As a functional medicine physician, I am a big believer in food as medicine, herbs as super-healers, and a healthy lifestyle as the foundation for healing and well-being. And within my integrative approach, I may also recommend specific medications to help address the root cause of chronic health issues and create a more favorable long-term prognosis.
This is what integrative medicine is, combining the safest and most effective science-based plant, nutritional, and pharmaceutical medicines to heal the individual while minimizing the risk of long-term issues.
And when it comes to the consequences of untreated thyroid disease, such as heart disease, obesity, infertility, depression, memory issues, and more1 the benefits of the right medication at the right dose for the right person often outweigh any risk of side effects (especially when you choose the right medicine!).
The thing about thyroid medication, and most plant- or pharma-based medications frankly, is there are nuances to taking them optimally. If you’re lucky, your doctor or pharmacist will clue you in on these…but if not, here’s my best advice on how to get the most from your thyroid medication.
The types of thyroid medication I prescribe
I always consider risk vs. benefit when recommending any medication. Thus, here are the thyroid medications I recommend in my functional medicine practice based on the individual.
- Levothyroxine (Synthroid® and Tirosint®) is a long acting synthetic T4-only medication which is typically dosed once in the morning. My preferred version of T4 medication is Tirosint® (available as a gel cap or a liquid solution), because it doesn’t contain a bunch of excipients or potential allergens, and has been shown to release the active medication more consistently.2 Tirosint®-SOL is a go-to for anyone who suffers from digestive issues or malabsorption, which is quite common with hypothyroidism.
- Liothyronine (Cytomel®) is synthetic T3-only medication that is shorter acting and also typically dosed once a day, though I sometimes dose twice daily. T3-only medication can also be compounded at a special pharmacy to be a sustained release form.
- Natural Desiccated Thyroid (Armour®, Nature-Thyroid®, and others) is an animal derived glandular medication that provides a preset ratio of both T4 and T3.
What about over-the-counter thyroid supplements that contain desiccated thyroid?
While I do recommend a variety of pharmaceutical-grade supplements, I’m not a big fan of OTC desiccated thyroid glandulars because these supplements typically don’t control hormonal levels like the aforementioned medications with more precise levels of thyroid hormone, and thus are not predictable in their action. I track this using lab work and just haven’t seen positive results in most cases and do not recommend them.
11 Tips for Taking Your Thyroid Medication Optimally
- Take your thyroid medication (usually) first thing in the morning on an empty stomach, and avoid eating for at least 45 minutes. This allows the medicine to get into your system most effectively.
- Avoid drinking black, green, white or oolong teas for at least 45 minutes as the tannins bind to the medication making it less effective.
- In a perfect world, you’ll also avoid drinking coffee for at least 45 minutes as it may also interfere with intestinal absorption.3 However, if you’re a regular coffee drinker (like me) it’s unlikely to have a significant effect (but consistency is key!)4. I’m usually okay with it (but check with your doctor please!). Studies have shown that absorption of the T4-only medication called Tirosint® is not affected by coffee.5
- Avoid taking supplements like prenatal vitamins, calcium, iron, magnesium, zinc, selenium, chromium or fiber for about 3 hours because they can affect absorption. An easy work-around is to take these supplements with lunch or dinner instead.
- Avoid taking antacids for 4 hours due to their ability to inhibit absorption.6 Likewise avoid taking acid blocking medications called Proton Pump Inhibitors (PPIs) for 4 hours. It’s worth noting that PPIs have been shown to have much less of an impact on absorption of Tirosint®-SOL vs. traditional levothyroxine tablets.7,8
- Avoid biotin for 2-3 days hours prior to any lab draw. To be clear, it won’t interfere with your thyroid medication function but can make your lab assay inaccurate.9 Be aware that many hair, skin, and nail supplements and multivitamins contain biotin.
- If you have absorption issues, consider Tirosint Solution (Tirosint®-SOL) vs. tablets. This is my go-to form of medication because it does not contain tablet-excipients, such as lactase, which can aggravate the digestive tract. Same goes for Hashimoto’s as it often co-exists with gut infections and other digestive health issues. For example, a 2007 study found among people with a history of autoimmune hypothyroidism, 54 percent had a positive breath test for SIBO (small intestinal bacterial overgrowth) compared to 5 percent of controls.10
- If you have Celiac Disease, food allergies, food sensitivities, or dietary restrictions/preferences always check the fillers (“inactive ingredients”) in your medication. Synthroid, for example, is notorious for excipients and fillers, that’s why I like Tirosent®-SOL (no lactose!).
- Tell your doctor if you have any side effects or unwanted symptoms! So many of us (especially women) have been trained to be such “good patients” that we don’t speak up if our medication is causing us problems. So puh-LEASE talk to your doctor about any side effects, large or small. We’re here to help, and chances are your medication can either be adjusted or another brand recommended to rid you of any pesky side effects. Compounding pharmacies can also remix medications for you to remove certain fillers, adjust active ingredients, etc. So you have lots of options!
- Finally, there is a large subset of patients treated with Levothyroxine alone who have persistent symptoms despite medication and a normal TSH. If this sounds like you, you’re not alone! Some studies estimate that 20-30% of patients with treated hypothyroidism still have symptoms!11,12
- I find many of these patients benefit from the addition of T3 medication (combination therapy) titrated to the right dose.13
In closing: there is no one-size-fits-all when it comes to thyroid medication
One of things I stress to my patients is that thyroid medication dosing, forms, duration of treatment, etc. is highly individual. Thus, if you’ve tried thyroid medication in the past without great results, maybe it’s because you were prescribed the wrong type, dose, or form of medication. It could also be something as simple as no one telling you not to eat for 45 minutes, or take your multi, or drink tea (this happens all. the. time.).
Bottom line: don’t give up, and find a doctor or functional medicine physician (like me) who can do a full lab workup (which is way more than just a TSH test) and recommend the best medication, or combination of meds, along with a personalized diet and lifestyle plan.
It gives me so much satisfaction to help patients navigate the world of integrative medicine…and I’d love to help you do the same!
And, to learn more about my approach to customizing thyroid medication, check out my interview with “The Thyroid Pharmacist” and best-selling author of Hashimoto’s Protocol, Izabella Wentz.
- https://www.thyroid.org/patient-thyroid-information/ct-for-patients/april-2018/vol-11-issue-4-p-4-6/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5113291/