How to Get Off Thyroid Medication Naturally - Dr. Michael Ruscio, DC

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How to Get Off Thyroid Medication Naturally

A Step-by-Step Guide for Safely Stopping Your Thyroid Medication

Key Takeaways:

  • Those who have thyroid labs within the normal, subclinical, “suboptimal”, or “sluggish” hypothyroidism ranges are good candidates for discontinuing thyroid medication.
  • People with overt hypothyroidism prior to starting medication, while on medication, and/or after stopping medication will likely require thyroid hormone replacement.
  • It’s important to get your thyroid labs checked both before and after weaning off your medication.
  • While it shouldn’t be stopped suddenly, there are a few different ways to wean off your medication safely and naturally with the help of your doctor. 
  • Misdiagnosis and inappropriate medication can distract from the real root cause of your symptoms, such as poor gut health.
  • An anti-inflammatory diet, lifestyle changes, and probiotics can help resolve any thyroid-related symptoms.

Overuse of thyroid hormone and an over-rendering of a hypothyroid diagnosis is becoming a documentable and serious problem. Recent studies show that 30%–60% of patients on thyroid medication are able to discontinue it and maintain normal thyroid status [1, 2]. Of course, this isn’t to say that everyone should attempt to stop their medication on their own, as it should be done with a healthcare provider’s careful supervision.

But the staggering statistics of overmedication in subclinical hypothyroid patients should give you pause if you’ve been told that you need to take thyroid meds for the rest of your life. If your thyroid hormone levels fall within the normal or subclinical hypothyroidism range while taking medication, you may be able to stop. 

If you’re asking yourself how to get off thyroid medication naturally, I’ll help you determine if you’re a good candidate and will safely walk you through this process. However, be sure to do this alongside your functional medicine doctor or endocrinologist. 

Additionally, I’ll provide the tools you need to address any residual symptoms and help heal and prevent future thyroid problems. Many thyroid issues can actually be attributed to high inflammation and an unhealthy gut, which can be addressed through diet, probiotics, and lifestyle changes.

How to Get Off Thyroid Medication Naturally

Discontinuing your thyroid medication can feel intimidating, especially if you have been taking it for a while. That’s why I have designed a step-by-step guide to help you get off your thyroid medication safely and naturally. It’s essential that you work through this process alongside your healthcare provider so they can help monitor your labs, symptoms, and medication strength. 

If you currently have hypothyroid symptoms, I highly recommend you start with healing your thyroid (and body) by implementing foundational steps for health. Addressing your thyroid health through diet and lifestyle changes prior to weaning off your thyroid medication can help ease the process and mitigate the appearance or worsening of symptoms.  

We will touch on these foundations later in this article, but for a comprehensive guide on how to heal your thyroid, you can enroll in my online thyroid course

Step 1: Get Your Thyroid Levels Tested

So how do you know if you are a good candidate for coming off your thyroid medication? It’s simple — get your thyroid levels checked. If your labs show that your thyroid levels are within the normal or subclinical hypothyroidism ranges while on medication, you can likely wean off of your thyroid hormone replacement.

Many people with mild elevations in thyroid-stimulating hormone (TSH) are inappropriately placed on thyroid medications, despite the growing body of research that shows this is unnecessary. In fact, a 2021 study showed that subclinical hypothyroidism resolved without treatment in over 70% of people [3].

The following chart can help you determine whether your thyroid-stimulating hormone (TSH) and free T4 (thyroxine) levels are indicative of normal thyroid function, subclinical hypothyroidism, or overt hypothyroidism. 

TSHFree T4Diagnosis
Normal (0.35-4.5 mIU/L) [4]Normal (0.8-2.7 ng/dL) [4, 5]Euthyroidism [4]
Somewhat high (4.5-8 mIU/L) [4]Normal (0.8-2.7 ng/dL) [4, 5]Subclinical hypothyroidism [4]
High (≥ 8.0 mIU/L) [4]Low (< 0.8 ng/dL) [4, 5]Overt hypothyroidism [4]

Again, if your labs fall into the normal or subclinical ranges while taking medication, you’re a good candidate. If you were originally diagnosed with subclinical hypothyroidism and/or had elevated TSH levels without symptoms prior to starting treatment, there’s also a good chance you can successfully stop your thyroid medication. 

