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Taking thyroid hormone replacement medication to replace low levels of thyroid hormone is the leading way to treat an underactive thyroid. Thyroid medication is not a cure for hypothyroidism. Still, thyroid medication does replace the thyroid hormones that your thyroid is not making on its own. Replacing these hormones helps to get your body get back to optimal function. Untreated hypothyroidism puts patients at risk for other ailments, such as heart disease, osteoporosis, or infertility.
There are many different types of thyroid hormone replacement medication—from brand names versus generic, which active ingredients or fillers are included, and custom compounded medications.
It's helpful first to know that the thyroid gland makes two primary hormones: thyroxine (T4) and triiodothyronine (T3). The inactive T4 hormone is released and then converted by the body into the active T3 hormone.
Often, the treatment of hypothyroidism starts with T4-only formulations, assuming that the body can successfully do the conversion on its own. Common T4-only medications include Levothyroxine, Synthroid, Levoxyl, Unithroid, Tirosint, and Euthyrox.
However, based on your lab results and symptoms, you and your healthcare provider may conclude that a T4-only formulation is not sufficient. Then, the addition of a T3 medication may be of benefit.
Typically, thyroid doctors prescribe T3 medications in combination with T4. Common T3-only medications include Liothyronine and Cytomel.
Combination therapies are also available. There are two primary types of combination thyroid hormone replacement medications—natural desiccated thyroid medications or compounded medications.
Natural desiccated thyroid (NDT) comes from the desiccated (dried) thyroid glands of pigs. NDT medication provides both T4 and T3 hormones, plus other thyroid hormones found naturally human thyroid glands. Pigs produce T4 to T3 at a 4:1 ratio. This ratio is higher than the human proportion of 14:1. Common NDT medications include Armour, Nature-Throid, and NP Thyroid.
Finally, compounded medications are available from specializing compounding pharmacies to provide the specific strength and T4:T3 ratio needed. Compounded medication gives the most flexibility for those who need a precise dosage or are sensitive to the non-active ingredients in the other thyroid medications.
Thyroid medications often include additional, non-medicinal ingredients known as fillers. These inactive ingredients do not increase or affect the medicinal properties of the active ingredient but ensure that a drug has reproducible and consistent quality.
Non-active ingredients may include coatings, lubricants, fillers or diluents, preservatives, coloring agents, sweeteners, or flavoring agents. Fillers for tablets and capsules often include cornstarch or sugars. In liquid formulations, glycerine and water help to dissolve or suspend the active ingredients.
Both active and inactive ingredients can cause sensitivities or allergies. It's essential to work closely with your thyroid doctor and healthcare team to find the safest, most effective medication for you.
It's possible to buy thyroid glandular supplements over-the-counter. However, glandular supplements should not be confused with a natural desiccated thyroid medication prescription. Glandular supplements contain thyroid tissues taken from animals like cows, sheep, and pigs.
Glandular supplements should not contain active thyroid hormones. Still, these supplements are not well regulated. Manufacturers of thyroid glandular supplements may accidentally include active thyroid hormones in their over-the-counter supplements, which can be dangerous. Dosing thyroid hormone is particular and should be managed directly by a thyroid doctor.
Thyroid hormone replacement medications are powerful. It's important to follow your thyroid doctor's instructions when taking these drugs, especially when starting a new brand or increasing dosage. Generally, you should take your pill(s) at the same time every day on an empty stomach. Things like calcium, iron, some foods, and other drugs like statins, blood pressure meds, or metformin can impact the absorption of your thyroid medication.
Missing a couple of doses should not significantly affect your thyroid health. Still, should you skip a dose, medication should be re-started as soon as possible. If you miss more than a few doses, contact your thyroid doctor to determine the best plan forward.
If you switch medications, it's important to retest your thyroid every four to six weeks. Work with your thyroid doctor to adjust your medication dosage as needed until your thyroid hormone levels are stable again.
Each of us is unique with individual sensitivities. Our bodies do not all react the same way to a specific medication or dosage. It usually takes a few weeks to see a noticeable improvement in your symptoms when you start thyroid hormone replacement therapy. Your thyroid doctor may need to adjust your dosing to reach a therapeutic level.
