Should I Take Thyroid Medication?

Navigating Thyroid Medication Decisions

Tired of feeling cold all the time and experiencing unexpected weight gain? When you have hypothyroidism, your body struggles to produce enough thyroid hormone—crucial for maintaining metabolism and overall function. By giving your body what it lacks, thyroid medication can help kickstart your metabolism and restore your energy levels!

The Doctor Recommended Medication—Should I Take It?

Your thyroid test came back, and you’ve been diagnosed with hypothyroidism. Your doctor recommends starting thyroid medication—but should you take it?

I understand the hesitation. The world of medications can feel overwhelming, especially with concerns about side effects and pharmaceutical influences. In our practice, we only stand behind a select few medications for these very reasons. Thyroid medication happens to be one we support—and here’s why.

When it comes to treating hypothyroidism, thyroid hormone replacement therapy is highly effective. This medication, often called levothyroxine, provides thyroxine (T4), the very hormone your body is struggling to produce. The best part? You might start feeling better within just two weeks of starting treatment (1).

By taking levothyroxine daily, you can restore normal thyroid hormone levels and start feeling like yourself again.

Understanding Your Thyroid Medication Options (1)

1. Tablets

The most common choice for thyroid replacement therapy, tablets are available in color-coded doses—12.5 mcg, 25 mcg, 50 mcg, 75 mcg, and 100 mcg—making it easier to adjust based on your thyroid-stimulating hormone (TSH) levels.

2. Soft Gel or Liquid

These forms work similarly to tablets but may offer better absorption for:

• People with stomach issues
• Those who’ve undergone bariatric surgery

Heads up: Soft gel and liquid versions are usually more expensive. If cost is a concern, increasing the tablet dose (with careful TSH monitoring) could be an alternative.

3. Brand vs. Generic

Whether you choose brand-name (like Synthroid) or generic (Levothyroxine), both work effectively. The choice often depends on availability, cost, or personal preference.

Maximizing Medication Absorption (1)

• Take levothyroxine by itself—do not take it with other supplements or medications without informing your doctor
• Morning option: 30-60 minutes before breakfast
• Night option: At least 2 hours after your last meal if taken at bedtime

How Long Until You Feel Better?

You might start feeling improvement in as little as 2 weeks, but it usually takes at least 6 weeks to see changes in your TSH levels (1). With the right dose and consistency, levothyroxine can reverse all symptoms of hypothyroidism.

💡 Pro tip: Levothyroxine dosing often requires adjustments at the start. If your doctor isn’t monitoring your thyroid labs every 6-8 weeks when you first begin medication, it may be time to find a provider who follows up more closely.

Understanding Potential Side Effects (1)

Adverse effects from levothyroxine are rare when taken at the correct dosage, but here’s what to watch for:

• Overdosing: Taking too much can swing you into hyperthyroidism, leading to fast heartbeat, heart disease, or stroke—especially in older adults
• Underdosing: Not taking enough increases the risk of complications like heart disease from prolonged untreated hypothyroidism

💡 Reminder: Regular follow-ups with your endocrinologist are essential to ensure your dosage matches your symptoms and lab values.

Thyroid Medication During Pregnancy

Absolutely! Levothyroxine is safe during pregnancy and breastfeeding. In fact, it’s vital for healthy conception and pregnancy outcomes.

• Studies show that hypothyroid women often need higher levothyroxine dosage during pregnancy (3)
• Early dosage adjustments (especially in the first trimester) can significantly reduce pregnancy loss risk (3)
• For those trying to conceive, an optimal TSH level of <2.5 mIU/L is recommended

Treat by Symptoms, Not Just Lab Values

Even if your thyroid hormone levels fall within conventional ranges, treatment might still be needed if you:

• Experience symptoms like cold intolerance, fatigue, or unexpected weight gain
• Are trying to conceive with TSH over 2.5 mIU/L
• Have subclinical hypothyroidism (normal T4 but abnormal TSH)
• Show abnormal metabolic labs, such as high cholesterol

Key Insight: The risk of harm is very low when TSH and T4 levels are properly monitored (5).

Keep getting retested until your TSH levels reach the optimal range—ideally below 3.0 mIU/L, or under 2.5 mIU/L if you’re trying to conceive. Many people feel their best when TSH is closer to 1-2 mIU/L. Most importantly, ensure your provider adjusts your dosage based on how you actually feel, not just lab numbers.

Is Levothyroxine a Lifetime Commitment?

Not necessarily! Once your thyroid levels stabilize, you can consider stopping levothyroxine—but only with careful planning.

Steps to Prepare for Medication Discontinuation:

• Adopt an anti-inflammatory diet with adequate thyroid-supporting nutrients
• If you have Hashimoto’s, monitor your thyroid antibodies
• Use herbs and supplements to support thyroid health
• Consult with your doctor and monitor thyroid labs 4-6 weeks after stopping

Remember: A healthy lifestyle and consistent monitoring are the pillars of long-term thyroid health. NO PILL WITHOUT A SKILL—meaning when we combine lifestyle changes with medications and supplements, we achieve the best health outcomes.

If you’d like to optimize your thyroid health by addressing root causes and lifestyle factors, our personalized services are here to help!

References

1. Treatment of primary hypothyroidism in adults - UpToDate. Accessed January 10, 2025.
2. Levothyroxine: a medicine for an underactive thyroid (hypothyroidism) - NHS. Accessed January 10, 2025.
3. Increasing levothyroxine doses early in pregnancy is associated with a lower risk for pregnancy loss in hypothyroid women. Accessed January 10, 2025.
4. Javed Z, Sathyapalan T. Levothyroxine treatment of mild subclinical hypothyroidism: a review of potential risks and benefits. Ther Adv Endocrinol Metab. 2016;7(1):12-23.
5. Adlin V. Subclinical hypothyroidism: deciding when to treat. Am Fam Physician. 1998;57(4):776-780.