What You Need To Know About Thyroid Medications

Overview of most common thyroid problems

The thyroid gland is an important endocrine gland located in the neck and shaped like a small butterfly. It is responsible for secreting hormones to control several bodily functions. Its main role is to control your body’s metabolism (the process that enables your body to convert food into energy that can be used by the body). 

Complications with the thyroid are very common, with around 20 million Americans experiencing some form of thyroid disease, many of which go undiagnosed.¹

Graves’ disease: Graves’ disease is an autoimmune condition in which the body attacks its own healthy cells. In Graves’, the body specifically attacks the thyroid stimulating hormone receptor (TSHR), resulting in excessive hormone secretion (hyperthyroidism). It affects women more than men, with a gender-specific incidence of 37.9 per 100,000 population for women.² ³

Hashimoto’s thyroiditis: Hashimoto’s is another autoimmune condition. However, in this case, the body attacks and destroys cells of the thyroid gland itself. As a result, the body is unable to produce sufficient thyroid hormone (hypothyroidism). 

Goiter: Goiter is a condition in which the thyroid gland swells. It can occur in both hyperthyroidism and hypothyroidism. The most common cause is iodine deficiency, as iodine is required to synthesize thyroid hormone. However, other causes include autoimmune conditions or inflammatory conditions. Females are around four times more likely to develop goiter. 

Thyroid nodules: Thyroid nodules are solid or fluid-filled lumps that can form in the thyroid. Most are benign (around 90%). However, they require removal if they’re suspected of being cancerous.⁴

Treatment for thyroid problems

Undiagnosed and untreated thyroid problems can lead to the risk of serious complications, so it’s important to talk to your doctor if you’re experiencing any symptoms. 

However, the good news is that treatment is available, and most thyroid complications can be managed with short-term or life-long medication. Your treatment program will differ depending on whether you’re experiencing hypothyroidism or hyperthyroidism.  

Starting on thyroid hormone treatment

Your doctor will give you your dose based on the severity of your symptoms, as well as your age, weight, gender, and if you have any comorbidities or are taking other medication.

When initiating treatment, your doctor may start you on a lower dose to avoid over or undertreatment. 

If you’re older, your doctor will have to take more precautions before starting you on treatment. Comorbidities are more common in elderly patients, some of which can present with the same symptoms as hypothyroidism, making it important to ensure that your doctor has made the correct diagnosis. 

In addition, hypothyroidism drastically impacts heart function in older adults, so it’s important to start with a smaller dose of medication initially or to carefully monitor the heart rhythm and function in response to medication.  

How to take your medicine

It’s best to take your medicine on an empty stomach — either 30–60 minutes before breakfast or 3–4 hours after dinner. It’s given orally as a pill, so having a glass of water with it will help you swallow it whole. 

Common thyroid medications

Thyroid hormone supplements

Levothyroxine is the first-line treatment for hypothyroidism. It’s a synthetic form of the body’s natural thyroid hormone. 

Some trials have been underway to investigate combining levothyroxine therapy with liothyronine, another synthetic thyroid hormone replacement, for patients who still have insufficient levels of thyroid hormone or are experiencing persistent symptoms. Further research is required to optimize this combination therapy treatment to best address symptoms and produce overall improved treatment outcomes. 

For hyperthyroidism, treatment entails either antithyroid medication or radioiodine therapy. Thionamides are a form of antithyroid drug that inhibit the synthesis of thyroid hormone. Methimazole and propylthiouracil are most commonly prescribed.

Treatment is generally recommended for at least 12 months. Beta blockers are often administered alongside antithyroid medication to help alleviate symptoms. 

Radioiodine therapy involves killing the overactive thyroid cells, resulting in a reduction in thyroid hormone levels. It’s available as a capsule, in liquid form, or as an intravenous injection.  

Surgery may be an option for people not responding to drug treatment or experiencing other complications. This can involve either partial or entire removal of the thyroid. Following surgery, you’ll have to take thyroid hormone replacements to maintain normal levels of thyroid hormone.  

What are the typical doses of thyroid treatments?

In hypothyroidism, the overall goal of treatment is to restore levels of thyroid stimulating hormone (TSH) as well as address all physical and mental symptoms. Levothyroxine is FDA approved for treating hypothyroidism. The initial dose should be 1.6mcg/kg/day with a 12.5- to 25-mcg/day dose adjustment every 6–8 weeks if necessary. 

If you’re experiencing cardiac disease or are over the age of 65 years, you should be started on a levothyroxine treatment of around 25mcg/day. Pregnant women require a larger dose of levothyroxine for hypothyroidism due to the hormonal changes occurring during pregnancy. 

If you’re receiving treatment for hyperthyroidism, the dosage of antithyroid drugs can vary depending on the extent of the disease. For example, the dosage of methimazole can vary from 5–60mg. Other factors also have to be considered regarding how your body metabolizes the drug, including your age, weight, and gender.

