Everything You Need to Know About Deprescribing Safely

Have you ever wondered, “Can I stop taking my thyroid meds?”

Several studies show that around a third of the people taking thyroid hormones don’t need them. Unnecessarily using medications can cause a greater risk of harm and open you up to unwelcome medical monitoring.

Others feel they don’t want to take them, but their tests indicate they would do better with even a minor prescription.

So how do you know if you really need thyroid medication? Could there be another type of hypothyroid disease treatment that’s better for you?

Let’s discuss who doesn’t need to take thyroid medications, how to treat hypothyroidism naturally, and the ways you can use deprescribing to taper off the meds slowly.

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What is Deprescribing?

In medicine, we sometimes focus on starting treatments to boost your health. Other times, the best course of action is to stop intervening. That’s what deprescribing is all about.

The term deprescribing is used to discuss quitting medication. It’s a thoughtful process of identifying if a medication or its dose has become problematic¹.

If stopping the medication is the most effective way to maximize a patient’s wellness, the treatment is reduced or stopped safely under proper medical guidance.

Let me be clear: this process is not about throwing out your medications immediately. Consult with your doctor to see if deprescribing could help you.

Deprescribing is the only safe way to quit medications, and many people could benefit from deprescribing with their thyroid medication.

New research suggests that around 30-45% of people on thyroid medication don’t need it. The medication doesn’t help everyone feel better or make them healthier.

In fact, there are risks to your bones and heart if the doses drift off target. Excessive amounts, or a hyperthyroid dose, could lead to dangerous side effects.

Monitoring your levels is also a downright hassle, and you may not even need to put yourself through it.

Can I Stop Taking My Thyroid Meds?

Before we dive into the research and explain some essential terms, I’d like to talk about who could cause severe health problems by stopping thyroid medication or altering treatment without consulting a doctor.

You should not stop thyroid medication if you:

• Do not have your doctor’s support
• No longer have a thyroid
• Are pregnant or nursing

If any of the above factors fit you, you could cause serious harm by quitting your meds.

You can probably stop taking thyroid medication if you’re prescribed thyroid medication long-term for a temporary issue and no longer need them.

Deprescribing is crucial for thyroid health because:

• Thyroid hormones are often prescribed long-term for people who don’t need to take them
• Only around 34% of adults of thyroid meds stop taking them without symptoms or abnormal thyroid levels
• You can probably only stop taking the medications if you have been on them for under four years, don’t have initial low T4 levels, have current TSH levels under 1.8, or are on a low dose.

However, it’s crucial for you to speak with your doctor about your thyroid health and specific needs.

What is Hypothyroidism?

To better understand deprescribing, it helps to know a bit about how your thyroid works. The following factors predict the likelihood of your success with deprescribing and finding the proper hypothyroid disease treatment for you.

Hypothyroidism

What is hypothyroidism exactly?

The term sometimes describes a lack of thyroid hormone or any symptoms that relate to thyroid issues previously.

But in the context of deprescribing, hypothyroidism is a diagnosis you get when you have elevated TSH, and T4 blood levels or your free T4 levels fall below range. (Read More: Testing Your Thyroid and the Definitive Guide to Optimal Ranges).

Most people with hypothyroidism exhibit classic symptoms, such as:

• Difficulty focusing and thinking
• Forgetfulness
• Hoarse voice
• Slower speech or movement
• Puffy face
• Brittle fingernails
• Swollen thyroid gland
• Constipation
• Muscle weakness
• Muscle and joint pain
• Swollen legs, ankles, or feet
• Heavy or irregular periods
• Low energy
• Depression

If you notice the above symptoms, your doctor will check your thyroid-stimulating hormone (TSH) levels to see how your thyroid functions.

Not everyone shows symptoms, though.

Subclinical Hypothyroidism

Subclinical hypothyroidism sometimes describes people with thyroid symptoms and blood levels in the normal range but not optimal.

Like hypothyroidism, a subclinical hypothyroidism diagnosis is based on blood levels. It’s marked by elevated TSH and normal T4 or free T4 levels.

The most common signs include:

• Anxiety
• Depression
• Fatigue
• Poor cognitive function

Only about ⅔ of people with subclinical hypothyroidism show relevant symptoms.

Euthyroid

The term to describe normal thyroid levels is euthyroid.

If you’re a euthyroid patient, it means you are lacking apparent thyroid symptoms. In this state, you have normal thyroid gland function as opposed to an over or underactive thyroid.

However, euthyroid doesn’t mean you’re cured.