However, if your levels show overt hypothyroidism while on thyroid medication, you are not a good candidate for discontinuing your medication. Those diagnosed with overt hypothyroidism prior to starting medication are also more likely to need long-term thyroid medication.

Step 2: Slowly Wean Off Your Medication

Once you and your doctor have determined that you are a good candidate for stopping your thyroid medication, it’s now time to start the weaning process. 

There are several different methods that you and your provider can discuss to see which is most appropriate for you. However, I want to emphasize that in order to avoid side effects, you shouldn’t stop your thyroid medication suddenly. It’s important to give your body time to adjust as you incrementally decrease your medication strength. 

Below are three different, simple strategies on how to get off thyroid medication naturally.

Strategies for Quitting Levothyroxine (LT4)
Option 1 (Most Aggressive): Cut the original dose in half at the start of week one and stop altogether at the start of week two [2]. 
Option 2: Cut the original dose in half and take it for four weeks, then cut that dose in half and take it for four weeks, etc., until you reach 12.5 mcg/day or less; then stop [2].
Option 3 (Least Aggressive): Cut the original dose in half, take that for two months, and then stop. Or cut the original dose by 25 mcg every two months, stopping no later than six months [2].

In general, those who are on high doses of thyroid hormone or who have been taking their medication for a longer amount of time will need to wean off more slowly. 

If you are on desiccated thyroid medication like Armour Thyroid, these tapering schedules can also work for you. Just be sure to speak with your doctor, as the dosage units are very different from levothyroxine and your schedule will need to be adjusted accordingly.

While it’s normal for your body to experience adjustments while stopping any medication, if symptoms return during your taper, consider a slower option. When it comes to stopping your thyroid medication, there is no rush. 

Though it’s less likely, in the case that you start to feel significant symptoms, reach out to your provider to have your thyroid labs checked as soon as possible. Otherwise, take your time, and when you’re at the end of your taper, continue on to the next step.

Step 3: See How You Feel (And Investigate Your Symptoms)

Once you’re done weaning off your medication you’ll want to assess how you feel. Depending on where you’re at, there may be some additional work to do (though everyone will need to continue on to Step 4). To simplify this process, you can look below to find which category you fall into to help determine your next steps. 

Category 1: If you are symptom-free after stopping your thyroid medication, great! Your body has likely restored its natural thyroid function and you can move directly to Step 4. 

Category 2: If you had symptoms while taking thyroid medication that resolved after weaning off, there is a chance that you were overmedicated and experiencing side effects. If this is the case, your symptoms shouldn’t return. But if they do, there may be another factor at play (see Category 3). 

Category 3: If you’ve continued to have persistent symptoms while both on and off your medication you will need to do some further investigation. It’s quite possible that your health concerns are actually related to another condition, like poor gut health. There are many avenues for addressing digestive health, which we cover in detail in our many gut-focused articles.

Category 4: If your symptoms were gone (or mostly gone) while taking thyroid medication and have returned since discontinuing, it’s possible you truly have overt hypothyroidism. While this should be confirmed with labs first, you will likely have to restart your thyroid medication. However, below are some tools you can use alongside your medication to support thyroid health.

Category 5: If your symptoms were gone while taking your medication, have returned since stopping, and your thyroid labs come back as normal, there’s a chance the thyroid medication was masking the root cause. Similar to Category 3, this is highly indicative of a gut issue, and starting a gut-healing protocol is a great next move.

Now that you know how to evaluate how you feel and have a general idea of what to do next, the final checkpoint is to head back to your doctor for a few blood tests. 

Step 4: Retest Your Thyroid Levels

Regardless of how you feel, you will need to get your thyroid levels checked six weeks after taking your last dose of thyroid medication. This is to ensure that your thyroid is working properly and confirm that you truly don’t need thyroid medication.

