Dr. Michael Ruscio, DC is a clinician, Naturopathic Practitioner, clinical researcher, author, and adjunct professor at the University of Bridgeport. His work has been published in peer-reviewed medical journals and he speaks at conferences around the globe.
How (and When) to Discontinue Thyroid Hormone Replacement Safely
You may be used to taking thyroid medication such as levothyroxine (LT4) each day to treat your hypothyroidism. What you might not realize is there’s a good chance you don’t actually need this medication.
For some people, thyroid medication is necessary and effective. But a growing body of research and significant clinical experience tells us there’s more to the story.
A 2021 meta-analysis of 17 studies found that more than 30% of patients can come off their hypothyroid medication and maintain normal thyroid hormone levels . Some studies suggest that this rate may be as high as 60% [1, 2]. In other words, as high as 30-60% of people who are taking thyroid medication don’t need to be.
Keep in mind that a higher proportion of patients with subclinical hypothyroidism were able to come off of their medication (compared to patients with true hypothyroidism).
Taking thyroid medication if you don’t need it isn’t likely to provide benefits and may actually cause harm. This might also be keeping you from finding the true cause of your symptoms.
However, that doesn’t mean you want to simply stop taking your thyroid medication, and certainly not all at once. You should first seek medical advice from your doctor, and test your thyroid hormone levels (after any discontinuation of medication) in order to assess whether or not you do require thyroid hormone replacement.
Here, we’ll consider why you may want to rethink your thyroid medication, as well as how to safely go about this and everything else you need to know about stopping thyroid medication suddenly.
Hypothyroidism, characterized by an underactive thyroid (the thyroid gland doesn’t produce enough hormones), is a condition that is typically treated with replacement thyroid hormones. Common prescriptions include:
Levothyroxine (LT4, T4, or thyroxine)
Brand names include Synthroid and Tirosint
Combination of triiodothyronine (T3) and T4
Brand names include Thyrolar and Liotrix
Causes of hypothyroidism may include:
Radioactive iodine treatment or thyroid surgery for hyperthyroidism
Hashimoto’s thyroiditis, an autoimmune condition in which the immune system attacks the thyroid
Why You Might Not Actually Need Thyroid Medication
For those who have true hypothyroidism, taking thyroid medication is appropriate. But unfortunately, many people who are taking thyroid medication don’thave true hypothyroidism. This is largely a result of pervasive misinformation on the internet and throughout the functional and integrative medicine fields in particular. That means that there are many who most likely don’t need to be taking medication.
Practitioners in the functional medicine and naturopathic fields may be more likely to prescribe thyroid hormone in subclinical or ‘sluggish’ cases than conventional endocrinologists typically are.
Thyroid medication is not beneficial for those with subclinical or “sluggish”hypothyroidism. While many in the naturopathic and functional medicine fields widely believe that the range should be looser at which people qualify for meds, the research doesn’t support this.It consistently shows that individuals with subclinical hypothyroidism, a mild form in which thyroid-stimulating hormone (TSH) levels are just slightly raised, do not require thyroid hormone replacement.
A 2018 study showed that taking thyroid hormones like levothyroxine in subclinical cases without hypothyroid symptoms didn’t improve quality of life. While this did reduce mean T4 levels to a normal range, it did not bring other benefits for non-pregnant patients .
Even patients with heart disease who are over age 65 don’t necessarily need these meds since they don’t benefit from replacement therapy in subclinical cases .
Overtreatment with thyroid medication may cause harm. What’s more, taking thyroid hormones when you don’t actually need these may cause harm. Study results show the body may react to excessive thyroid hormones, not unlike that seen with an overactive thyroid . Such signs include the following:
Thyroid medication is not necessary for all Hashimoto’s cases (only for those that have led to true hypothyroidism). The autoimmune condition Hashimoto’s, in which the immune system erroneously attacks the thyroid gland, is commonly cited as the most common cause of hypothyroidism. This is true, but it can also be misleading without a bit more context.
Even though the vast majority of hypothyroidism cases are caused by Hashimoto’s , only 9-19% of individuals with Hashimoto’s develop hypothyroidism . In other words, a Hashimoto’s diagnosis does not mean that you have hypothyroidism or that you need to be taking thyroid medication unless your lab results indicate that you have developed the condition.
In fact, if you have Hashimoto’s, there’s a higher likelihood of not needing medication (81-91%) than of needing medication (9-19%) .
Thyroid hormones are sometimes prescribed to help with fertility (for those with hypothyroidism or subclinical hypothyroidism, but not sluggish or normal thyroid).
If thyroid hormones were prescribed to enhance fertility, they can generally be discontinued after a successful pregnancy. If you started taking thyroid hormones while trying to get pregnant and are no longer at this stage you can most likely discontinue your medication.
In fact, most studies agree that medication may not help those trying to get pregnant or to carry a baby to term if they don’t have symptoms of hypothyroid.
An exception may be those with fertility problems. In a 2018 study, there was a 49% lower risk of miscarrying in this group if they took levothyroxine. But for those who just had subclinical disease alone or Hashimoto’s, there was no benefit. There were no improvements in miscarriage rates, numbers of clinical pregnancies, or live births .
