The thyroid gland is an important part of the endocrine system, secreting a number of hormones that affect everything from heart health to metabolism. One of those hormones is thyroxine, also known as T4. Because of the many functions that thyroxine impacts, it is considered one of the most important thyroid hormones. Understanding thyroxine is crucial to protecting your overall health.
What does Thyroxine do?
Thyroxine is a hormone the thyroid gland secretes into the bloodstream. Once in the bloodstream, thyroxine travels to the organs, like the liver and kidneys, where it is converted to its active form of triiodothyronine. Thyroxine plays a crucial role in heart and digestive function, metabolism, brain development, bone health, and muscle control. It affects almost all of the body’s systems, which means proper thyroxine levels are vital for health. This is why many doctors will test T4 levels along with the more common T3 levels when testing for thyroid disorders.
What Can Go Wrong with Thyroxine?
Having too little thyroxine or too much thyroxine can cause health problems. If your body releases too much thyroxine, you will suffer a condition called thyrotoxicosis. This can cause a goiter, which is a swelling of the neck because of an enlarged thyroid gland. Thyrotoxicosis can also cause menstrual irregularities, an increase in bowel movements, weight loss, heat intolerance, fatigue, and irritability. Thyrotoxicosis is commonly caused by hyperthyroidism, tumors in the thyroid gland, or thyroid inflammation.
The body can also produce too little thyroxine, a condition known as hypothyroidism. Low thyroxine levels cause problems with development if it occurs when an individual is young. In adults, thyroxine deficiency will lower the metabolic rate, causing weight gain, memory problems, infertility, fatigue, and muscle stiffness.
Questions to ask your doctor
If you are struggling with symptoms of a thyroid disorder and suspect thyroxine deficiency, it’s crucial that you talk with an endocrinologist. You will need a series of blood tests to determine whether or not your thyroid hormone levels are where they should be. As you discuss your thyroid health with your doctor, consider asking these questions:
- Is thyroid function causing my symptoms?
- What could have caused my thyroid to stop functioning properly?
- How can I regain proper levels of thyroxine and other thyroid hormones?
- What type of monitoring will I need while on thyroid medication?
- How long will I need thyroid medication?
If you feel tired and are struggling with your weight, your thyroid may be to blame. Find an endocrinologist near you, and take the next step toward regaining your health.
FRIDAY, April 8, 2011 (HealthDay News) — The human body’s intricate framework of interconnected systems, which work together to maintain health and life, depend on one small, butterfly-shaped gland that weighs less than half an ounce.
The thyroid gland, located in the front of the neck, releases hormones that regulate metabolism, directing the body to break down food into energy and then either use it immediately or store it for later use.
“The thyroid gland is essential to life,” said Dr. Peter A. Singer, a professor of endocrinology at the University of Southern California, a past president of the American Thyroid Association and a board member of the American Association of Clinical Endocrinologists. “If you didn’t have a thyroid gland, you could not survive.”
When disease strikes the thyroid, this directly affects the body’s metabolism by altering the amount of hormone produced by the gland.
Too little thyroid hormone results in hypothyroidism, a condition that causes the body to slow down as metabolism lags.
People with hypothyroidism usually feel chronically fatigued, have difficulty concentrating and need to sleep more than normal, according to the U.S. National Institutes of Health. Their body begins to change as its processes slow down, resulting in weight gain, thinning hair, constipation and pain in the muscles and joints.
When too much of the hormone is being produced, hyperthyroidism occurs. In many ways, the symptoms are a mirror image of hypothyroidism: nervousness, irritability, weight loss, difficulty sleeping, rapid heartbeat, hand tremors and diarrhea.
Singer suggested thinking of the body as a car. “If you have a four-cylinder car, you may be going on 6 or 8,” he said. “Everything is amped up , like you are on adrenaline.”
Both too much and too little thyroid hormone most often result from autoimmune disorders that cause the body’s immune system to attack the thyroid and interfere with its function, Singer said. The most common cause of hypothyroidism is known as Hashimoto’s disease, and the most common cause of hyperthyroidism is called Graves’ disease.
“Hypothyroidism is by far more common than hyperthyroidism,” said Dr. Alan P. Farwell, an associate professor of medicine and director of the Endocrine Clinics at the Boston Medical Center/Boston University School of Medicine.
Hyperthyroidism affects about 1 percent of the United States population, whereas hypothyroidism affects about 5 percent of the population, according to NIH.