Provided that your labs now fall into the normal or subclinical range, you probably won’t benefit from taking thyroid medication. However, if you are still having symptoms or your labs aren’t “perfect” there are many ways to support your thyroid health. As mentioned in Step 3, hypothyroid symptoms, such as fatigue, brain fog, and mood imbalances, are often due to digestive issues, and we have ample resources to help heal a suboptimal digestive tract including my book, Healthy Gut, Healthy You.

If thyroid levels reflect overt hypothyroidism you will need to restart your medication. This isn’t to say you will need to be on thyroid hormone indefinitely, as there are many ways to naturally support and heal your thyroid. Addressing your thyroid health can even help you lower the strength of your thyroid medication, or even allow you to discontinue it in the future.

Additionally, if you have overt hypothyroidism and don’t feel totally better while on your medication, you can consider other options like liquid T4 or adding T3 (Cytomel) to your regimen. 

Now, let’s get into the gut-thyroid connection and ways that you can heal your thyroid — whether you’re on or off your thyroid medication.

Why Gut Health Matters

Poor gut health is at the root of a surprisingly long list of health conditions, including mood disorders, sleep problems, cognitive decline, cardiovascular issues, and thyroid disease. 

Poor gut health is often marked by the presence of leaky gut and gut dysbiosis, both of which can lead to chronic inflammation that affects thyroid health. Treating your gut often means treating your thyroid dysfunction.

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Leaky gut occurs when the tight junctions of the intestinal tract become permeable. This allows substances to leave the digestive tract and enter the bloodstream where they are seen as foreign and provoke an inflammatory response. 

Gut dysbiosis is an imbalance of bacteria inside the digestive tract that can create and exacerbate inflammation, which damages the gut walls and leads to leaky gut syndrome. 

Both of these inflammatory conditions can disrupt the thyroid and decrease the absorption of nutrients that are key for a healthy thyroid.

A study found that over half of pregnant women with subclinical hypothyroidism tested positive for small intestine bacterial overgrowth (SIBO), a common type of gut dysbiosis. Women who tested positive for SIBO through a hydrogen breath test also had a higher number of TPO (thyroid peroxidase) antibodies, indicating that their immune system was mounting an attack on their thyroid [8]. These findings were supported by another small study that found that SIBO patients are more likely to have impaired thyroid function [9].

A study examining the relationship between gut dysbiosis and thyroid function found that patients with both Hashimoto’s thyroiditis (can lead to hypothyroidism/underactive thyroid) and Graves’ disease (can lead to hyperthyroidism/overactive thyroid) had an extremely high prevalence of gut dysbiosis [10].

Addressing the root cause of symptoms plays a huge role in how to get off thyroid medication naturally. Healing your gut to improve your thyroid health is a multi-step process of dietary changes, supportive supplements, and lifestyle improvements. 

Foundational Steps for Thyroid Health

While you may not need thyroid medication, you can still have symptoms of hypothyroidism, especially if they never resolved while being on medication. This is often due to poor gut health which can mimic, or even cause, thyroid dysfunction. 

It’s essential to heal your thyroid (and gut) before weaning off your medication to help alleviate these symptoms and make the process as smooth as possible. You can find the following recommendations (and many more) in our virtual thyroid course

If you are still taking your thyroid medication, keep in mind that as you heal your gut and thyroid, you may begin to feel overmedicated. This is due to your body restoring its natural thyroid output and enhanced absorption of your thyroid medication from a healthy gut.

Symptoms of overmedication may include fatigue, insomnia, heart palpitations, anxiety, and/or a fast pulse. 

Have your doctor keep an eye on your thyroid labs while you implement these foundations for better health to make sure you aren’t taking too much thyroid medication.

Optimize Your Diet

Reducing inflammatory inputs that come from a poor diet means that you’re no longer throwing fuel on the fire in your gut. It might take some trial and error to determine which diet works best for you, but the best place to start is a Paleo diet

A gluten-free, grain-free, legume-free, and low-dairy diet rich in fruits, veggies, proteins, and healthy fats is the perfect place to start. 

