Whether you have hyperthyroidism/Graves’ disease or hypothyroidism/Hashimoto’s thyroiditis, there is a good chance that you have been faced with the decision as to whether or not you should take thyroid medication. And while many people with thyroid and autoimmune thyroid conditions have already made the decision to take or not to take thyroid hormone replacement (i.e. levothyroxine, Nature-Throid) or antithyroid medication (i.e. methimazole, carbimazole), I’m sure there are some reading this who haven’t yet made this decision, and aren’t sure what they should do. There also are some people taking thyroid medication who are wondering if they are doing the right thing.
Since the medication someone takes will differ depending on whether they have a hyperthyroid or hypothyroid condition, what I’m going to do is separately talk about the risks and benefits of thyroid hormone replacement, and the risks and benefits of antithyroid medication. As a result, if you have hyperthyroidism or Graves’ disease then of course you’ll want to focus on the section where I talk about antithyroid medication, and if you have hypothyroidism or Hashimoto’s you’ll want to focus on the section where I talk about thyroid hormone replacement.
Benefits of Taking Antithyroid Medication
The obvious benefit of taking antithyroid medication is that it can help to lower the thyroid hormone levels. This in turn can greatly help to reduce the hyperthyroid symptoms (i.e. high resting pulse rate, heart palpitations, weight loss, etc.). High thyroid hormone levels can also have a negative effect on bone density, and so this is another benefit of taking antithyroid medication.
Risks of Taking Antithyroid Medication
There are a few different risks of taking antithyroid medication:
Risk #1: Side effects are common. Although I’ve worked with a lot of people who did fine taking methimazole, common side effects include dizziness, headaches, hives, itching, nausea, rashes, and vomiting.
Risk #2: Elevated liver enzymes. Everyone who takes antithyroid medication should have their liver enzymes monitored on a periodic basis. Not too long ago I wrote an article entitled “How To Decrease Elevated Liver Enzymes In Hyperthyroidism and Graves’ Disease“, and so you might want to check this out if you haven’t done so already.
Risk #3: Agranulocytosis. This refers to an extreme reduction in the production of white blood cells. Although not everyone with agranulocytosis experiences symptoms, some will experience a high fever and a sore throat.
Risk #4: Temporary hypothyroidism. This is especially common in those taking large doses of antithyroid medication, although I’ve also had a few patients become hypothyroid with lower doses. This can lead to symptoms such as increase in fatigue, brain fog, and weight gain. The good news is that this is usually temporary, as once the dosage of antithyroid medication has been decreased the hypothyroidism resolves.
Risk #5: Not doing anything to address the cause of the problem. This should be obvious, but it’s common for endocrinologists to tell their hyperthyroid patients that they might get into remission when taking antithyroid medication. While taking the medication can help to normalize the thyroid hormone levels, because it doesn’t address the underlying cause of the problem the person is likely to relapse in the future.
Should You Take Antithyroid Medication?
As for whether or not you should take antithyroid medication, of course this is ultimately your decision. Although I personally didn’t take antithyroid medication when I was dealing with Graves’ disease, this doesn’t mean that this is the right decision for everyone else with hyperthyroidism. Even if your goal is to address the underlying cause of your condition, while doing this you want to be safe. In other words, uncontrolled hyperthyroidism shouldn’t be taken lightly.
If you’re already taking antithyroid medication and are doing well on it then it might be a good idea to stay on it, as not everyone can have their symptoms effectively managed by herbs such as bugleweed. On the other hand, if you’re not currently taking anything to lower your thyroid hormone levels and prefer not to take medication you can start with bugleweed and see if this helps. I’ll add that I’ve worked with patients who were taking antithyroid medication but wanted to switch to bugleweed, and what I usually recommend in this situation is to take both at the same time (i.e. methimazole along with bugleweed), and then work with your endocrinologist to gradually decrease the dosage of the antithyroid medication as your thyroid panel results improve.
Benefits of Taking Thyroid Hormone Replacement
One of the main reasons people take thyroid hormone replacement is to help with the hypothyroid symptoms. And in many cases thyroid hormone replacement can do a good job of helping people who experience fatigue, brain fog, weight gain, and other symptoms related to hypothyroidism. However, besides helping with symptoms, you need to understand how important thyroid hormone is to our health. There are thyroid hormone receptors everywhere in our body, and the reason for this is because thyroid hormone acts on most cells.