In general, hypothyroidism is more difficult to diagnose because it occurs more often in older people and can be mistaken for the normal slowing down that occurs with aging, Farwell said.
“Hyperthyroidism has some pretty specific symptoms,” he said. “There are lots of things that can cause the symptoms of hypothyroidism. It can be harder to tease out what’s going on.”
Treatment for hypothyroidism is fairly simple, Farwell said. Replacement thyroid hormone is widely available, easy to take and without major side effects for most people.
Hyperthyroidism can be a bit trickier to treat. Anti-thyroid drugs are available, but they cause side effects for many people. As a result, doctors more often opt to attack the thyroid gland through the use of radioactive iodine.
“In the United States, radioactive iodine is the most effective treatment,” Singer said.
The thyroid gland is the only organ in the body that collects iodine, which it uses to make its hormones, Farwell explained. Radioactive iodine damages the thyroid, reducing its ability to make hormone and bringing hormone levels back to normal.
“About 85 percent of people with Graves’ disease in the United States eventually are treated with radioactive iodine,” he said.
However, most people who are hyperthyroidal and treated with radioactive iodine will eventually develop hypothyroidism because of the damage done to the thyroid gland. “Now the patient is hypothyroidal and needs to be put on a thyroid pill,” Farwell said.
Doctors consider this an acceptable trade-off, given that hyperthyroidism can cause more long-term damage to the body and is more difficult to treat with medication, according to NIH.
Radioactive iodine has also been shown to be an effective treatment for thyroid cancer, which most often occurs as a painful lump in the front of the neck.
“Radioactive iodine gives us a magic bullet that goes only to the thyroid, affecting both normal and cancerous cells,” Farwell said.
It is such an effective treatment, in fact, that thyroid cancer has a high survival rate. According to NIH estimates, about 44,670 new cases of thyroid cancer were diagnosed in 2010, but only 1,690 people died from it.
“The good news is 85 percent of are readily treated,” Singer said. “Most thyroid cancers tend to be relatively easily treated.”
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about Graves’ disease and Hashimoto’s disease.
For more on thyroid disease, read about one woman’s struggle with Graves’ disease.
- REPORT OF CASE
- Table 1
- Your Thyroid Levels Aren’t Optimal
- Your Medication Isn’t Right for You
- There’s Something Else at Play
- You’re Not Addressing Your Hashimoto’s
- You May be Taking Your Thyroid Medication Wrong
- You’ve Not Got The Right Diet
- Do you still feel unwell despite being on thyroid medication? Share in the comments below.
- Written by Rachel, The Invisible Hypothyroidism
- Hypothyroidism symptoms linger despite medication use, normal blood tests
Medical Editor: John P. Cunha, DO, FACOEP
Last reviewed on RxList 3/13/2018
Levothroid (levothyroxine sodium) is a replacement for a hormone that is normally produced by your thyroid gland to regulate the body’s energy and metabolism used to treat hypothyroidism (low thyroid hormone). Levothroid is also used to treat or prevent goiter (enlarged thyroid gland), which can be caused by hormone imbalances, radiation treatment, surgery, or cancer. Common side effects of Levothroid include:
- hair loss during the first few months of treatment. This side effect is usually temporary as your body adjusts to Levothroid.
Contact your doctor if you experience serious side effects of Levothroid including:
- sleep problems (insomnia),
- feeling nervous or irritable,
- hot flashes,
- pounding heartbeats or fluttering in your chest,
- changes in your menstrual periods,
- appetite changes, or
- weight changes.
For adult hypothyroidism, Levothroid is started at 12.5-125 mcg/day taken orally. Dose may differ with individuals based on age, the presence of cardiovascular disease, tolerance, side effects, and blood levels of thyroid hormone. It may take one to three weeks before effects are seen. Levothroid may interact with calcium carbonate, ferrous sulfate iron supplement, sucralfate, sodium polystyrene sulfonate, antacids that contain aluminum, and cholesterol-lowering drugs. Tell your doctor all medications or supplements you are taking. Current information shows that Levothroid may be used during pregnancy. Tell your doctor if you are pregnant as your dose may need to be adjusted. This medication passes into breast milk but is unlikely to harm a nursing infant. Consult your doctor before breastfeeding.
