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Levothyroxine

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Overview

Thyroid hormones come in a variety of formulations and brand names.

Synthroid is the most commonly prescribed of all the thyroid supplements. That is because the dose is more reliable than natural products made of dried thyroid glands.

Synthroid is long acting and comes in a wide variety of doses that allows for individualized treatment.

When people develop a sluggish thyroid gland they often feel tired and weak. They may become constipated, sensitive to cold or anemic.

They may also suffer with dry skin and hair, thick brittle fingernails and have shortness of breath when they exercise. Some people report clumsiness, weight gain, or puffy eyes.

Thyroid problems are diagnosed with blood tests. The best is one that measures thyroid stimulating hormone, or TSH.

This test also helps determine the proper dose of thyroid hormone for treatment.

Side Effects and Interactions

Side effects of thyroid replacement therapy are rare if the dose is appropriate.

Specialists recommend beginning treatment with a low dose and gradually increasing it until symptoms of underactive thyroid disappear and the TSH blood test is normal. This may initially require blood tests every four to six weeks and good communication with the doctor.

Signs of overdose include insomnia, heart palpitations, jitteriness, rapid heart beat, increased sweating, higher blood pressure, changes in appetite, and reduced menstrual flow.

Other adverse reactions of excessive thyroid levels include tremor, headache, heart disease, diarrhea, and weight loss.

Report any such symptoms to your physician promptly.

A number of medications may interact with Synthroid or alter the tests that detect thyroid problems.

People taking estrogen, asthma medicines, decongestants (including those found in over-the-counter cold or flu remedies), antidepressants, certain cholesterol lowering drugs, blood thinners such as Coumadin or heart medicine like digoxin should check with a physician or pharmacist.

In theory, the herb guggul might counteract thyroid-suppressing drugs or increase the effect of thyroid hormones. Monitoring thyroid function is prudent.

Licorice may alter the required dose of levothyroxine because of its impact on the thyroid gland.

Never stop taking Synthroid without first checking with your health care provider.

Special Precautions

Too much Synthroid can make a person more susceptible to osteoporosis or weakened bones.
You may wish to discuss with your doctor whether you need tests to monitor bone density.

Thyroid replacement is usually needed for the rest of one's life, and stopping the medicine suddenly could precipitate symptoms of inactive thyroid.

Don't discontinue Synthroid without your doctor's supervision.

Taking the Medicine

The usual recommendation is to take Synthroid before breakfast.

Although this hormone is probably best taken on an empty stomach, it is more important to take it at the same time every day to maintain a constant level in your body.

Do not take this medication with iron pills, as they can interfere with proper absorption.

21 Comments

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I have been taking levothyroxine for two years now, and at times still feel very tired. Earlier in the year I had a very bad cold and took some decongestant medicine. I was not aware that there would be any interactions. Within ten minutes of taking the decongestant I was on the floor with severe stomach pains. It was so agonizing that I could not get up for awhile. The pain continued for another three or four days with stomach cramps. I thought that I may have developed IBS even though I took no more decongestant. I only discovered a few months later that these medicines should not be mixed. I do not know why this happened.

Can anyone tell me what the decongestants do either to the thyroid or to the absorption of the thyroid supplement? I have a thyroid problem; was hypo, is now hyper, we are trying to lower my medication.

I just had a cold and use Afrin and Mucinex. I have been off the sinus medicines for three or four days. Now I am feeling the symptoms of hypothyroid; depressed and anxious.

I would really like to understand the chemical reaction that is going on with the decongestants and the thyroid so I can make an educated decision in case I have to take the medicines.

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I've been taking synthroid (levothyroxine is usually dispensed) for about 10 years. Lately, I've begun to experience mild anxiety that I suspect is related to the med. I'm on the minimal dosage. TSH blood tests have always been normal...without the synthroid when first prescribed, and with the med for the past 10 years.