Here are some of the functions of thyroid hormone:
- Increases the metabolic rate
- Affects gene expression
- Plays a role in protein, fat, and carbohydrate metabolism
- Required for skeletal development and establishment of peak bone mass
- Important for reproduction
- Plays a role in peripheral nerve regeneration
- Wound healing
Risks of Taking Thyroid Hormone Replacement
I can’t say that serious risks are common when taking thyroid hormone replacement, especially when compared with other prescription medications. This doesn’t mean that there are no concerns. First of all, not everyone does well on thyroid hormone replacement. There can be a few reasons for this. One reason is that someone might react to one of the fillers or inactive ingredients. In this case the person can switch to a hypoallergenic brand of thyroid hormone, such as Tirosint if they’re taking synthetic thyroid hormone, or WP Thyroid if they’re taking desiccated thyroid hormone. Another option is to get a prescription through a compounding pharmacy.
Many people have a problem converting T4 to T3. I discussed this in greater detail in a blog post entitled “6 Factors Which Can Affect The Conversion of T4 to T3”. On a blood test this will present as normal T4 levels and low or depressed T3 levels. If someone is taking synthetic thyroid hormone they might benefit from taking synthetic T3 (i.e. Cytomel), or switching to desiccated thyroid hormone. Of course the goal should be to address the conversion problem, but this usually will take time to accomplish.
Another risk of taking thyroid hormone replacement is that too high of a dosage can make someone hyperthyroid. Fortunately this usually is temporary, as frequently the patient will alert the prescribing doctor that they are experiencing anxiety, an increased resting heart rate, palpitations, etc. If not then this probably will be detected on a future thyroid panel.
Of course one of the main problems with thyroid hormone replacement is that it’s not doing anything to address the cause of the condition. For example, most people with hypothyroidism have Hashimoto’s thyroiditis, which is an autoimmune condition. While taking thyroid hormone might be necessary for many people with Hashimoto’s, this isn’t doing anything for the cause of the problem. And unfortunately most medical doctors don’t do anything to address the underlying cause, as they simply recommend thyroid hormone replacement while ignoring the autoimmune component.
Should You Take Thyroid Hormone Replacement?
Some people understandably don’t want to take thyroid hormone replacement because it isn’t doing anything for the cause of the problem. Others are concerned that they will become dependent on it. But if your thyroid hormone levels are very low then it usually is a good idea to take thyroid hormone replacement due to the importance of thyroid hormone that I discussed earlier. While most people who have depressed thyroid hormone levels experience hypothyroid symptoms, occasionally I’ll work with a patient with overt hypothyroidism (depressed thyroid hormone levels) who feels fine. Even when this is the case it’s wise to take thyroid hormone replacement in those who have depressed thyroid hormone levels. Of course while doing this you also want to work on addressing the underlying cause of the problem.
What should you do if you have thyroid hormone levels that are within the lab reference range, but are less than optimal? In this situation it can be more challenging. Many medical doctors pay more attention to the thyroid stimulating hormone (TSH). Thus, they will recommend thyroid hormone replacement if the TSH is elevated, regardless of what the thyroid hormone levels look like. And while elevated TSH levels are frequently a good indication of hypothyroidism, there can be other reasons for an elevated TSH, such as a pituitary adenoma and dysregulation of the hypothalamic-pituitary-thyroid (HPT) axis.
The truth is that there is no solution that fits everyone perfectly. When someone has an elevated TSH and thyroid hormone levels that are within the lab reference range, this is referred to as subclinical hypothyroidism. If someone with subclinical hypothyroidism is experiencing hypothyroid symptoms then in some cases it might be a good idea to put them on thyroid hormone replacement while trying to address the cause of the problem. Another situation where taking thyroid hormone replacement is warranted in someone with subclinical hypothyroidism is pregnancy.
However, what approach should be taken if someone has subclinical hypothyroidism, is asymptomatic, and isn’t pregnant? Once again, there isn’t an answer that fits everyone perfectly, and different natural healthcare practitioners will have different opinions. While it can be argued that some people who have subclinical hypothyroidism don’t need to be on thyroid hormone replacement, we also need to remember the importance of thyroid hormone. So for example, if someone has a TSH of 4.86 μIU/mL, a free T4 of 0.94 ng/dL, and a free T3 of 2.6 pg/mL, some natural healthcare practitioners would recommend for the patient to take thyroid hormone replacement, even if they are feeling fine from a symptomatic standpoint. And the reason for this is because the free T3 is less than optimal.
What’s The Deal With Low Dose Naltrexone?