Our Levothroid (levothyroxine sodium) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
REPORT OF CASE
We present a 48-year-old female with an 11-year history of prolonged nocturnal sleep time and severe daytime somnolence requiring multiple naps. She denied cataplectic symptoms such as head drop and atonia. Her initial evaluation took place in another state, and she came to our attention to establish care with a sleep clinic. Her records indicated an initial multiple sleep latency test (MSLT) with mean sleep latency of 6 min without sleep onset REM periods (SOREMPs). She was diagnosed with IH with long sleep time. She tried multiple stimulants including methylphenidate, modafinil, armodafinil, lisdexamfetamine dimesylate, and dextroamphetamine/amphetamine. All stimulants exacerbated her underlying anxiety and were intolerable. She was also prescribed fluoxetine, citalopram, bupropion, and desvenlafaxine for concerns that underlying depression caused her sleepiness, but these had no effect on her sleep. Her past medical history was significant for elevated Epstein-Barr virus antibody titers, anxiety, B12 deficiency, GERD, asthma, and hypertension. Medications upon presentation included albuterol-ipratropium, vitamin B12, desogestrel-ethinyl estradiol, dicyclomine, montelukast, and omeprazole. Physical exam demonstrated no focal neurological deficits and no cataplectic symptoms.
A repeat polysomnogram with MSLT (Table 1) performed prior to her first visit demonstrated an apnea-hypopnea index of 2/h, total sleep time of 400 min, 85% sleep efficiency, and no SOREMP. Her MSLT showed a mean sleep latency of 3.4 min and 3 SOREMPs in 4 naps without notable sleep paralysis. At the time of her initial sleep clinic consult she slept 12 h/night with 4 one-hour daytime naps. Her Epworth Sleepiness Scale (ESS)5 score was 16/24. TSH was 2.13 mIU/mL with T4 un-measured. An MRI of the brain was normal. Her diagnosis was changed to narcolepsy without cataplexy as defined by the International Classification of Sleep Disorders, 2nd edition.6 She was not interested in trying additional stimulants or sodium oxybate for her sleepiness. We initiated levothyroxine 25 mcg/day based on its reported benefits in patients with idiopathic hypersomnia.4
Baseline sleep study results.
After 12 weeks, her ESS was 13/24 and her mean total sleep time dropped to 10 h/night with only 3 one-hour naps. She refused TSH and T4 testing after 12 weeks, though TSH after 9 months of therapy remained within normal limits at 1.69 mIU/ mL. No clinical signs of hyperthyroidism were reported or observed. Temperature, weight, and blood pressure were unaffected. She considered levothyroxine to be the most effective treatment thus far and felt the change represented clinical success, as she gained 3 hours awake each day. The benefits were sustained over a 9-month follow-up interval with no clinically significant change in TSH (2.13 vs 1.69 mIU/mL).
Click here to listen to a reading of this blog:
The Thyroid Books You Need: “Be Your Own Thyroid Advocate” and “You, Me and Hypothyroidism”. Get them on Amazon now! This post may contain affiliate links, to find out more information, please read my disclosure statement.
Originally published on 4th April 2016 Last updated on 2nd November 2018
Are you on thyroid medication but still don’t feel well? A lot of thyroid patients feel this way. They might even question if their thyroid medication is working at all.
May people are often left confused and wondering:
- Why am I feeling extremely tired on Levothyroxine?
- My thyroid meds make me tired!
- Does thyroid medicine make you sleepy?
Their doctor puts them on thyroid medication and tells them they are now adequately treated. They may even do a blood test and tell them that their levels are ‘normal’. So then why do they still feel tired?
Can thyroid medicine make you feel tired?
There are a few reasons you can still feel unwell and I’m going to explore these below.
Your Thyroid Levels Aren’t Optimal
Most doctors will put you on T4-only medications like Levothyroxine and then test you via blood samples and tell you “you’re now all OK” and ‘fine’.
The problem is, most doctors just test your TSH alone and this isn’t accurate when getting the full picture of your thyroid health.
In order to know if your thyroid levels are actually optimal, you need a full Thyroid Panel doing, and this should include at the very least: TSH, Free T3 and Free T4. Reverse T3, TPOAB and TGAB are also hugely beneficial. You need as many doing as possible to accurately see how you’re doing on your thyroid meds. If your doctor won’t order the full thyroid panel, do know that it is relatively inexpensive and simple to order these tests yourself. UK thyroid patients can order them from here and a worldwide link can be seen here.
Most thyroid patients seem to feel best when their levels are also optimised and not just in range.