During the past 6 months, I have significantly changed my diet. I've added sea vegetables and stick very closely to whole foods. After 10 years on this med, I am wondering if there is a safe way to stop taking it....to further investigate the link to my anxiety? A graduate of my school, The Institute for Integrative Nutrition, lectures about how she "cured her own thyroid disease." I'd love to have some more scientific information about this possibility. Thank you!

I haven't had any side effects from this medication, but I was wondering, are there any over the counter medications besides what has already been mentioned that should not be taken with levothroid? Is it okay to continue drinking soy milk?

An increase in Omega-3s in my diet in the form of fish oil (2 softgels per day-Nordic Naturals "Ultimate Omega") is the ingredient that seems to have finally helped eliminate an ever-present goiter of 10 years. I am still taking levothyroxine and have switched to more of an anti-inflammatory diet (along Dr. Sears/Zone Diet guidelines.

I started taking levothyroxine (I have hashimotos) about a month ago, and I was wondering if it was ok to continue taking green tea diet pills while I am on this medication?

I would really like to understand the chemical reaction or interaction that is going on with the decongestants and the thyroid, so I can make an educated decision in case I have to take the medicines. I was told I could not take Allegra D because of the decongestant, but I would like to know what could happen if it is taken with the levothyroxine. Can you help me with this question?

I have been taking Synthroid since early 1990. My dosage has never been changed. I have stopped taking it as of yesterday to see if i feel better. I disagree with some of the Dr.,s comments about side effects, I have many including severe weight gain. I weighed 155-165 lbs most of my adult life until about 8 years ago. I'm very active and cannot lose the weight! I am more fatigued than I was before I went on Synthroid. I want to enjoy the last years of my life. I'm 55 years old and don't want to sleep all the time.
Thankyou

I have been taking snythroid since march 2008 and have also been on Allegra D for 2yrs. I did not have any side effects.

Hello, my mom had a complete thyroidectomy and is now awaiting radiation. She was taking Synthroid but for the past 3 weeks doctor put her on another pill until her blood work etc... Now she's suppose to stop the other pill (don't remember it's name) but there's no mention of her starting up Synthroid again until her blood test - is this normal?? So for about 2 weeks she won't be on any Thyroid drugs?? Can someone please comment.

Hi, just wanted to tell you it is normal treatment. i have thyroid cancer and had my thyroid totally removed in november. I was without any thyroid medicine so i could go through the I-131 treatments with radioactive iodine- i finally got my synthroid last Saturday after months of nothing! Let me tell you - your mom will feel horrible so be kind to her. I have experienced anything so pitiful as being without a thyroid or any hormone for two months!

am taking 100mcg levothyroxine for approx 2 mos. I am ready to dump it due to irregular heartbeats increased pulse rate 110. I have to watch my exercise routine.
I check my BP- daily now it seems and may be perimenopause as well.

I am looking into alternative therapies- but I honestly can say I noticed an improvement in my attitude and less pufiness and hair/skin problems. Why cant we just heal ourselves naturally? I read synthroid has a narrow margin for balance -the dosage amount may have you teeter for the rest of your life.

Does anyone know if I should take or not take my Levothyroxine the same day, prior to having labs drawn for levels, or does it matter? Thanks. Sean.

I recently was at a friends house. We had a bonfire and everyone was having fun except me. Every time I tried to get up where I was sitting everything would start going grey, I felt very weak and tingly and very faint. If I would not have sat back down I would have passed out.

This went on for about an hour or two. I finally just wanted to go home. Well, I didn't make it home. Before I knew it I started another passing out session. I pulled to the side and had some water. This made me feel better so I continued my mission home. Unfortunately I did black out and ended up crashing into the rear of a car which was parked at a stop light. In addition I was not drinking!!! Later I was taking my meds which includes Synthroid.

That night I realized all my meds were there except my Synthroid. After days of looking for my Synthroid I found it between the fridge and counter on the floor. I don't really know the exact time I had been without Synthroid but I'm pretty sure after thinking about it that it could have been two weeks by how many tablets were in the bottle. My Question is, is it not taking my Sybthroid for two weeks could that have caused this fainting and blacking out hitting a car and not knowing why?
Thanks.
Will

My mom had her thyroid removed about seven weeks ago, tried 5 different thyroid medications.
She is so sick and has terrible diarrhea from all her medications. She is now in the hospital and
every time they try giving her a thyroid pill she will start
getting sick all over again.