More restrictive diets like the low FODMAP diet or the autoimmune protocol (AIP) diet might be necessary if standard Paleo doesn’t help reduce your symptoms on its own. To learn how to determine which foods could be triggering your symptoms, check out one of our articles on following an elimination diet

Don’t Forget About Water

Many of us are chronically dehydrated, and proper hydration supports your body’s natural detoxification and helps with clearing any unwanted toxins from an overtaxed thyroid. Consider using a filter that removes fluoride from tap water, which can negatively impact proper thyroid function [11]. Fluoride can impair your thyroid’s ability to absorb iodine, which is an essential nutrient for proper function.

Introduce Probiotics

The most important supplement you can take when it comes to gut health is a good quality probiotic [12, 13, 14]. Probiotics help restore microbial balance and seal the gut lining in people with leaky gut, which can help reduce persistent symptoms that didn’t resolve with thyroid medication. 

One interesting study also found that probiotics may reduce your need for the thyroid medication, levothyroxine (Synthroid) [15]. I recommend starting with a Triple Therapy approach, which includes microbial strains from all three categories of probiotics and will help you restore balance quickly.

Assess Your Lifestyle

Admittedly, “lifestyle changes” is a broad category that encompasses a number of behaviors. The three big ones that will help support your gut and your thyroid are stress reduction, sleep improvements, and moderate exercise.

Chronic stress can be more harmful for your health than you might think. It has an especially negative impact on the adrenals, thyroid, and gut health. While stress is a normal part of life (and not all stress is bad stress), having some supportive habits in place for yourself is a great way to prevent it from becoming chronic or crippling. 

Yoga, meditation, mindfulness practices like journaling, or even taking a slow, quiet walk in nature can all be restorative practices that help reduce the effects of stress in your life [16, 17, 18].

Sleep, which is related to stress, is where your body heals and restores itself. Poor sleep is linked to many of the same health conditions caused by inflammation, and that’s in part because sleep helps clear inflammation out of your system — but only when you have enough of it. 
Thyroid dysfunction overlaps with a number of sleep disorders [19]. Getting seven to nine hours of sleep each night will not only improve your gut and thyroid health but your overall health as well [20].

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Moderate daily exercise has been shown to be protective against low-grade inflammation [21]. It also helps regulate endocrine function, an important factor in thyroid regulation [22]. Furthermore, sweating daily is a great way to help cleanse your system if you’ve been exposed to any external factors that could be affecting your thyroid gland.

Try Thyroid-Boosting Supplements

If changing your diet, staying properly hydrated, and addressing your lifestyle don’t completely resolve your symptoms it may be a good time to look into taking thyroid-supporting supplements.

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If your thyroid levels don’t completely normalize after coming off your thyroid medication, you may also consider supplementing for condition-specific thyroid function. 

Vitamin D and selenium can be helpful for thyroid conditions. Vitamin D deficiency is highly correlated with hypothyroidism [23, 24]. Several studies show that selenium decreased antibodies in those with Hashimoto’s disease — a common cause of hypothyroidism [25, 26]. Though there are studies that show selenium has no effect on thyroid antibodies or hormone levels [27, 28, 29, 30], it’s inexpensive and easy to try. 

Hypothyroid patients may consider adding HCl, iron, and/or zinc to improve thyroid nutrient absorption in the gut and boost thyroid health. However, you probably won’t get all of the benefits you are looking for from these supplements alone if an unhealthy gut is behind your symptoms. It’s essential to start with the basics, like diet and lifestyle, before moving on to thyroid supplements. 

Finding Freedom From Thyroid Medication

Stopping your thyroid medication doesn’t have to be complicated. Hopefully, you now understand the basics of how to get off thyroid medication naturally. If you have thyroid levels within the normal range or that are reflective of subclinical hypothyroidism, you are likely a good candidate. By getting your labs tested, finding the right tapering schedule, and observing how you feel you can be medication-free in no time. 

If you’re still dealing with symptoms after coming off your medication, there are plenty of ways you can heal your thyroid (and gut) naturally. Diet, lifestyle, and supplements all come into play when it comes to better thyroid health.

However, the most important part of discontinuing your medication is finding a provider who is willing to work with you throughout the process. If you are in need of assistance, we are here to help at The Ruscio Institute for Functional Medicine

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

➕ References
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