If you’ve been told that you need to be taking Levothyroxine, you absolutely have to know what’s going on and what it’s all about! I put together this helpful guide to help you learn more about it, when you might need it, and how to get the most from it.
Most importantly, I’ll help you get a firmer grip on what’s going on with your health, to help you understand your diagnosis, and why you might have been put on medication in the first place – so let’s get started.
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Levothyroxine is a synthetic form of an active thyroid hormone. Your thyroid makes two main hormones, T4 and T3, which are both active and important in your body. There are also other active hormones, with T2 being the most common.
Levothyroxine is most often used for those struggling with hypothyroidism. Hypothyroidism can occur in terms of ‘degrees,’ and some degrees are far enough along that the body cannot make enough hormones on its own. Medications can help here.
While most degrees of hypothyroidism are real, and they can certainly cause symptoms, many do not benefit from going on medication. Instead, diet and lifestyle can make a big difference for mild-to-moderate cases of hypothyroidism – that’s why I wrote the Thyroid Reset Diet.
Turning back to Levothyroxine, some of the related medications might be:
Those are the most directly related medications, and they are all T4 medications. What happens is that the body makes these hormones by packing iodine onto thyroglobulin, which is then released and broken down by removing the iodine attached to them.
I want to quickly touch on other forms of thyroid medication, which include:
The first question to ask yourself and your partner in healthcare is whether you genuinely need Levothyroxine. You’d want to ensure that you have overt hypothyroidism to the point that medication is going to truly support you.
If you were found to have subclinical hypothyroidism or suboptimal thyroid levels, neither of those things consistently benefit from thyroid medications. It’s also a risk to take medication when you don’t really need it – so make sure that you need it!
The starting amount for someone whose thyroid has been removed or has shut down would be 0.8 micrograms per pound of body weight.
While 0.8 is a good idea, it’s not the law. You might find different amounts, but it is a pretty good approximation of what you are likely to need. The things that will begin to add nuance and difference would be influenced by your:
Here’s a quick example: If a woman weighed about 150 pounds, a tenth of that would be about 15. Two-tenths would be 30 – subtracting two-tenths would get us 0.8. The result is about ​​125 mcg of T4 required.
Here’s the thing: I want you to think through this standard dosage range. That’s because you might be on an amount or considering an amount that isn’t close to the above. Let’s break that down by asking ourselves some questions.
This is pretty worrisome. If your thyroid dose is much higher and your TSH is below range, you are simply on too much medication. In some cases, this could be done deliberately, but that doesn’t make it less of a concern.
If your dose is much lower, like half or a third of the above, and your blood levels are stable, your thyroid is back in the game. The good thing is that you may not need to be dependent on medication in the long term.
Key Insight: It is a great exercise to consider the doses you’re taking and whether they are truly optimized for your thyroid health. If you are on medication or considering it, that should become one of your primary considerations.
There’s a lot to consider when it comes to Levothyroxine and timing. This medicine is most commonly taken once a day, or maybe a few times per week, but you would not need to take it multiple times per day. It’s as simple as that.
Levothyroxine is simply very difficult to absorb. The amount is microscopic, but it can get bound up in all sorts of things – which is why you’ll often be advised to take it on an empty stomach first thing in the morning.
Most people will be okay if they take it an hour before their breakfast or their other pills, but that only applies to most people – not everyone. Some things that might be an issue could be:
Cases like this may require separating the supplements or coffee by four or more hours after your thyroid medication. This might be tricky, but it’s essential!
Key Insight: One of the most common workarounds is to move taking your medication from the morning to the evening. Studies have shown that most will do fine with bedtime dosing, so it may be possible if needed.
Another significant consideration is your changing needs. Your body’s thyroid needs can differ if you work on fertility or breastfeeding. In almost all cases, it helps to test more frequently and to make adjustments as required.
All of this is also important in terms of checking your scores more regularly. If everything is stable, you should check in once per year. That said, twice yearly is good for the vast majority of people.
You should check more often if you have changed your dose or have unstable levels. But, when we check our thyroid, there are five rules to live by to ensure we get the most accurate results possible. These include:
As we round out today’s article, here are a few more thoughts I’d love for you to remember. Let’s say you’re on medicine, everything is stable, but you’re still not feeling well – what do we do next? How can we troubleshoot that?
You may be someone where medication wasn’t necessary in the first place. In those cases, there is no right amount – any amount, regardless of the dose or the blood levels, will not make you feel good. It can even have the opposite effect.
Generally, medications are needed for those who lack a thyroid or who have overt hypothyroidism. If you have anything else, medications may not help.
Additionally, you may be getting too much iodine. Iodine is very tricky and requires a very narrow range, but we can often find quite a bit of iodine in our medication. Once you’re on that medication, it’s far too easy to get too much iodine.
We also need to consider comorbidities. That’s because there are a lot of things that go alongside thyroid disease. If you are prone to thyroid disease, you’re more likely to:
A lot of people are on medicine, trying to feel better, but it’s simply not working. Then, they adjust that medicine and things still don’t improve. That’s such a frustrating feeling, but what I want you to know is that you may not need the medicine in the first place.
Are you interested in learning more about thyroid medications and evaluating the state of your thyroid? Take this quiz to get a deeper sense of what’s going on in your own body, or take a look at the Thyroid Reset Diet to see how you can quit the medications that may not be helping you. Here’s to your best health!
P.S. Whenever you are ready, here is how I can help you now:
Dr. Alan Glen Christianson (Dr. C) is a Naturopathic Endocrinologist and the author of The NY Times bestselling Hormone Healing Cookbook, The Metabolism Reset Diet, and The Thyroid Reset Diet.
Dr. C’s gift for figuring out what works has helped hundreds of thousands reverse thyroid disease, heal their adrenals, and lose weight naturally. Learn more about the surprising story that started his quest.
