Why Thyroid Medication Is Often Necessary | Chris Kresser
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Why Thyroid Medication Is Often Necessary

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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. My Thyroid went out and I could not move, I had changed my diet, eating shredded wheat, ground turkey, taking brewer yeast for B vitamins, doing everything that Drs. used to tell you when you get older. They all are full of gluten, as soon as I got off gluten I felt better. I had anxiety, depression, tired, constipation, brain fog…. I didn’t know I had celiac. If I would have ate what I wanted, I might not have had such severe symptoms. that was along time ago and I am one of the celiac that don’t heal after stopping gluten. I had hypoglycemia and eat a lot fat, the Drs. told me to eat carbs like spaghetti, that almost killed me, I went to work and would black out. I then developed chemical sensitivity, the Drs. gave me anti depressants, I didn’t sleep for 4 days. Now I have been diagnosed hypothyroid, I have had symptoms a log time and telling Drs. I am tired. I need to make sure I don’t have gluten or other foods causing it. I have taken cow thyroid and tyrosine and feel a lot better, I found Ginseng works great if your tired from adrenal fatigue. I don’t want to take synthriod and get dependent on it, I do believe that my thyroid is low, high tsh and normal t3,t4. Free t3 and t4 are unknown, they wont give me the antibody test. Said it wouldn’t matter, I would still have to take meds. I have found out something after all these years. There is a physical reason for every health condition. it is rarely ever just in your head. My B12 got low about 2 yrs. after celiac, that’s how long your liver store it, use Methylcobalamin only or your wasting your money. My C ran out and had all the low vit. C symptoms, and just lately my D ran out, aching joints and tired, Vitamin D makes most people nauseated, It made me real sick, I cant take oils and vit. D is oil solliable. If you have trouble with oils try grape seed oil. I go out in the sun shirtless 10 minutes for vit D. Any cheap vit. C works, I have a citrus allergy, so no citrus for me, vitamin C absorbic acid usually made from corn, I cant eat that either. I have leaky gut from my immune system attacking it, so all kind of food allergies. I am saying all this to give you some ideas, maybe one of these things is causing your problem. Milk protein is very similar to gluten and your body cant tell the difference. I wondered why soy bothered me, till I read the comments here. Foods have high hormones, cows last 2 yrs. then to hamburger, pesticides, GMOs, thanks Monsanto. Chickens grow twice as fast then some die on aspartame. There is chlorine in water, it is a carcinogen. Sugar is the worst thing you could eat, fat does not make you fat, sugar makes you fat and hardens your arteries and the outside lining on your disks causing disk degeneration in your back. There is a lot of fat people now days and our food is causing most of our problems. Fragrance is made from petroleum chemicals and is making people sick, all that fragrance is in your food and water, I can taste it. why does everything have to fake smell good. the air in most areas is full of trash truck masking scent. that is a chemical and its in your water.

  2. I just 19 and diagonized with TSH About 9.6 in my very first test should i take medicine..for that…..

  3. My TSH level is 0.82. What does this indicate about the functioning of the pituitary gland? Should I go for any further investigation?

    • I don’t know much but it sounds a bit low… mine was 4,4 … Dr put me on meds now mine is 1,7 …

  4. I see no comments from men, is this a women issue mostly? I a male, my TSH is high, my Dr wants to do another test in 4 wks, if that test is high he’ll put me on Thyroid med. My problem that’s led upto doing TSH test; swollen feet, ankles, legs, thighs. I’m not sure my problem is caused by my TSH results.
    What is your opinion?

  5. I’m 36 years old male, healthy, sporty. My thyroid levels:

    TSH: 13.2
    Anti-thyroglobulin Tg (chemiluminescence): >500
    Anti-peroxidase TPO: <1300

    I was diagnosed Hashimoto last year but I feel as good as ever, have none of the symptoms they associate with Hashimoto. Went to the doctor and she told me to take medication.

    My question: Do I really need to take medication if I feel good? I was told – we are our best doctors because only we know how we feel. So if I feel nothing, why would I take medication?