It can be tricky getting your doctor to test a full thyroid panel, but ordering tests yourself is also an option. I can’t stress how important it is to check all of these levels and ensure your levels are optimised as opposed to just ‘in range’.
Your Medication Isn’t Right for You
Some people do OK on Levothyroxine or Synthroid, the T4-only medications, but many equally do not. You may be on this medication and still feel tired.
A study in 2018 demonstrated that Levothyroxine was associated with a lower quality of life in those with Hypothyroidism. So you may well do better on a different type if you’re still not feeling well on T4-only meds like Levothyroxine.
Other thyroid medication includes adding T3 to your T4, or switching completely to Natural Desiccated Thyroid. I’ve covered all of these in detail here and here.
Especially if you have a full thyroid panel tested, and your T3 is low, you should explore the possibility of a conversion problem and maybe adding that T3 in. This can be done by adding T3 to your T4 (Levo), or switching to NDT, which has it in. These can be discussed with your doctor.
I support people finding what medicine works for them, and Levothyroxine simply doesn’t help a lot of people.
Thyroid UK reportsed: “Levothyroxine treatment provided total relief of symptoms in 7% of the respondents and significant relief in 41% of respondents. However, 6% of respondents received no relief from symptoms and 40% only slight relief.
NDT provides the most relief of symptoms providing 29% with a total relief of symptoms and 57% with significant improvement. However, 10% only received slight relief and 2% no relief of symptoms.” and that is a huge difference.
If your current doctor isn’t open to exploring other medication options, you may wish to explore other types of medical professionals which may be able to help. See types here.
There’s Something Else at Play
Other deficiencies or issues are common if you also have thyroid problems. These can include the below, so they’re worth exploring if you still don’t feel well.
Vitamin Deficiencies such as D, B12, Iron, Ferritin etc. can all give you similar symptoms to low thyroid function, so it’s worth checking these if you are tired a lot, have hair loss, bruise easily, are fatigued etc.
Adrenal dysfunction can also cause havoc in thyroid patients too, without us even realising. Symptoms include fatigue, waking up still feeling tired, not being able to cope with stress very well and craving sugary and salty foods. The most accurate way to test if you have adrenal fatigue is via a 24-hour saliva cortisol test, to check cortisol levels. If your doctor won’t do this, you can very simply order it yourself and complete it at home. If your doctor won’t check your adrenals, you can very simply order testing yourself from here and here. They should ideally read as stated here.
The book by James Wilson is helpful too.
You’re Not Addressing Your Hashimoto’s
Most of us with hypothyroidism have Hashimoto’s to thank as the cause, yet don’t even know it.
I’ve created a whole piece on Hashimoto’s here, and ways to treat it include obviously getting your thyroid levels right (TSH, Free T3 and Free T4,Thyroid antibodies) and for a lot of patients, cutting out gluten. They claim it helps their fatigue. More ways to help your Hashi’s are listed here.
Addressing the autoimmune condition that may be causing your hypothyroidism and getting it under control can help with fatigue and managing symptoms.
Getting my Hashimoto’s in to remission seriously helped in management of symptoms.
You May be Taking Your Thyroid Medication Wrong
Many patients take their thyroid meds an hour away from any food or drink, excluding water. The reason being to stop anything else from affecting its absorption. You shouldn’t really eat or drink anything for an hour either side of your thyroid meds, as well as take other medication, and you should avoid taking calcium, magnesium, contraceptive pills and iron close to it in particular. Take your thyroid meds at least four hours away from these.
Oestrogen, calcium, magnesium and iron bind some of the thyroid hormones and makes them unusable, affecting how much you really absorb. If you’re on NDT, many also state that taking it sub-lingually (dissolved under the tongue) has a better effect than just swallowing it.
See a full article on how to correctly take your medication here.
Some patients on T4-only meds like Levothyroxine also state it works better for them when taken at night, instead of the morning.
You’ve Not Got The Right Diet
You’ve got to nourish to flourish!
Eating and drinking right is key, too. Avoid alcohol where you can and there are certain foods to avoid or limit if you have thyroid problems. Many cut out gluten, or go paleo, Keto or try AIP and feel the benefits. We’re advised to eat goitrogenic foods in moderation and cut back on sugar and processed foods, also ensuring you give yourself a nice, varied diet. You can’t expect your body to work wonderfully if you don’t feed it wonderfully!
Find a thyroid cookbook here.
Once you’ve corrected all of the above, you should hopefully see some improvement. If not, you should also consider the checklist here, which you can tick off as you check each point.
