In this article:
- Reasons why you may need thyroid medication
- What happens if you don't need it
- Can you trial off your thyroid medication?
- How can you best assess your thyroid function?
The discovery of thyroid medication was groundbreaking in medicine. Just as iodized salt forever reduced the number of people with a goiter in iodine-poor geographies, thyroid medication has made critical illnesses like myxedema coma rare. Myxedema is an extreme complication of hypothyroidism.
One of the first forms of thyroid medication came directly from sheep and pigs. In the mid-19th century, doctors gave instructions to people who had thyroidectomies to eat thyroid glands from these animals to prevent myxedema. Once people started taking a pill in the early 20th century, records suggested that "alarming symptoms" could occur.
While we do not know what these symptoms were, they likely came from being overmedicated. Having too much thyroid hormone circulating in your body can lead to a state of hyperthyroidism. While this was probably a common occurrence decades ago before better medication regulation, it can certainly still happen today to people who take thyroid medication when they don't need it—or who have too high a dose.
In recent years, there has been mounting evidence that suggests some providers are overprescribing thyroid medication. Several factors may be at play, including discrepancies in how labs interpret results. Thus, many people question whether or not they need to be on medication.
Reasons why you may need thyroid medication
There are several thyroid diseases and treatments that can alter thyroid hormone levels in your body. Most thyroid issues fall into two categories:
- Hyperthyroidism, a state where your thyroid produces too much thyroid hormone
- Hypothyroidism, a condition where your thyroid produces too little thyroid hormone
People with hyperthyroidism often get treatment to reduce the size of the thyroid gland. Sometimes, a doctor prescribes radioactive iodine to shrink the thyroid, whereas other times, surgery is required. Treatment for hyperthyroidism often leads to the state of an underactive thyroid. In that case, a patient needs to take thyroid hormone replacement to replace the hormones that their thyroid does not produce.
Individuals with primary hypothyroidism need to take thyroid hormone placement for the rest of their life. Hashimoto's thyroiditis, an autoimmune condition where your immune system attacks thyroid tissue, is the leading cause of hypothyroidism.
Other situations may also warrant the need for thyroid medication, including surgical removal of the thyroid gland due to cancer, trauma, and congenital hypothyroidism.
What happens if you don't need thyroid medication
Suppose you are taking medication to treat hypothyroidism and don't need it. In that case, you will likely have symptoms associated with too much thyroid hormone (or hyperthyroidism). These symptoms may include insomnia, anxiousness, diarrhea, and heat intolerance.
The more concerning issue of taking thyroid medication when you don't need it lies in the possible side effects, including:
- Irregular heart rhythms
- Rapid heart rate
- Symptoms of heart failure (shortness of breath, swelling, unexpected weight gain)
- Loss of bone density
The decision to prescribe thyroid medication is not always straightforward. Doctors often rely on your thyroid function tests (a blood test) to help decide if you need medication. However, your symptoms are also a significant factor.
Sometimes, people have borderline thyroid function levels, which does not necessarily mean you need treatment.
Normal TSH (thyroid-stimulating hormone) levels are under 4.0mIU/L. A TSH level above 10mIU/L is an indication of hypothyroidism, which requires treatment. However, there is a gray area in whether treatment is necessary for people with rising TSH levels just under 10mIU/L. This state is called subclinical hypothyroidism and is one of the most common forms of hypothyroidism.
People with subclinical hypothyroidism who experience uncomfortable symptoms may wish to try thyroid medication for a short time. If they feel better on medication, their doctor will likely continue them on an appropriate dose. Suppose medication doesn't make you feel better. In that case, your doctor will probably stop treatment and look at other causes of your symptoms.
Can you trial off your thyroid medication?
You should not stop taking your thyroid medication without consulting your doctor first. Going "cold turkey" can have negative consequences. Suppose you wish to decrease your medication or try to go off it entirely. In that case, your thyroid doctor may recommend you taper off your dose so that the process is more gradual.
If you wish to quit taking your medication or think you are taking too much, make a list of your symptoms and reasons for stopping your medication. Then, share your concerns with your thyroid doctor.
People with primary hypothyroidism usually require lifelong medication. However, for individuals with subclinical hypothyroidism, you may be able to trial off your medication.
How can you best assess your thyroid function?
The best way to understand your thyroid function is with a thyroid blood test. Many labs only look at thyroid-stimulating hormone (TSH). Still, we believe it's helpful also to measure free triiodothyronine (fT3), free thyroxine (fT4), and TPO antibodies (which may indicate the presence of Hashimoto's disease).
Besides looking at your thyroid function, your thyroid doctor will also want to know about your symptoms, lifestyle, and medical history. The combination of these factors can help determine whether or not you may benefit from thyroid medication.
A note from Paloma Health
If you think you have a thyroid condition or are concerned you are over-treated, schedule a consult with a trusted Paloma Health thyroid doctor to create a personalized thyroid treatment plan that fits your specific needs.