These effects can be temporary. It could mean your thyroid gland has recently recovered from inflammation, or it may appear before you go into a hypothyroid phase.

Who Is Likely to Deprescribe Easily?

A recent research paper from February 2020 encapsulates the prior studies on deprescribing thyroid medication.

When the researchers combined the results from the previous 2,683 studies, they could look past any errors and form a meta-analysis or deep dive into what the results truly mean.

They found that in the 17 studies with the highest quality results, 34% of patients remained in a euthyroid state at follow-up².

This means that over a third of those who take thyroid medication show adequate thyroid function without them.

And the results were consistent across many thyroid medication types.

Most of the previous studies only explored T4 medications such as Synthroid. Other research touched on T4 and T3 medications like Cytomel. Some focused on natural desiccated thyroid medications, including brands like WP Thyroid and Armour Thyroid.

However, the previous studies did not follow the same taper process in each example. The various approaches included:

• Discontinuing therapy within two weeks by first halving the dose at week one and stopping the remaining amount at week two
• Cutting the LT4 dose in half every four weeks until a dose of ≤12.5 mcg/day was reached, then discontinued therapy
• Halving the dose and eliminating the remaining amount in two months following 25 mcg reductions until discontinuation

Although they’re not uniform, the study did manage to identify several factors that predict euthyroidism in adults, such as:

• Family history of thyroid disease
• Ultrasound findings
• Thyroid antibodies
• TSH levels > 8

The results showed that people with a family history of thyroid disease were more likely to have euthyroidism, as were those with positive thyroid (TPO) antibodies and loss of tissue showing up on their ultrasound. People with TSH levels over eight also had success with deprescribing thyroid meds.

The Algorithm

From the data, researchers created a basic outline for deprescribing.

As the table shows, the patients who are best suited for deprescribing are based on their medications and other considerations. Before the study, participants were warned about the possible side effects and downsides. They then followed the algorithm above to taper off the medication.

What Factors Predict Deprescribing Success?

Soon after Dr. Burgos’ February meta-analysis was published, another set of researchers completed a study on deprescribing. Dr. Jung and his crew set out to find the clinical factors that predict the successful discontinuation of hormone replacement therapy, particularly in patients diagnosed with hypothyroidism.

They studied 382 patients who were on thyroid treatment for at least a year. During the study, they lowered the patient’s doses or stopped treatment entirely for an entire year.

Over 22% of the patients in the group successfully stopped therapy, and 58% were able to lower their dosage safely³.

The results closely tracked the differences to figure out who could and could not stop taking thyroid medications, and they provide several insights.

The most crucial variables to deprescribing include:

• Treatment duration
• TSH level before stopping the medication
• Medication type and dosage

Gender and ultrasound findings also play a relevant role. For example, women were more than twice as likely as men to discontinue taking their medication. Those with hypervascularity or additional blood vessels also had a likelihood of success.

Patients whose thyroid glands appeared on the ultrasound as hypoechoic (solid or dense) or heterogeneous (with holes like Swiss cheese) were less likely to succeed at deprescribing.

From the data, researchers created the following decision tree to help with deprescribing.

The study found that TSH levels are a better factor to determine if patients who have had thyroid disease for under 4.6 years can deprescribe successfully. Medication dosage was the best predictor for those who have had the condition longer.

For example, a person with thyroid disease for less than 4.6 years and TSH scores under 1.8 has a 44.8% successful chance of quitting medication.

Patients with the disease longer than 4.6 years with a dose of over 56 mcg of T4 only had a 6.4% chance of success.

How Did The Patients Feel?

How did deprescribing go for the patients in the study?

Many stopped tapering off the meds when their TSH levels reached over 10 IU/mL, or significant symptoms emerged.

The most common symptoms that predict a poor outcome include:

• Facial edema
• Constipation
• Weight gain
• Severe fatigue

However, the distinctions are not absolute. Some people who were able to reduce their dose had the same problems later.

Of those who could discontinue the medication, a small portion of patients’ TSH levels elevated to between 5 and 10, and about half of the patients showed symptoms.

The main difference is that, for these people, their symptoms did not become progressively worse over time.

How to Treat Hypothyroidism Disease Naturally

If deprescribing sounds right for you, there are steps you can take to boost your odds for success. The best methods are to reduce your iodine intake and make sure you’re getting the micronutrients you need.

Reduce Iodine

Researchers in the Jung trial suggest reducing iodine intake as the sole recommendation to make the deprescribing process go better. They explain that iodine is an essential component in thyroid hormones, and a high intake could make diseases like autoimmune thyroiditis worse.