Of course, if you have other health conditions, then they’ll need to be explored and managed properly, too. If you still feel ill after looking at all of the above, you may have another underlying health condition altogether, so find a doctor who will uncover this for you and medicate you properly for it.
You may need to see several GP’s or other medical professionals to explore all of these, or even order tests yourself, in order to get them investigated and crossed off. It’s important to address these as soon as possible before they get worse and have a knock-on effect with other things. I found that my GP on the NHS wasn’t particularly helpful and it wasn’t until I started seeing a functional medicine practitioner, that I really got my health back.
Related post: 6 Ways to Create an Energy-Boosting Morning Routine as a Thyroid Patient
The book Be Your Own Thyroid Advocate: When You’re Sick and Tired of Being Sick and Tired, which builds on this article in detail. Learn how Rachel reclaimed her life when thyroid medication wasn’t helping.
There is also an online thyroid course exactly for thyroid fatigue. Freedom From Thyroid Fatigue helps you tackle low energy with a personalised approach, so you can wave goodbye to tiredness.
You can click on the hyperlinks in the above post to learn more and see references to information given.
If you found this article beneficial, please take a moment to share it so we can help others get better with hypothyroidism and Hashimoto’s, whilst also raising awareness. “Be Your Own Thyroid Advocate.” 1K Shares
Written by Rachel, The Invisible Hypothyroidism
Give my Facebook page a like, follow me on Instagram, Twitter, Pinterest.
Join My Facebook Support Group for patients Thyroid Family: Hypothyroidism Advice & Support Group
You’ll get an easy to digest, relevant round up of thyroid news, advice and support to get you feeling better, once every two weeks.
Don’t stay feeling rubbish. Get better.
Get real, helpful advice directly from another thyroid patient. Me!
Give my Facebook page a like, follow me on Instagram, Twitter, Pinterest.
Join My Facebook Support Group for patients
Join My Facebook Support Group for patients Thyroid Family: Hypothyroidism Advice & Support Group
Rachel Hill is the highly ranked and award-winning thyroid patient advocate, writer, blogger, speaker and author behind The Invisible Hypothyroidism. She has two books: ‘Be Your Own Thyroid Advocate‘ and ‘You, Me and Hypothyroidism‘. Her thyroid advocacy work includes writing, speaking on podcasts and co-creating Thoughtful Thyroid courses. Rachel has worked with The National Academy of Hypothyroidism, BBC, The Mighty, Yahoo, MSN, ThyroidChange and more. She is well-recognised as a useful contributor to the thyroid community and has received eight 2019 WEGO Health Award Nominations.
Hypothyroidism symptoms linger despite medication use, normal blood tests
Despite normal TSH tests, these patients still have many nagging symptoms of hypothyroidism. “Patients complain of being depressed, slow and having a foggy mind,” said Rush’s Antonio C. Bianco, MD, PhD, an immediate past president of the American Thyroid Association that is professor of medicine at Rush and an expert on thyroid disorders “They have difficulty losing weight. They complain of feeling sluggish and have less energy. Yet we doctors keep telling them, ‘I’m giving you the right amount of medication and your TSH is normal. You should feel fine.'”
New research gives these patients — who often feel dismissed and forgotten — evidence that their persistent symptoms are not just in their heads.
Research conducted by Bianco and other Rush colleagues published Oct. 6 in the Journal of Clinical Endocrinology and Metabolism found that individuals on levothyroxine who had normal TSH levels were significantly more likely to be taking antidepressants than peers with normal thyroid function. The individuals taking thyroid medication were also less physically active, suggesting lower energy levels. They weighed about 10 pounds more than peers of the same height even though they consumed fewer calories, after adjustments for body weight. Plus, they were more likely to be using beta blockers, a drug frequently prescribed to lower blood pressure, and statins that reduce cholesterol levels.
“These findings correlate with what patients have been telling us,” Bianco said. “This study documents for the first time, in an unbiased fashion, that patients on levothyroxine feel worse and are much less active than controls, exhibiting objective cardiometabolic abnormalities despite having normal TSH levels.”
The Current Treatment Approach
Women are most likely to suffer from hypothyroidism, which occurs when the thyroid gland in the neck stops producing enough hormones, most commonly due to an autoimmune disorder, according to Bianco. Hypothyroidism also develops when the thyroid is surgically removed (for example, due to cancer or benign nodules).