Aside from being on too high a dose of thyroid medication, other factors can affect how your body responds to thyroid medication. These factors may include drug quality, dietary changes, pregnancy, or other drugs and supplements.
Signs of too much thyroid medication may look similar to those of hyperthyroidism. In hyperthyroidism, your metabolic processes speed up, causing symptoms like:
Being undermedicated is problematic when treating hypothyroidism. If your thyroid medication dose is too low, hypothyroidism symptoms and possible complications persist.
When your thyroid is under-functioning, it works harder to meet the demands of your pituitary gland. Located in your brain, the pituitary gland releases thyroid-stimulating hormone (TSH) to signal the thyroid to make more thyroid hormones. When your TSH is high, indicating hypothyroidism, the pituitary does not detect enough thyroid hormone in your bloodstream.
You should frequently check your TSH levels when you start or switch to a new medication to ensure you are on an adequate dosage.
Signs of too little thyroid medication may include:
People with an underactive thyroid often go undiagnosed for years despite experiencing symptoms. However, without thyroid hormone replacement medication, a person with overt hypothyroidism cannot function optimally and will suffer from the symptoms of hypothyroidism.
Hypothyroidism that is left untreated can lead to several health problems, including goiter, increased risk of heart disease and heart failure, mental health issues, peripheral neuropathy, myxedema coma, infertility, or congenital disabilities. Babies with untreated hypothyroidism present at birth are also are risk of serious physical and mental developmental problems.
Hypothyroid symptoms are likely to return if you stop taking your thyroid medication. The longer you go without your medication, the higher your risk for the complications and conditions listed above.
Right after you stop your thyroid medication, you may experience casual symptoms like tiredness or low mood. However, the longer you go without a prescription, the more intense your symptoms are likely to become.
People with hypothyroidism who stop taking their medication put themselves at risk for more extreme health events. For instance, in severe cases, stopping medication can induce a myxedema coma. Myxedema is a life-threatening complication of hypothyroidism. This condition typically arises when someone already has uncontrolled hypothyroidism and a precipitating event like infection or pregnancy.
Taking your thyroid medication as prescribed to manage your low thyroid can also reduce the risk of developing cancerous and non-cancerous thyroid nodules. Please talk to your thyroid doctor if you want to stop or change your thyroid medication.
Hashimoto's thyroiditis is an autoimmune disorder that attacks the thyroid gland. In Hashimoto's thyroiditis, the immune system mistakenly attack the healthy thyroid tissue, causing inflammation of the thyroid gland. Hashimoto's thyroiditis is a progressive disease that, over time, can lead to insufficient thyroid hormone production. Without enough thyroid hormone circulating in the blood for your body to function correctly, you develop hypothyroidism.
In many cases, thyroid antibodies can be the first indication of a thyroid problem. Still, thyroid peroxidase (TPO) antibodies in the blood do not necessarily mean that a person has hypothyroidism yet. These antibodies represent an ongoing attack against the thyroid, increasing the risk for future thyroid disorders.
If you have elevated TPO antibodies but regular thyroid function tests (TSH and free T4), you do not necessarily require treatment with thyroid medication. Similarly, patients with only slightly elevated TSH (subclinical hypothyroidism) may not require medication, either. They should repeat testing after three to six months to monitor thyroid status.
While you cannot necessarily reverse Hashimoto's thyroiditis, you can stall progression. Working on eating a nutrient-dense diet, exercising regularly, managing stress, and lowering inflammation in the body can help limit the disease's progress. There is no cure for Hashimoto's, so proactively monitoring and adjusting your treatment plan is critical to feeling your best each day.
Natural desiccated thyroid (NDT) medication is often caught in the FDA's crosshairs, leading to short or longer-term recalls and shortages of NDT. These recalls and shortages make it challenging to get prescriptions filled. For some patients, it means switching to an alternative treatment that is not as effective for their specific needs. If you experience a recall or shortage of the NDT medication you take, first contact other pharmacies in your area or consider a mail-order pharmacy to see if they have your medication still available. If not, consider switching to an NDT medication, a synthetic T4/T3 combination treatment, or a compounded medication. As always, work closely with your thyroid doctor to determine the safest, most effective solution for you.