    But my parents are putting a lot of pressure and I feel I may regret doing nothing. Any advice? if so really appreciate you taking 2 minutes to write me a line, thanks so much

    • Ricardo,
      I’m curious what you’ve heard from others, but I agree that “we are our best doctors because only we know what we feel,” or “physician heal thyself.” I wondered if you’ve gone off gluten or dairy? It’s possible that going off of these might normalize your numbers. Thyroid drugs are pretty powerful and do give people side effects. If you are feeling good I don’t think you should mess with a pharmaceutical. I tried levothyroxine for a short time and felt like I was going to die. I’m much older than you, 65 years and have resisted going on the pharma drugs. You might have your parents take you to a naturopath if you have some symptoms.

      • I just realized you are 36, you might just take yourself to a naturopath, though some of them are very ready to prescribe the big pharma drugs. Your testing might vary completely the next time you get testing. The testing could normalize on it’s own, I believe.

      • Hi Gail

        I tried going off gluten but it proved too hard (given my childhood eating habits). I just can’t resist bread, pasta, etc.. But my body never gave me any signs of gluten intolerance…so I went back to normal diet (I do eat always wholegrain bread/pasta though). Diary wise, I stopped drinking milk but still eat cheese and organic yogurt (in the morning with oatmeal and nuts). I did stop drinking coffee because I was hooked (all addictions are bad for health). Plus, every time I did not take coffee, I’d get a headache, so I stopped completely and now I never have headaches. That was a good example of me being the doctor. Haven’t tested for sometime now, but assume I’m good as I feel great.

        • I just don’t like to be dependant on big pharma for optimal health.I’d rather try looking and diagnose the underlying causes

          • I think that is a good suggestion. I take the tablets too and I’m not very happy with them at all.my thyroid is stable and I’m cutting them down. I eat healthy and lots of vitamin A. Healthy food is more my style than tablets hope u sucide… Gayle….

  6. HI i been taking 150mcg Levthroxin for 13yr’s now, theres time where i’ve gone without it,which i know not good! with my thyroid sometimes goes up & down but now i have it under control. I was wondering would it be ok to stop taking them and which to a thyroid supplement like a vitamin instead ???

  7. I have been taking Armour Thyroid, after a TSH of 4.8. I have been taking it for 2 months and after a few weeks, I started having terrible nausea and several loose stools a day. The Pharmacist said those are common side effect of Armour. I didn’t want to take Synthroid, and from what I hear, it can have the same effect.
    My recent TSH was .72. The doctor says it is great! I’m wondering, though, if my symptoms indicate that my dosage is too high.

    • I have been taking levothyloxie for a long while they said I jade to cut it down from 150-125 .now down to 112 they said I’m over medicated . What does this mean in my health I had cancer 2010.?

    • hi my name is marion and i have hashimotosdisese i havebeen taking thyroid pills for 15 years iam on a rollercoaster i have taken levoxyl 75 that had bad side effects now iam taking tirosintand cytomel my blood work came back in range but still not feeling wellthey repeat onme i tried armour last year that worked for a while sometimes i get dizzy and brain fog if you have any advice for me i would be thankful help me please

  8. This the first time I’ve come across web page. I’ve concerns about my Levothyroxine Tablets as I feel I would be better without them. I’m on 125mg per day.

    My Thyroid function test.

    (MRE) – Satisfactory no action taken

    My, serum TSH level is 4.64 mU/L (0.27 – 4.2)
    serum free T4 is 18.7 pmol/L (12 – 22)

    Request states patient is on T4 replacement.
    Over 60 years TSH 0.27 – 4.2 mU/L
    fT4 not above 25 pmol/L.