In their study, subclinical hypothyroidism increased with high levels of iodine.

Several other studies also show that 50 to 60% of patients with hypothyroidism show spontaneous remission or lower TSH levels after restricting iodine in their diet.

The Thyroid Reset Diet book is a full guide you can use to reduce your iodine intake for better thyroid health.

To lower your iodine intake, start by avoiding any supplements with iodine. I include a complete list of the hidden iodine in your medications and vitamins on pages 71 to 76 of my book. You can also find steps to focus your diet on page 129.

Other studies show that reducing iodine reverses thyroid disease in 78.3% of patients who are not yet on medication⁴.

In this study, the iodine levels did not vary significantly between responders and non-responders, which means testing your iodine levels before starting to deprescribe won’t help.

The study also shows that you’re less likely to respond to reducing your iodine intake alone if you have high TSH levels, had the disease for a long duration, or show more elevated anti-TPO antibodies.

Iodine and TPO

What is TPO, and how does it relate to iodine?

Lowering your iodine intake alone can improve your odds of successfully deprescribing. It can also improve your odds of reducing your thyroid peroxidase (TPO) antibodies.

TPO is an enzyme in your thyroid gland. It plays a crucial role in producing thyroid hormones. Thus, it’s the perfect marker to detect how your thyroid responds to treatment.

Some of the studies on deprescribing suggest that a higher TPO predicts an inadequate response, which is particularly true for people with heterogeneous or hypoechoic ultrasound findings.

So if you have a high TPO level, lowering your iodine intake may not be the answer for you.

Maintain Micronutrient Sufficiency

The one thing the studies I previously cited fail to evaluate is the participant’s micronutrient sufficiency. This includes vitamins and minerals.

Tons of data show that low levels of some micronutrients predict your thyroid disease may worsen.

The top micronutrients to focus on for thyroid health include:

• Selenium
• Zinc
• Vitamin D
• Magnesium

(Read More: Top 21 Nutrients for Optimal Thyroid Function).

The best course of action is to maintain these nutrients, which are more manageable by using a thyroid-specific multivitamin like my Daily Reset Packs rather than focusing on several isolated micronutrients.

How to Deprescribe Safely

So how do you deprescribe if you’re one of the many people on thyroid medication who don’t need it?

First, you should not attempt to stop taking your thyroid medications if you:

• Had a total thyroidectomy
• Are pregnant or lactating
• Need an unusually high dose of medication.

You’re more likely to have success with predescribing if you’re a woman. Those who can most likely deprescribe also include people who:

• Have had the disease for under 4-5 years
• Take lower doses of medication
• Have a TSH under 1.8 (while on medication)

If predescribing is the best option for you, work with your doctor to taper off the medication. Follow the Thyroid Reset Diet and begin taking a thyroid-specific multivitamin at least two months before you start the process for optimal results.

The taper process varies based on your needs. In my experience, I’ve found it easier to reduce the dosage by 50% every four weeks. When the T4 levels lower under 12.5 mcg or ⅛ of a grain of natural thyroid, you can stop taking the medication.

Here’s how the medical supervision could look for someone on a 100 mcg dose of Synthroid:

• Weeks 1-8 – Thyroid Reset Diet + Daily Reset Pack
• Weeks 9-12 – 50 mcg of Synthroid daily – Retest TSH at week 12 and review progress with the prescriber
• Weeks 13-16 – 25 mcg of Synthroid daily. Retest TSH at week 16 and review progress with the prescriber
• Week 17 – discontinue Synthroid
• Week 23 – Retest TSH and review progress with the prescriber

If you need any help determining if deprescibing is right for you, please contact me. I’m happy to help you find the best care for you.

P.S. Whenever you are ready, here is how I can help you now:

1. Schedule a Thyroid Second Opinion with me, Dr. C, Click Here for Details
2. Need A Thyroid Supplement Recommendation? Take My Thyroid Specific Formulations Quiz Now
3. Need a Personalized Supplement? Check out My Thyroid Specific Formulations
4. Download and use my Favorite Recipes Cookbook Here
5. Check out my podcast Medical Myths, Legends, and Fairytales Here

Dr. Alan Glen Christianson (Dr. C) is a Naturopathic Endocrinologist and the author of The NY Times bestselling Adrenal Reset Diet, The Metabolism Reset Diet and The Thyroid Reset Diet.

Dr. C’s gift for figuring out what really works has helped hundreds of thousands of people reverse thyroid disease, lose weight, diabetes, and regain energy. Learn more about the surprising story that started his quest.