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Weighing the Benefits and Risks of Thyroid Medication

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 [1], 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 [2]“, 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 [3], 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 [4]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:

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 [5]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 [6]”.  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) [7] 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.