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Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

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How Long Can You Go Without Thyroid Medication?

Written by Dr. Ruscio on October 2, 2020

Written by Dr. Ruscio on October 2, 2020 — Reviewed by Hannah Hamlin

Thyroid Medication Mistakes To Avoid

• Skipping a Dose|
• Discontinuing Medication|
• Poor Absorption of Medication|
• Overprescribed Medication|
• Alternative Medications|
• Bottom Line|
• Recommended Products|

Thyroid hormone replacement medication, like levothyroxine (Synthroid), is prescribed when your thyroid gland isn’t making enough thyroid hormone. The medication provides needed thyroid hormone, which helps with symptoms of hypothyroidism, like fatigue, weight gain, or hair loss.

If you take Synthroid and you’ve ever wondered how long you can go without thyroid medication, you’re not alone. Generally, if you take a synthetic thyroid hormone like Synthroid and accidentally skip a dose, there’s little harm. But not taking your thyroid medication for longer periods of time can lead to bigger problems and long-term risks.

On the other hand, overdiagnosis and overtreatment of hypothyroid are very common. [1] Additionally, with the right health support, some patients may be able to reduce or discontinue their thyroid hormone replacement. In this article, we’ll help you answer the question, “How long can you go without thyroid medication?”

Skipping a Dose

If you miss your dose of synthetic thyroid hormone (Levothyroxine), don’t panic. Supplemental T4 hormone circulates in your blood for several days, so one missed dose won’t harm you.

Synthetic thyroid hormone (Levothyroxine) does work best if you take it consistently, on an empty stomach, and at the same time every day. It’s a good idea to develop good daily medication habits.

However, if you forget to take your thyroid medication on time, it’s generally OK to take it later in the day. The exception is if you missed a dose by more than 10 or 12 hours, in which case you should wait until your next scheduled dose.

Note: If you had a thyroidectomy due to thyroid cancer or radioactive iodine therapy for Grave’s disease, your body no longer produces thyroid hormones. In this case, staying on top of your thyroid medication schedule is even more important. Missed doses of thyroid medication could lead to a noticeable increase in thyroid symptoms, such as fatigue, feeling cold, dry skin, and weight gain.

Discontinuing Thyroid Medication

If you are truly hypothyroid, discontinuing your thyroid medication for a longer period of time can have serious consequences. Within a few days to weeks, you can expect symptoms of hypothyroidism, including:

• Fatigue
• Brain fog
• Depression and/or anxiety
• Constipation
• Dry skin and hair
• Hair loss
• Weight gain

Longer term, untreated hypothyroidism can lead to more serious problems like heart disease, infertility, and cognitive issues. Severe hypothyroidism can lead to Myxedema coma, a potentially fatal slowing of metabolism. Fortunately, this condition is rare.

There’s no good reason to let overt hypothyroidism go untreated. Standard T4 hormone replacement is a safe medication with few side effects when taken at the correct dosage.

How Well Are You Absorbing Your Thyroid Medication?

Certain foods, medications, or health conditions can cause you to absorb your thyroid hormone poorly, effectively lowering your dose.

According to a 2017 research review, the following can decrease your ability to absorb the thyroid hormone levothyroxine [2]:

• Gastrointestinal disorders, such as celiac disease, lactose intolerance, and H. pylori infection. [3, 4, 5, 6]
• Soybeans
• Coffee
• Certain medications: cholestyramine, colesevelam, ciprofloxacin, aluminum hydroxide, sevelamer, or proton pump inhibitors
• Certain supplements: calcium carbonate, calcium citrate, calcium acetate, and iron sulfate

Vitamin C was found to increase thyroid medication absorption. [7]

The treatment of GI disorders can lead to increased absorption of thyroid medication. [8] This can also happen when you change your medication or even your diet.

Better absorption can lead to too much thyroid hormone. If you take a medication like Synthroid and notice symptoms of hyperthyroidism (palpitations, anxiety, weight loss, and even high blood pressure), have your doctor test your thyroid hormone levels.

For patients who cannot resolve the reason for poor medication absorption, liquid T4 may be a better choice than standard T4 medication.

Thyroid Medication Is Overprescribed

A subset of people who take thyroid hormone replacement would likely be better off without this medication, as overdiagnosis of hypothyroid conditions is very common. [9, 10]

One study showed up to 60% of patients may be taking thyroid hormone replacement unnecessarily. [11] In this study, 291 patients taking Levothyroxine (Synthroid) were asked to pause their medication for 6-8 weeks. Many of these patients had been taking thyroid medication for years but did not have strong diagnostic indicators of thyroid disease.

• After going without synthetic thyroid hormone for several weeks, patients were given blood tests for thyroid function. 60.8% of patients had normal levels of thyroid hormone, meaning they did not require thyroid medication.

When Medication Is and Isn’t Required

Standard blood tests for TSH (thyroid-stimulating hormone) and free T4 are very reliable indicators of who needs thyroid hormone replacement [12]:

• TSH levels are abnormally high, and your free T4 levels are abnormally low: This means you have true hypothyroidism. T4 medication is required.
• Slightly elevated TSH levels and normal free T4: This is called subclinical hypothyroid. This is an early form of hypothyroidism and requires monitoring but not T4 medication.
• Low free T3: This is a sign of inflammation, digestive issues, or a diet too low in carbs or calories. T3 medication is not normally required.
• Elevated thyroid antibodies with normal thyroid hormone levels: In this case, you do not need thyroid hormone replacement. Hashimoto’s disease does not always lead to hypothyroidism. [13, 14]
• Low free T4 and normal TSH: This is a sign of dysfunction in the pituitary gland. Consult an endocrinologist.

Whether your thyroid condition requires medication or not, many thyroid conditions can be improved through better gut health. [15, 16, 17, 18, 19, 20, 21]

Alternative Thyroid Medications

Online search results often recommend alternative thyroid medications like Armour Thyroid and T4/T3 combination therapy. While alternative thyroid meds have their place, their potential for resolving thyroid problems is often overstated. [22]

Additionally, thyroid hormone replacement therapy helps to balance your hormones, but it doesn’t get to the root cause of thyroiditis and autoimmunity.

Don’t chase the next miracle supplement or the best thyroid medication. Thyroid patients do better when they follow a simple, step-by-step process that addresses health fundamentals first:

1. If you are truly hypothyroid, get on standard thyroid hormone replacement.
2. If thyroid medication alone doesn’t resolve your symptoms, take steps to improve your gut health.
3. Once your gut is in better shape, fine-tune your medications and thyroid supplements.

Bottom Line

Many people with thyroid issues wonder, “How long can you go without thyroid medication?”

While it’s good to develop a consistent routine for taking your thyroid medication, it’s generally not a problem to occasionally miss a dose.

Standard thyroid medication like Synthroid is generally safe and effective when used in the right doses. Note that improving your gut health may help you absorb your medication.

Keep in mind there’s more to thyroid health than maintaining your thyroid hormone levels. For example, thyroid disorders like Hashimoto’s disease are a sign of imbalances such as gut dysbiosis, gut infections, and immune dysfunction. If you take steps to improve your gut health, your thyroid gland will likely benefit.

For professional help with your thyroid health, schedule an appointment at our center for functional health.

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