Should I Take Thyroid Medication?

Tired of feeling cold all the time and gaining weight all of a sudden? When you have hypothyroidism, your body is struggling to produce enough thyroid hormone crucial for maintaining the body’s metabolism & overall function. Therefore, by giving the body what it lacks, you may benefit from thyroid medication and kick start your metabolism and feel energetic again!

The Doctor Asked Me to Take a Pill… Should I?

So, your thyroid test came back, and you’ve been diagnosed with hypothyroidism. Your doctor recommends starting thyroid medication—but should you take it?

I get it. The world of medications can feel overwhelming, especially with all the talk about side effects and the influence of Big Pharma. Trust me, I understand the skepticism. In fact, in our practice, we only stand behind a select few medications for those reasons. But when it comes to thyroid medication, it’s one we support—and here’s why.

When it comes to treating hypothyroidism, thyroid hormone replacement therapy is highly effective. This medication, often called levothyroxine, provides thyroxine (T4), the very hormone your body is struggling to produce. And the best part? Your symptoms may start to fade away within just two weeks of starting treatment (1).

By taking levothyroxine daily (tablet, liquid, or soft gel), you may restore normal thyroid hormone levels and start feeling like yourself again. So, let’s break down the thyroid medication options:

Types of Thyroid Medication (1)

1. Tablets:

The most common choice for thyroid replacement therapy, tablets are available in color-coded doses—12.5 mcg, 25 mcg, 50 mcg, 75 mcg, and 100 mcg—making it easier to adjust based on your thyroid-stimulating hormone (TSH) levels.

Unsure what your thyroid labs mean? Check out this blog to decode your results!

2. Soft Gel or Liquid:

These forms work just like tablets but may offer better absorption for:

• People with stomach issues.
• Those who’ve undergone bariatric surgery.

Heads up: Soft gel and liquid versions are usually more expensive. If cost is a concern, increasing the dose of tablet (with careful TSH monitoring) could be an alternative for those with absorption issues.

3. Brand vs. Generic:

Whether you go with a brand-name option (like Synthroid) or a generic version (Levothyroxine), both work pretty much identically. The choice often depends on availability, cost, or personal preference.

Tips to Maximize Absorption (1)

• It’s often recommended to take levothyroxine by itself, DO NOT take it with other supplements or medications without informing your doctor as it can alter the effects of the drug. Levothyroxine has been shown to be effective when taken either:
  • In the morning: 30–60 minutes before breakfast.
  • OR at night: At least 2 hours after your last meal if taken at bedtime.

How Long does it Take for levothyroxine to Work?

You might start feeling better in as little as 2 weeks of starting levothyroxine, but it usually takes at least 6 weeks to see changes in your TSH levels (1). With the right dose and consistency, levothyroxine can reverse all symptoms of hypothyroidism. The key? Taking your medication correctly and following your doctor’s guidance on lab monitoring!

💡 Pro tip: Levothyroxine dosing can often require adjustments at the start. If your doctor is not monitoring your thyroid labs every 6-8 weeks when you first start levothyroxine medication, it may be time to find another provider who is more keen on following up & properly adjusting your medication.

Levothyroxine Side Effects

Adverse effects from levothyroxine are rare when taken at the correct dosage, but here’s what to watch for (1):

• Overdosing: Taking too much levothyroxine can swing you into hyperthyroidism, leading to a fast heartbeat, heart disease, or even stroke—especially in older adults.
• Underdosing: Not taking enough levothyroxine increases the risk of complications like heart disease due to prolonged untreated hypothyroidism.

💡 Reminder: Regular follow-ups with your endocrinologist are essential to ensure your dosage matches your symptoms and lab values.

Levothyroxine During Pregnancy?

Absolutely! Levothyroxine is safe during pregnancy and breastfeeding. In fact, it’s vital for healthy conception and pregnancy outcomes.

• Studies show that hypothyroid women often need a higher levothyroxine dosage during pregnancy (3).
• Early dosage adjustments (especially in the first trimester) can significantly reduce the risk of pregnancy loss (3).
• If you remember what we talked about in blog Do I Have a Thyroid Problem?, for those trying to conceive, an optimal TSH level of <2.5 mIU/L is needed. You may need to increase levothyroxine dosage if your TSH is >2.5 mIU/L.

Treat by Symptoms, Not by Lab Values

Even if your thyroid hormone levels fall within the conventional range, treatment might still be needed if you:

• Experience symptoms like cold intolerance, fatigue, or unexpected weight gain.
• Are trying to conceive and your TSH is over 2.5 mIU/L.
• Have subclinical hypothyroidism (normal T4 but abnormal TSH).
• Show abnormal metabolic labs, such as high cholesterol, since thyroid medication can improve heart health (4).

Key Insight: The risk of of harm to the patient is very low, provided that we can monitor TSH and T4 levels as an assurance so the patient is not being over-treated (5).

Following up with your endocrinologist is key! Keep getting retested until your TSH levels are in the optimal range—ideally below 3.0 mIU/L, or under 2.5 mIU/L if you’re trying to conceive. Many people feel their best when their TSH is closer to 1-2 mIU/L, so don’t hesitate to advocate for yourself. Most importantly, make sure your provider isn’t just treating a number on a lab report but is adjusting your dosage based on how you actually feel.

Do You Have to Stay on Levothyroxine Forever?

Not necessarily! Once your thyroid levels are consistently normal, you can try stopping taking levothyroxine—but only with careful planning.

Steps to Prepare for Levothyroxine Discontinuation:

• Adopt an anti-inflammatory diet and ensure adequate thyroid-supporting nutrients (check out the article Fuel Your Thyroid: What is a Hypothyroidism Diet?).
• If you have Hashimoto’s, don’t forget to check your thyroid antibodies. If they’re still elevated, staying on levothyroxine may be beneficial for you.
• Use herbs and supplements to support thyroid health (see Blog Natural Remedies for Hypothyroidism).
• Consult with your doctor and monitor your thyroid labs 4–6 weeks after stopping levothyroxine.

Remember: A healthy lifestyle and consistent monitoring are the pillars of long-term thyroid health. NO PILL WITHOUT A SKILL. Meaning, when we use lifestyle changes alongside medications and supplements is when we achieve the best results for our health. If you’d like to optimize your thyroid health by addressing the root causes and lifestyle factors that play a role, our personalized services are here to help—check them out!