Thyroid disease is one of the most common conditions in America, yet the cause remains mysterious. More than 20 million people suffer from a thyroid disorder; some of them don’t even know it. They just feel awful. More than 80 million prescriptions are filled every year for thyroid hormones like levothyroxine (Synthroid, Levoxyl, Levothroid, Unithroid) and Armour desiccated thyroid. If we didn’t know better, we would say there is an epidemic of hypothyroidism in America.
Nobody knows exactly what makes the thyroid gland stop working properly. In many cases of hypothyroidism (an underactive thyroid), the immune system attacks the thyroid gland and undermines its ability to produce thyroid hormone. Like diabetes, this may be considered an autoimmune disease. Environmental exposure to chemicals like perchlorate, found in rocket fuel, and polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs), both used as flame retardants, may have an impact on the developing thyroid gland. Some of these are pervasive environmental contaminants, so it’s plausible that they might be contributing to the prevalence of thyroid problems.
The thyroid gland is so small that it doesn’t look particularly important. It is located in the neck and weighs just a few ounces, but it has an impact on the entire body. A healthy functioning thyroid gland normally puts out two hormones: triiodothyronine, or T3, and thyroxine, known as T4. (The numbers indicate how many atoms of iodine are part of the hormone molecule.) These hormones control how every cell in the body uses energy. They also affect a cell’s response to growth hormone and other compounds, including estrogen and calcium. Because the thyroid regulates so many different activities, symptoms of thyroid problems may be vague and general. This can make diagnosis difficult.
Untreated hypothyroidism can be a very serious condition, contributing to other problems like infertility, heart disease, and depression. Getting the proper diagnosis and treatment may take some negotiating. Remember, how you feel is an important criterion for how well your treatment is going, although the blood tests are also important.

  • If you have four or five of the symptoms of low thyroid activity, ask your doctor to test your thyroid function.
  • Keep track of your results, especially if you have been diagnosed with hypothyroidism. You will want to follow trends and see how your treatment affects the value of TSH, T4, and T3.
  • Levothyroxine is the usual treatment. Especially in older people, the starting dose should be low and gradually increased until symptoms ease and the test results normalize.
  • Some people do better on one levothyroxine formulation than on another. They are considered bioequivalent, so use the one that works for you. But don’t switch back and forth between them, or between a brand name and generic. Differences in formulation can make a difference in the dose you need.
  • If levothyroxine alone does not alleviate your symptoms, ask your doctor about a trial with a small amount of Armour desiccated thyroid or another source of T3. You may need to reduce the dose of levothyroxine slightly to compensate.
  • T3 (Cytomel) may need to be taken two or three times a day if it is added to the regimen. It does not last long in the body.
  • Don’t overdo on foods, especially soy, that interfere with thyroid peroxidase.
  • Consider daily supplements of selenium (50 to 100 micrograms) and zinc (15 to 25 milligrams).
  • For more information, consult Mary Shomon’s book Living Well with Hypothyroidism.

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  1. Joyce Ratner
    Texas
    Reply

    What medications are to be avoided when taking levothyroxine?

  2. Joyce R.
    75206
    Reply

    What medications are to be avoided when taking levothyroxine?

  3. Susan K.
    Reply

    Hi, Joe and Terry, I’m hypothryroid and take levothyroxine. Since I’ve been eating more cruciferous vegetables and nuts such as almonds, I’ve been told that these foods interfere with the effectiveness of my thyroid medications. I take levothyroxine, 88 mcgs early in the a.m. an hour before eating anything.
    What should I do about eating kale, broccoli, almonds, almond milk, cabbage, cauliflower, and other cruciferous veggies for anti-inflammation and health while taking needed medicine for low thyroid?? I am 66 yrs. old.

  4. wilma m.
    Reply

    Everyone talks about hypo. No one talks about hyper. I am borderline hyper. All blood tests seem to show tsh 4 (???) but my endocrinologist says I am borderline. Can’t lose weight but told that was not my problem..I am 75.

  5. Joe
    Reply

    I am hypo thyroid. Levothyroxine may be the usual treatment, but it can cause problems because you may need a balance of T3 and T4. Armour thyroid works well, is more balanced, and unlike levothyroxine does not cause bone loss (according to my physician). I take both to get the mix particular to my need. If you take thyroid and don’t feel right, you may need a different mix.
    The Barnes test can be done at home for free. In the morning before getting up or stirring, put a thermometer under your armpit for 10 minutes. Record the temperature. Do this for 5 days for an average. Why armpit? Because there can be localized infection in the mouth that causes false readings. If you are female and still menstruating, take temperatures after your period, when you temperature is not higher from ovulation. Why not move? To get a true baseline. My lowest temperature was 94 degrees. There was no mistake.
    There is also a highly sensitive blood test that will tell if you are hypothyroid, but you can convince the doctor to prescribe it if you have the average temperature to share. You will also find that, if you take thyroid medication, you may need a bit more in the winter than summer. Also, Vitamin D at a proper level will help whether you are hypo- or hyper- thyroid.