I’ve spoken about low dose naltrexone (LDN) in previous articles and blog posts. This is a medication that can modulate the immune system, and in some cases it works so well that people with Graves’disease and Hashimoto’s don’t need to take medication. Just keep in mind that this is a best case scenario, and the downside is that LDN isn’t always effective. But the reason I brought it up here is because in some cases LDN can be an alternative to thyroid medication, although some people with Graves’ disease and Hashimoto’s take LDN in combination with thyroid medication.
For those with Hashimoto’s thyroiditis, LDN can potentially slow down the damage taking place to the thyroid gland, which is something that thyroid hormone replacement doesn’t do. And in those with Graves’ disease, LDN can prevent the immune system from attacking the TSH receptors, and it doesn’t cause the side effects commonly associated with antithyroid medication. I know for some people reading this it might sound too good to be true, but while many people with autoimmune thyroid conditions (and other autoimmune conditions) have benefited from LDN, as I mentioned earlier, LDN isn’t always effective, which is one reason why it’s not commonly recommended instead of thyroid medication.
Another thing to keep in mind is that if someone with Hashimoto’s has overt hypothyroidism, LDN may help to stop or slow down the damage the immune system is causing to the thyroid gland, but if the thyroid hormone levels are depressed then the person probably still needs to take thyroid hormone replacement. On the other hand, if someone with Graves’ disease who is on antithyroid medication takes LDN and it works, they very well might be able to stop taking antithyroid medication, or at the very least decrease the dosage.
It’s important to understand that someone who is taking either thyroid hormone replacement or antithyroid medication and then starts taking LDN will need to monitor their thyroid hormone levels on a frequent basis. The reason for this is because by modulating the immune system, some people with hypothyroidism and hyperthyroidism will experience an improvement in their thyroid hormone levels. While this is a good thing, if they are also taking thyroid hormone replacement or antithyroid medication then this can make someone with hypothyroidism become “hyper”, and someone with hyperthyroidism become “hypo”.
So hopefully you have a better understanding of the benefits and risks of thyroid medication. Regarding hyperthyroidism and Graves’ disease, antithyroid medication can do a great job of lowering the thyroid hormone levels, which in turn usually helps to reduce the symptoms associated with hyperthyroidism. Some of the risks of taking antithyroid medication include elevated liver enzymes, agranulocytosis, temporary hypothyroidism, and not doing anything to address the underlying cause. Regarding hypothyroidism and Hashimoto’s, thyroid hormone replacement not only can help with the hypothyroid symptoms many people experience, but thyroid hormone also has many important roles in the body. The “risks” of thyroid hormone replacement is that some people don’t do well when taking it, it doesn’t address a T4 to T3 conversion problem, and just as is the case with antithyroid medication, thyroid hormone replacement doesn’t address the cause of the condition.
Please feel free to share your experience with thyroid medication in the comments section below.
Lee says
Hello Dr Eric, I’ve been following your blog for some time now and I greatly value the info. My question is as follows, I’ve been taking propranolol and CARBIMAZOLE for more than 2 years, for the most part it’s okay but my symptoms pop up now and again, particularly fast and horrible palpitations. I would really like to switch to a natural course but not sure where to begin. 2 years ago I also had a DVT , and I don’t know why I get thigh spasm . Your thoughts?
Dr. Eric says
Hi Lee,
Thank you so much for following my blog posts. While I’m glad that the Carbimazole and propranolol are helping with the symptoms, we both know that they aren’t doing anything to address the cause of the problem. While you can take herbs such as bugleweed and motherwort to manage your symptoms, ideally you want to find and remove the triggers, which is why I would recommend working with a natural healthcare practitioner.
Maggie says
Hi, thank you so much for the informative article. Very grateful for your expertise and this is something that I have struggled with – to take or not to take meds. My functional medicine chiropractor put me on a natural T3 supplement. My concern is my body getting too use to it and not being able to live life without it. I have Hashimoto’s, but my numbers aren’t too bad. My main symptom is hair loss over the last 8 years. So, my question is if I continue to take this, will I get dependent on it? I did stop after 2 months just to see what would happen and for a few days, I felt hyperthyroid-ish. Just don’t want to take medication if I don’t have to. Thank you for your thoughts. God bless! Maggie
Dr. Eric says
Maggie, I’ve had patients who were able to get off of thyroid hormone replacement (and glandulars) after taking it for awhile. That being said, everyone is different, and of course the goal is to try to address the cause of the problem. Of course I’m sure your functional medicine practitioner is trying to help with this, but it sounds like you might be taking too much of the T3 glandular if you’re feeling hyperthyroid. And if it’s not helping with the hair loss then it might be caused by something else (i.e. sex hormone imbalance, nutrient deficiency).