One of the thyroid’s primary jobs is to regulate metabolism, which affects almost every organ and function in the body. For example, when thyroid hormones are low, as in hypothyroidism, the heart rate slows and the intestines process food at a reduced speed, causing constipation. The thyroid also affects the brain. “Your brain turns off,” Bianco said. “Patients are tired, sleepy and might experience feelings of depression. If not treated, might slow down dramatically and slowly go into a sleep state, and eventually into coma.”
There are two types of thyroid hormones: triiodothyronine (T3) and thyroxine (T4). Until the 1970s, patients with hypothyroidism were given pills containing both T3 and T4, which were made from desiccated, or desiccated, thyroid glands from cows and pigs.
But things changed after scientists made two seminal discoveries. One is that the thyroid mostly produces T4, which turns into T3 as it travels through the body. “The important thing to understand is that T4 is not the active hormone,” Bianco said. “T4 must be converted to T3 by our bodies with an enzyme called deiodinase.”
This finding led to the widespread treatment of hypothyroidism with levothyroxine monotherapy, which is the pharmaceutical grade of T4. As Bianco explained: “The medical community reasoned, ‘Hypothyroid patients should be given only T4 as opposed to giving desiccated thyroid with both T3 and T4. Then the body, in its wisdom, will make enough T3.” This would avoid the potential side effects of giving straight active thyroid hormone T3.
The second discovery involved TSH, which is a hormone produced by the pituitary gland, a small organ at the base of the brain. Scientists determined that the pituitary and thyroid glands work together to ensure the body has enough T4 to turn into T3. When T4 levels are low as in hypothyroidism, the pituitary gland secretes TSH into the blood stream, stimulating the thyroid to produce more T4. A high TSH level in the blood is how physicians diagnose hypothyroidism, and they adjust up the dose of T4 (or the drug levothyroxine) until TSH levels are back in the normal range.
“That is how patients are generally treated and monitored today for hypothyroidism,” Bianco said. “While the therapeutic goal is to make patients feel better, symptoms alone are not utilized for judging adequacy of treatment. Blood TSH levels are. In other words, the dose of levothyroxine is adjusted based on the TSH levels and not whether or not the patient feels better.”
A Changing Paradigm
Because the majority of patients with hypothyroidism do well on levothyroxine monotherapy, which is considered a safe medication, the medical community has considered the treatment approach a success. However, in recent years, patient advocacy groups have helped draw attention to the plight of hypothyroid patients who feel sick despite taking levothyroxine and having normal TSH levels.
Because he and his colleagues specialize in thyroid disorders, Bianco tends to see a lot of these patients. “What they’re looking for is someone to believe what they’re saying,” he said. “When I say, ‘I understand and I believe you,’ many of my patients start crying. These patients have been suffering and physicians have been dismissing them.”
To learn more about why some patients were not feeling well in a completely objective, unbiased fashion, Rush researchers turned to a large publicly available survey, called the U.S. National Health and Nutrition Examination Survey (NHANES). More than 10,000 people participate in NHANES, a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations.
From that database, the Rush researchers identified 469 adults who were taking levothyroxine monotherapy and compared them to 469 individuals who were not on levothyroxine. Both groups were matched for age, sex, race, and serum TSH levels.
“We looked to see how 52 clinical measures differed between the two groups. Individuals taking levothyroxine weighed significantly more and moved less, they were also more likely to take antidepressants than those who were in the control group,” said Sarah Peterson, PhD, first author of the study and registered dietitian at Rush University Medical Center.
Other findings included a significantly higher use of statins and beta blockers in the levothyroxine group, presumably for high cholesterol and high blood pressure.
A Revised Dialogue
Hypothyroid patients who continue to have symptoms on levothyroxine monotherapy might talk to their physician about trying combination therapy, or a pill that contains both T3 and T4. Trials of combination therapy are supported by the American Thyroid Association, but clinical studies are mixed on whether this approach works, Bianco said. Subjectively, some patients report feeling better and others don’t.
Better medications are needed to treat hypothyroidism, Bianco believes. Until that day, he urges physicians to change how they talk about hypothyroidism treatment with patients. “Doctors should be telling their patients, ‘I’m going to normalize your TSH, but you’re going to be at a higher risk for gaining weight, experiencing depression and fatigue. It is also more likely that your cholesterol will go up.’ That’s what we should be telling patients, based on our study. This conversation is particularly important for any patient that is considering surgical removal of the thyroid gland.”