  6. T.P. Beaverson
    Reply

    I have thyroid disease, as well as hepatitis C. Recently I have developed other auto immune illnesses. Raynould syndrome and probably arthritis in hands and wrists. I am 66 and am now experiencing very itchy legs and this in turn effects my sleep. Are these things related? I am hesitant to take steroids, but must have some relief.

  7. Gd
    Reply

    My husband’s thyroid has been removed due to cancer 2 yrs ago. He is taking L-thyroxine, 125 mcg. His libido is low, also energy level. Are we doing enough, or is it just age 71? Thank you

  8. maria
    Reply

    I suffer from thyroidism the symptoms are: fatigue, sadness (depression) sweats in the night like menopause, lethargy, tired, itching all over my body (it was not exzema or allergies my skin was dry feel like a crocodile skin…) not funny, went to the Dr. he prescribed a medication and I am feeling better.

  9. Oceola
    Reply

    In a recent newspaper column you advised people with thyroid problems not to consume large quantities of celery seed, as it could have an adverse effect. Are there other foods, in addition to soy and celery seed, that should be avoided or limited?

  10. cCCRW
    Reply

    I read that Iodine is only used to treat hyperthyroidism. I have hypothyroidism and have been on Levothroxine for 3 months and I’m feeling no different than before. Although my doctor isn’t a very good one. But is Levothroxine suppose to help you lose the weight you gain from the hypothyroidism??

  11. JAB
    Reply

    why does the doctor advise me to see an endrocrinology – I am a diabetic and my A1c goes up and up !!
    PEOPLE’S PHARMACY RESPONSE: AN ENDOCRINOLOGIST IS A DOCTOR WHO SPECIALIZES IN HORMONE PROBLEMS SUCH AS DIABETES OR HYPOTHYROIDISM. THE FACT THAT YOUR “A1c” (GLYCATED HEMOGLOBIN) IS RISING INDICATES THAT YOUR BLOOD SUGAR IS NOT UNDER GOOD CONTROL. AN ENDOCRINOLOGIST MIGHT BE ABLE TO HELP YOU CHANGE THAT.

  12. cm
    Reply

    What do you think about Iodine supplements for women with hypothyroidism? I have been treated (with non-generic synthroid) for hypothyroidism for 5+ years. Although my lab work is “perfect”, I feel tired and depressed often. I have been seeing various recommendations about Iodine supplements online, but my doctor has never mentioned it. Thank you!
    PEOPLE’S PHARMACY RESPONSE: THIS IS NOT A “ONE-SIZE-FITS-ALL” SITUATION. YOU SHOULD WORK WITH A PROVIDER WHO CAN MEASURE AND MONITOR YOUR IODINE LEVELS. BOTH IODINE DEFICIENCY AND IODINE EXCESS ARE BAD FOR THE THYROID, SO YOU DON’T WANT TO TAKE IT WITHOUT KNOWING YOU NEED IT. HERE’S A LINK TO A GOOD WEBSITE ABOUT THIS: http://thyroid.about.com/od/newscontroversies/a/toomuchiodine.htm

  13. ERB
    Reply

    You don’t say anything about Hyperthyroid. I had this problem for months before it was finally detected in a blood test. I lost so much weight, my blood pressure was up and I was extremely irritable. I underwent a lot of tests and was told it was probably just thyroiditis that might have been a result of a virus of some kind. It eventually turned around to a slightly hypothyroid. I tapered off of levoxyl on my own and now my latest test shows normal thyroid levels. I’ll still never know what caused it and if it will every come back.

  14. ggib
    Reply

    Can anyone tell me anything about radio iodine therapy for hyperthyroidism. My Dr. has suggested it or surgery.
    I also have acid reflux. I have tried fresh ginger and ginger root. It helps but I really have to watch what I eat. Thanks.

  15. S Odine
    Reply

    What are the symptoms of hypothyroidism? It doesn’t say, but if you have 4 of 5 talk to your doctor.

  16. LLP
    Reply

    I have suspected that I have low thyroid function for decades. Doctors consulted have been quick to treat my paperwork [low normal lab results] and have attributed my symptoms to: being a menstruating woman, being a menopausal woman, being a mother of young children, being a mother of teens…. A friend recommended Ioderol as a possible benefit.
    I read online info about it and decided to give it a try. I started taking 50 mg daily 18 months ago. From the first day my symptoms became less pronounced. My “fatigue” is almost gone, I can think of what to do next without endless lists, I can complete tasks without mental strain. I note many benefits on 37.5-50mg daily. If I miss three days in a row my symptoms return. I am convinced that our RDA limits for Iodine are woefully wrong.

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