Thyroid hormone replacement medication is available by prescription only. A thyroid doctor, also called an endocrinologist, can diagnose you with hypothyroidism and prescribe your thyroid hormone replacement medication online.
Managing hypothyroidism does not necessarily require a hands-on physical exam for medication to be prescribed. If appropriate, you can get an online prescription for your thyroid medication without a face-to-face consultation with a thyroid doctor. To determine the best treatment option for you, your doctor will consider the results of your complete thyroid blood test, in addition to your symptoms, medical history, family history, and lifestyle.
Paloma Health thyroid doctors and endocrinologists are board-certified in providing specialty thyroid care, focusing on hypothyroidism specifically. With our online doctor prescription services, you can have your thyroid medication refilled or even a new thyroid medication prescribed to you after bloodwork and a consultation.
You don't need insurance to use Paloma Health and the visit fee you see is the full price. There are no hidden fees.
Using telemedicine to get or refill a thyroid medication prescription helps you save time booking, waiting, and traveling to your doctor's office. Our providers and care advisors make every effort to keep you and your thyroid healthy so you can dedicate your valuable time and energy to other areas of your life.
Treating an underactive thyroid is an exact skill. It requires careful observation and management from a thyroid doctor or trained healthcare team. FDA-approved medications for treating an underactive thyroid are only available by prescription.
Still, many supplement companies claim to provide non-prescription drugs to "naturally" raise your thyroid hormone levels if you have hypothyroidism. There are thyroid support supplements that contain essential vitamins and minerals to help optimize your thyroid function. However, as covered earlier, thyroid glandular supplements also have thyroid tissues from animals and possibly active thyroid hormones.
Indeed, the difference between thyroid glandular supplements and natural desiccated thyroid (NDT) is confusing. NDT is a prescription thyroid medication that contains active thyroid hormones (T4 and T3) from pigs. Over-the-counter thyroid glandular supplements contain thyroid tissues from animals. Still, they do not have active thyroid hormones—or, at least, they shouldn't.
You should consult your thyroid doctor before you use over-the-counter glandular thyroid supplements.
The best medication for hypothyroidism is the one that works most safely and effectively for you. It's important to work with a trusted thyroid doctor who considers your symptoms, history, and lifestyle, in addition to your lab results, when treating your thyroid condition.
Between retail prices, copay prices, and coupon prices, paying for thyroid medication can feel complicated, and many people end up paying too much.
To start, there are three categories of prices for your thyroid medications: retail cash price, insurance copayment price, and direct purchase price.
The retail cash price is what you pay at a pharmacy if you do not have or use insurance. There are discount programs and coupons that you can use to pay a discounted retail price on thyroid medication. Free services like GoodRx or SingleCare make it easy to compare cash prices and search for discounts on any prescription medication.
If your health insurance plan covers the drug, the insurance copayment price, or "copay," is what you pay for your thyroid medication. Each insurance plan assigns a drug to a particular copay tier. Less expensive generics are in lower copay tiers, and most expensive brand-name drugs are in higher copay tiers. To complicate matters, different insurance plans may assign the same drug to a different tier.
Lastly, the direct purchase price is what you pay for your thyroid medication if you purchase directly from a manufacturer-dedicated mail order pharmacy.
One of the most effective ways to save on the cost of your thyroid medication is to take advantage of manufacturer copay cards and direct purchase programs. A copay card or copay coupon is a discount card offered by a drug manufacturer to lower your insurance copay or lower your out-of-pocket cost. When you use a copay card, you will pay a percentage off of a fixed amount for your thyroid medication prescription.
Hypothyroidism requires thyroid hormone replacement medication to reduce symptoms and prevent additional complications. While you cannot cure hypothyroidism naturally, your lifestyle choices can help in managing your condition. Managing stress, exercising regularly, eating a nutrient-dense diet, and avoiding processed or refined foods can help improve your thyroid and overall health.
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