jayn says
I have Graves. I am 51 yo, fit as a fiddle and happy as can be. I was diagnosed with advanced long term thyrotoxicosis in Jan 2015 and took methimazole and beta blockers for about 6 months while I worked out what alternatives I had to RAI and anti thyroid medications. I altered my already gluten free diet to being vegetarian with paleo leanings i.e. no grains, sugar (honey yes), meat, dairy milk, cream and only home grown organic eggs and vegetables. I avoid any packaged food, only fresh or homemade. I was free of symptoms for almost 2 years when I had an acute relapse at the beginning of 2018 due to extreme emotional and financial stress. I was prescribed with carbimazole and took it for 3 months before once again achieving remission, and I began taking bugleweed (1:3 concentration), about 1.5 to 3 mls per day. I am presently drug free other than minor symptoms – fast-ish resting heartbeat never under 75 bpm, but no longer over 95 (reached 156 bpm when ill) and/or grogginess occasionally. My weight is stable. I keep wondering what would have happened to me had I allowed the doctor’s to make my decisions for me, while being aware that my genes may deliver that destiny inevitably, but for the time being I am satisfied that my body is capable of healing itself sufficiently that i can get on with a normal life.
Dr. Eric says
Jayne, thank you for sharing your experience with everyone, as it sounds like you did some great things for your health. I’m sorry you had the acute relapse, but I’m glad that you are currently not taking drugs, and I’m also glad that you didn’t follow the advice to get RAI.
Karen says
Not sure where to start
My doc says I have hasimoto
My TSH was 48 now down to 18.
I can’t take levo, it makes me very depressed,
So that’s the only medication we can get in the UK,
I’m so tired, headache, low mood,
I have a endo, but she is happy just to let me carry on with no treatment.
I don’t work, I’m 57 lost my job with levo depprsion,
I stoped taking levo over 2 years ago, my TSH did drop in past 2 years, I think with good vitamins,
I can’t afford to buy gluten free, I don’t earn any money, my hubby struggling to pay morgage etc.
What basics can I do, which fresh veg, which best meats, fresh fruit.
I read so much I can’t concente and take things in,
My mood is low at min, but I think money worries are part of that.
Not sure whst to expect, but hopefully a hopefully good advice,
Thank you for reading.
Dr. Eric says
Karen, although I can’t give you specific recommendations since you’re not a patient, I will say that some international patients who are unable to get desiccated thyroid will take thyroid glandulars. One example of this Thyro-Gold. I’m not sure if this is what you need, but I did wanted to let you know that there are other options available. You mentioned that you “can’t afford to buy gluten free”, but if you are eating whole foods then these shouldn’t contain any gluten. I’m guessing you’re referring to packaged gluten free foods, and I would try stick with eating whole healthy foods.
Carol says
I am very concerned now that having been diagnosed with Graves in 2009 I have been on carbimazole ever since with no discussion of stopping it. My symptoms were mild, slight tremor, occasional irregular heartbeat, but always feeling somewhat anxious. My endocrinologist said there was no cure and wants to remove my thyroid. I have no intention of having it removed and would love to get off the medication. Where do I start please? And thank you so much for your articles.
Dave Anderson says
That is nice that thyroid hormone replacement can do a good job for those experiencing fatigue, brain fog, and weight gain. That is something that I think I might be struggling with and I might want to see if I can get on thyroid treatments. Maybe I should visit a doctor who specializes in this type of stuff.
Dr. Eric says
Dave, I agree that it would be wise to visit a doctor who can evaluate your thyroid health, and if necessary prescribe thyroid hormone replacement (while trying to address the underlying cause of your condition).
Linda Durec says
For the last 15 years, I’ve been on various different levels of Armour trying to feel good having blood tests every couple of months. Two years ago, I started having heart palpitations that were attributed to thyroid issues. I have felt the best on 90 mg. of Armour 2x a day. The doctor lowered the dosage because of the blood work results and I then went to 60 mg 2x a day and then to 1 60 mg and 1 30 mg and then back to 60 mg 2x a day. In these changes, I started experiencing hair loss. About 4 months ago, I was switched to 65 mg of WPThyroid because of having some issues with the formulation of Armour. My recent blood work shows elevated T4 of 7 while still low T3. She says natural thyroid medication won’t work anymore because they all contain both T4 and T3. I have never been on anything except natural and have read so many side effects regarding Tirosent. Is the only option to discuss having a prescription formulated by a compound pharmacy.
Linda Durec says
Sorry the T3 is what is elevated.