I'm really stumped as the doctors are with this.
Any help would be greatly appreciated it. I'm afraid if they don't figure this out something could happen to her.

I have spend 6 years without any thyroid medication. I was born without a pituitary gland and Synthroid is one of the meds I've had to take. For my entire childhood it felt like a rope tying me down, and when I was in my early 20s and I just quit. I have felt like a sack. laying on the ground.

I've had only willpower aiding me to do simple things no matter how much I've eat/starve myself I gain weight. I'm at 280 pounds. It's not a life I have enjoyed in these last years and be damned I'll be talking to my doctor about taking Synthroid again. Life sucks without energy. Just getting out of a chair takes time. Walking takes time. It's been a test of will and it never had to be. If you question the balance of your thyroid medicine that's fine but it's worth it. It's not a rope holding you back it's the key to having a decent life we all should have had.

Six weeks ago, after taking Synthroid for nearly 3 yrs., I discontinued the medication at my doctor's request. My resulting bloodwork came back normal. However, around the time I stopped the Synthroid, I began having loose bowels in the middle of the night. Is there a connection?

Sandra, I just read your blog it seems as though I wrote it i have the same symptoms. Actually iIwent to the Dr after a couple of months of rapid heart rate & nocturnal panic attacks and she put me on prozac. OMG, I got worse. I just quit the prozac (weaned off) and I cut my levothyroxine in half to 50mcg. I feel she put me on too much, she disagreed because my blood work showed normal, however I am not.

I too think I am going through peri-menopause I am 44 I will see my Dr tonight, I am going to ask her to send me to an endocrinologist. This isn't right. Good luck to you let me know if you find out anything. P.S. I am taking Colonopin for the terrible anxiety, I hate this!

Hi Alf. I have just read your comment and would be interested to know how you got along when you came off the synthroid. I am on levothyroxine and feel awful exhausted, bloated and piling on the weight. This is really hard to take as I have always been slim and very active. Thanks, kay

I have been taking Levothyroxine for 8 months. I started with 100 mcg but the doctor reduced it to 88 after a couple of months. My blood work shows my level to be at the top of the acceptable chart. I also started taking Lipitor 20 mg at the same time, and this has been increased to 40 mg. after two months.

I have not felt well since. I have gained 25 lbs. without changing my diet or exercise. I reduced my calories and increased my exercise, but am unable to lose any weight. My weight it still increasing. My hair is getting thinner, drier and curly. I experience extreme insomnia, and suffer chronic fatigue. I frequently feel excessively warm. I am at my wit's end trying to cope. Any ideas?
Nancy

Sandra and Lynn and anyone else having similar side effects, I wonder if you are also taking metformin (glucophage)? If so, I have an answer for you. I started taking metformin 3 months ago, then synthroid 2 months ago. Doc raised my synthroid after labs showed a still low thyroid. A week or so later, I began getting severe tachhycardia (very rapid heartbeat) so much that my internal defibrillator shocked me 4 times.

I would have been dead without it. Anyway, trying to figure out why after 10 years, my v-tach was back (last happened in pregnancy) I did some research. I found out that metformin can give you a sort of "false positive" on TSH. It looks on tests as though you are hypothyroid, but if you test your thyroid horome, it is normal. Therefore, the synthroid you are taking is probably unnecessary and most likely an overdose which can cause all that heart nastiness and fainting and insomnia, etc.

Have your doc check your actual thyroid hormone if you take any diabetes drugs. You may save your life. Jan

PEOPLE'S PHARMACY RESPONSE: THE DOCTOR MAY WANT TO LOOK THIS UP: TSH-LOWERING EFFECT OF METFORMIN...BY CAPPELLI ET AL IN DIABETES CARE, SEPT., 2009

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