing more hair than I have in the past. Now, my lab workup shows I’m pre diabetic. Is all this a pattern of side effects due to taking my thyroid meds? Because I was fearful of becoming diabetic, I cut out extra sugars plus fruit & refined carbs for the past 2 weeks. But, lately I have no energy & I feel extremely weak. I would prefer to do things natural without meds. I do my own fermented veggies, kombucha, kefir & fermented breads, like sour dough. Do you think that these are possitive things for maintaining overall health? I would appreciate you advice.

  3. I am 23 y.o, female. I had suspected: my TSH levels is 7.27 but my T3 and T4 were normal. They prescribed me 50 mg Levothyroxine for a start. But I am feeling irritation after taking this tablet daily? Can I stop the tablet?
    Thanks for listening! I appreciate your input.

    • Wow I’m taking the same meds. For years now no symptoms and feeling pretty good. Just made an appointment to get it checked out to see what going on and what are my numbers. I was also told I have to stay on the is Levothyroxine for the rest of my life. Oh my name is Angie

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