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5 Things to Do If Your Thyroid Hormone Medication Isn't Working

If you're still feeling depressed, tired and the scale won't budge, you'd be surprised how these small tweaks can get your TSH levels normalized.

For about one in seven of the 10 to 12 million Americans with an underactive thyroid gland, conventional treatment with the synthetic thyroid hormone levothyroxine just isn’t enough.1  If you continue to feel sick, tired, depressed or have symptoms like stubborn weight gain, it’s worth talking with your doctor about the best solution for treating your hypothyroidism. But in the meantime, these tips might be just what you need to help you get the most out of your levothyroxine:

levothyroxine and hypothyroidism

#1.  Time levothyroxine for optimal absorption. For best absorption into your bloodstream, levothyroxine should be taken on an empty stomach—30 to 60 minutes before breakfast, or three or more hours after dinner. Taking levothyroxine with or too soon before or after a meal or snack could reduce absorption to 64%, from a high of 80% when you’re fasting, according to the American Thyroid Association (ATA). 3 Just changing your timing could bring your thyroid levels back into a normal range. In one older but often-cited Italian study 4 of four people whose thyroid numbers were not in control despite taking thyroid hormone, researchers found that they all took their medication just 15-20 minutes before breakfast. Changing their routine, so they took thyroid hormone 60 minutes before their morning meal, improved their numbers within a month. Take it with water. In another Italian study, coffee interfered with absorption. 5 And don’t take antacids or supplements containing calcium or iron with four hours of your levothyroxine. 6

#2.  Practice patience and ask for tests. Some people start feeling more energetic and alert within a week or two of starting thyroid hormone – but not everyone. It could take a month or two to feel better. And you may have to see your doctor several times for tests of your blood levels of thyroid stimulating hormone (TSH) and adjustments to your levothyroxine dose to get it just right. 2

#3. Don't switch back-and-forth between brand-name and generic levothyroxine. Switching from a brand-name to generic thyroid hormone, or vice-versa could affect your TSH levels—even if the dose is the same. 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. That’s why the group’s guidelines recommend sticking with the drug type (generic or brand name) to keep your TSH levels steady. (Ask for it at every refill.) If you’ve 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

#4. Consider adding T3, but know that it might not help.  Stories about the purported wonders of synthetic triiodothyronine (T3) for hypothyroid symptoms are all over the internet—but don’t believe everything you read. Some endocrinologists recommend that people whose hypothyroidism symptoms persist despite normal TSH levels try adding  T3 to their levothyroxine therapy. T3 is the body’s active form of the thyroid hormone thyroxine. Enzymes in organs like the liver, brain, and heart convert thyroxine (T4) into T3 and the thyroid gland produces some as well. For most people with hypothyroidism, the body converts levothyroxine into T3. But there’s evidence this doesn’t always happen.

Early research from Chicago’s Rush University suggests that a genetic mutation could be responsible, preventing enzymes from making the conversion. But more studies are needed.9

Meanwhile, many experts maintain this unproven combo therapy isn’t ready for prime time. The ATA’s 2014 guidelines say it shouldn’t be used routinely because long-term studies have yet to prove it has benefits, while the European Thyroid Association (ETA) since 2012 has considered it an “experimental treatment modality” for people whose fatigue, depression, weight gain and other hypothyroidism symptoms haven’t waned even though taking levothyroxine alone has moved their TSH levels into the normal range. 10

Testing T3 levels in people with lingering symptoms is also controversial. In one new study, published in April 2017 in the European Thyroid Journal, researchers found that combination therapy helped 24 out of 37 people in this situation. But it didn’t seem to matter whether they had low T3 levels beforehand or if their levels rose during treatment. 11

If you’re curious about T3, talk it over with your doctor. It’s also wise to check that your health insurance covers testing and treatment.

#5. Skip “natural” thyroid medications and supplements. Many supplements claim to “support” thyroid health—but some are laced with thyroid hormones not listed on the label. Adding them to your medication could mean you’re getting too much. In a 2013 study of 10 top-selling thyroid-support products sold on the internet, researchers from Germany’s Landstuhl Regional Medical Center and from the Walter Reed Army National Military Medical Center in Bethesda, MD, found that nine were laced with T3, T4 or both in a variety of amounts. Ingredient labels listed animal thyroid tissue for some while others only listed herbs such as ashwagandha, guggul, and Coleus forskohlii. The researchers concluded that drugs were added to the supplements. 12 Supplements, including types containing a seaweed called kelp, may also contain dangerously high levels of iodine. And natural thyroid supplements may contain gland tissue from the thyroid, liver, heart, pancreas and other animal organs—raising a small but serious risk for exposure to prions, which are agents that could transmit the brain disease Creutzfeldt–Jakob. 13


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