    I’m also a diabetic, I still feel very tired, fed up and thinking of asking my doctor to take me off them, What is the point of taking them! I feel, I don’t feel better at all, I’ve put on weight as well,

  9. I need serious help from someone who understands thyroid issues. I’ve been dealing with the issue of not being able to lose weight no matter how hard I try; how healthy I eat and how active I am. and recently I’ve been noticing a lot of fat gain in a short period of time. So I got my thyroid checked and my levels are: TSH is 1.03, T4 is 9.6, T3 is 3.1. Are my levels normal? My doctor wants me to start taking levothyroxine.. do I need to? will it help my issues? any input would be extremely helpful

    • Hey, I have autoimmune thyroid disease etc, I personally wouldn’t be taking levothyroxine or upping my dose with that result as tsh is normal and this is what gp’s normally use to diagnose but I suppose may depend on whether your t4 test was total t4 or free t4. If it was total t4, then it is low, if it was free t4, then this is okayish as long as doesn’t keep going lower. I would suggest going for a second test as things such as illness can affect results sometimes. Are you feeling tired, slow, digestion issues or any other thyroid problems? If you are feeling really healthy, I would suggest looking into everything much much further before starting meds including nutrition and diet and food intolerances etc. In terms of weight loss, I find the most weight I can put on is a stone when my thyroid is low and the most I can lose when levels good is also a stone and I think that this is generally accepted as the case so wont make much difference to your weight. I have many autoimmune problems and loads of different diagnoses which all dissappeared when I gave up gluten and am on less thyroid meds now so take a little longer investigating and definately get retest :o)

      • Oh water retention is normally the reason behind any extreme weight gain for me, are you drinking enough water etc? Basically check everything else first x

  10. Hi i am 26 yrs old,my tsh was 12.5 last yr but now its 2.5 . I am still taking medicine, how long medicine will go on ??

    • I was diagnosed with hypothyroid about a year ago. I felt perfectly fine but it showed up in a routine blood test. My dr. put me on Levothyroxine and in about a week, I developed every symptom of low thyroid and felt completely miserable. Two months ago I asked her to put me on Armour and it helped with the brain fog and mental confusion but I still felt completely exhausted and slept way more than normal. She recently told me I could stop the thyroid med for 2 months since I was having a hard time accepting the diagnosis. I read a lot about coconut oil capsules and decided to try them. After a week of being on the coconut oil and not on any thyroid med, I got up today with extremely high anxiety. I was diagnosed with generalized anxiety disorder back in 1996 and have been on meds for it ever since. I called my dr.’s office and told her to go ahead and renew my thyroid med which she wanted to do but at a little higher dose. She says my T3 and T4 are fine but my TSH is 4.8. What I really want to know is will it hurt to take the thyroid med AND the coconut oil capsules?

  11. I had a horrible time with Levothyroxine .25 I felt like I drank 500 pots of coffee. I couldn’t sleep, eat, drinking a cup of coffee made it worse. I felt like my head was going to explode all day long. That happened with one pill. The next day I got up and this voice says do you really want to feel like you did yesterday? I took half 12.5 same thing just a little less and I stopped taking it. I already take Propranolol. That could be why I felt like exploding. All I know is my TSH was at 12 the last time they checked it. I refused to take the meds and it might be a little higher.
    My opinion my thyroid issue started when I was in menopause and had 50 hot flashes a day. I’ve been eating a couple of eggs a day and feel I have more energy.
    Any ideas on a medication I can get from the Dr for my thyroid that won’t make me feel so anxious? She thinks it’s my anxiety but I can tell the difference between anxiety and what that pill did.

    • Yes, I had horrible reflux when my thyroid went out…but have never seen low stomach acid under a thryoid symptom before (this post is the first). My doctors have always treated this with acid blockers (which would do the opposite of what is needed if low thyroid actually suppresses acid). I just started having terrible reflux again…and just had my blood work done. I think that my levels might be crazy again. Although doctors have advised acid blockers, I think I will try using pepsin instead.

    • Hi i am taking Levothyroxine been two months. This med is very well tolerable. I have no problem what so ever.My thyroid Tsh was 4.97 and i feel tired all the time, but since i am taking this med i am feeling very well.

      • I also take thyroid and sometimes u get tired of taking it sometimes it works and sometimes if I don’t take it I feel like I can’t do anything I just want to lay around and b lazy all day long

  12. 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.

  13. 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?

    • 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.

  14. 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.

  15. 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

  16. 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

  17. 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!

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

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