Signs your thyroid medication dosage is too low

Hypothyroidism: The risk of undertreatment is cardiovascular disease and persistent symptoms. It’s important to remember that medication will take time to reach its peak effects, around six weeks, so you won’t have immediate alleviation of symptoms. However, if you’re still experiencing symptoms of hypothyroidism, including fatigue, cold intolerance, constipation, depression, and impaired memory, then it may be a sign that your medication is too low. 

Hyperthyroidism: Too little medication means that your body’s metabolism is still working too fast. This means you’ll be experiencing symptoms like fatigue, heat intolerance, sweating, weight loss, and a rapid heartbeat. If this is the case, talk to your doctor about potentially adjusting your dose. 

Signs your thyroid medication dosage is too high

Hypothyroidism: Risks are involved with overtreatment as it can lead to atrial fibrillation and osteoporosis. Signs that you’re taking too much medication include common symptoms of hyperthyroidism, such as heat intolerance, fatigue, and a rapid heartbeat. 

Overall, your doctor should be monitoring your medication initially after 6–8 weeks of first administration. But once you are on the correct dose, this can be extended to quarterly or yearly checkups. 

It’s really important to be transparent with your doctor about any symptoms you’re still experiencing so you and your doctor can address them early. This will allow you to boost your overall well-being and health, limiting the chances of any side effects or other complications.

Tips for taking your thyroid medication

Setting a timer or alarm on your phone can help remind you to take your medication. Taking medication at the same time every day can ensure you don’t forget, and it easily incorporates it into your routine, so you don’t have to think about it as much. Keeping it somewhere visible and easily accessible can also help to make this easier on you. 

If you miss one dose, it’s nothing to be worried about — just skip that dose and take your medication at your normal time the next day. 

How do you know your medication is working?

Ideally, your medicine should resolve your thyroid hormone levels so they’re at a normal level and you should no longer be experiencing any symptoms. Ongoing follow-ups with your doctor will enable them to check that your thyroid hormone levels are returning to normal. When this isn’t the case, your doctor may investigate potential changes in your medication dose. 

When your symptoms don't go away

In around 5–10% of patients who are successfully treated with levothyroxine therapy, some symptoms persist, such as impaired cognition and depression.⁵

If you’re still experiencing symptoms, talk to your doctor to see if your dose needs adjusting or if any other potential drug or nutrient interactions are preventing your medication from working. Being symptom-free is the aim, so you don’t need to feel like you’re stuck with your symptoms forever. 

What are the most common side effects of thyroid medications?

For hypothyroidism treatment with levothyroxine, some potential side effects can occur, including anxiety, insomnia, weight loss, and irregular heart palpitations. However, these can be avoided by having your doctor monitor your dosage, check that thyroid hormone levels have been restored, and adjust your dose if necessary. 

Only about 5% of people experience adverse effects on drugs for hyperthyroidism. These are generally mild and temporary and can include gastrointestinal distress and itching.⁶

Interactions with other medications

Some drugs are known to interact with the absorption, availability, or metabolism of levothyroxine. These include calcium carbonate, ferrous fumarate, and sevelamer. Iron supplements also limit the absorption of levothyroxine. 

It’s recommended to take these drugs at separate points in the day, at least four hours apart, to minimize or avoid any negative interactions. Levothyroxine absorption is also affected by some gastrointestinal conditions — including coeliac disease, Helicobacter pylori gastritis, and autoimmune atrophic gastritis. 

Stick with treatment

Medication nonadherence is relatively common in any chronic condition and is often the cause of failure to reach treatment targets. Having to take medication daily can be tiring. If you aren’t educated on the benefits of your medication, have a strained relationship with your doctor, or are worried about adverse side effects, you’re much more likely to stop taking your medication. 

It’s important to find a doctor you trust and express any fears or concerns you have with them. This will allow you to stick with your treatment and give you the best possible outcomes for the future. 

The lowdown

The thyroid is an important gland that secretes hormones that have effects on essentially all of our bodily functions. If you’re experiencing thyroid complications, medication is available. It’s really important to check in with your doctor as early as possible to identify the best next steps for you. 

In most cases, treatment for thyroid problems involves daily medications. It takes some time for your medication to peak, around six weeks. If you’re still experiencing symptoms at that time, then your doctor may adjust your dose to address this. The good news is that adverse side effects are uncommon and it’s possible to be symptom-free. 

People also ask:

What should you avoid when taking thyroid medication?

As calcium interferes with levothyroxine, it may be best to avoid eating calcium-rich foods at the same time as taking your medication. Try to leave at least a four-hour gap between taking your medication and consuming foods high in calcium, including milk and cheese.

Fibrous foods and soy products have also been shown to limit the absorption of thyroid medication, so it’s recommended to leave a one-hour gap between taking your medication and consuming foods high in fiber, like breads and cereals.