A 2020 systematic review and meta-analysis of 6 randomized controlled trials involving more than 2200 patients with Hashimoto’s and normal thyroid levels concluded that levothyroxine use was not associated with any beneficial outcomes on pregnancy .
For those who have Hashimoto’s with normal thyroid levels, a 2020 study showed taking thyroid drugs did not help women to stave off miscarriage and successfully have a baby .
Side Effects of Levothyroxine
Medications like levothyroxine are generally understood to be safe, but they can have side effects. For example, a 2010 survey of 1,536 physicians who frequently prescribe levothyroxine gave 199 reports of negative side effects that they came across, such as :
Tiredness (yes, unnecessary thyroid medication can cause fatigue)
Fortunately, most studies show that taking levothyroxine, at least for up to 12 months of use, doesn’t necessarily bring with it any increased risk for serious side effects [5, 12, 13].
But in one study, some people on levothyroxine for about four and a half years did have issues. For some, there was actually an increased risk of serious problems. Those who were under- or over-treated had a higher risk of heart disease, abnormal heartbeat, and fractures related to osteoporosis .
The biggest concern, though, is that taking unnecessary thyroid medication can set you off track from uncovering the true cause of your symptoms.
Unfortunately, we see patients on a weekly basis who have been suffering chronic symptoms for far too long because of a faulty thyroid diagnosis and/or unnecessary medication.
Stopping Thyroid Medication Suddenly is Not Recommended
If you’re planning on stopping thyroid medication suddenly, even if you think that you may have been taking it unnecessarily, you don’t want to quit taking thyroid hormones abruptly.
In addition to first talking to your endocrinologist or other health care professional, if you do get the go-ahead, it’s important to have a plan for doing it safely.
Stopping hormone replacement should be done with medical supervision and testing. You want to make sure that you have your thyroid levels tested both before and after discontinuing your medication.
Of course, no one practitioner may know all. It’s possible that your practitioner may be misinterpreting your test results, and so you may wish to get a second opinion. Still, this opinion needs to be grounded in the numbers and based on your actual thyroid labs.
Know Your Numbers
Knowing where you actually fall on the hypothyroid spectrum is essential in considering whether you can realistically think about stopping thyroid medication suddenly, albeit safely.
Current guidelines consider TSH (thyroid-stimulating hormone) alone as the best test for detecting thyroid dysfunction . But a combination of TSH levels and T4 levels are the numbers most medical professionals look at.
Screening for hypothyroidism and knowing your levels can be very helpful. This just takes a routine blood test.
Begin with a simple TSH and T4 evaluation for hypothyroidism.
If you are truly hypothyroid, you will need to be on thyroid hormone medication.
If you are not truly hypothyroid but your levels are slightly off, you do not need treatment. In many cases, these levels normalize over time.
The numbers tell an important story. Here’s how to tell what your story is and if you may be able to think about stopping thyroid medication suddenly.
Your TSH number tells how hard your body is working to get your thyroid to produce enough thyroxine.
If your body isn’t making enough thyroid hormone, more TSH is needed, and this number goes up. It is your TSH that triggers your body to make the thyroid hormones thyroxine (T4) and L-triiodothyronine (T3) .
Thyroid Level Ranges
Keep in mind, when looking at conventional ranges, your TSH is considered somewhat high when it’s above 4.5-8 mlU/L and very high when it is at 8 mlU/L and above . Your T4 levels should normally be in the 0.8-2.7 ng/dL range . Anything below 0.8 ng/dL is considered low .
If both of your numbers are in the normal range, this is best — you’re hoping for something in the optimal thyroid level range. But if your TSH is somewhat high and you have normal T4 levels, this is what’s called subclinical hypothyroidism . On the other hand, if your TSH is high and your T4 is low you have overt hypothyroid .
Those in this high range whose bodies don’t make enough thyroid hormones truly need to be on medication. If they don’t, there can be consequences from not getting the hormones they need and even a risk of myxedema coma or near coma for some .
For others though, it may be much more open-ended.
To see where you may fall on the continuum, check out the table here. If you find you were in the subclinical range when you were put on the medication, it’s possible that you can come off of your medication. It will of course depend on your individual numbers and circumstances.
While stopping thyroid medication suddenly is not advisable, there are a number of helpful options and strategies for stopping thyroid medication safely. A range of different options are generally safe and effective, and you can choose the one that’s right for you.
Strategies for Quitting Levothyroxine (LT4)
Cut the original dose in half during week one and stop altogether at the start of week two .
Cut the original dose in half and take it for four weeks, then cut that dose in half and take for four weeks, etc., until you reach 12.5 mcg/day or less; then stop .
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 .
Cut the original dose by 12.5-50 micrograms/day, spread out over three months .
Stop levothyroxine (LT4) and switch to liothyronine (LT3) for 2-4 weeks and then taper off LT3 for two weeks .
The most successful discontinuations seem to be for those who’ve been taking thyroid medication for a shorter period of time or who have been on a lower dose . If that’s not you, you just may need to take a little more time and move more cautiously.
Once you’re off the medication, remember to look into other causes of your symptoms, especially if your thyroid levels remain normal. You may have some non-specific issues such as fatigue or depression that you hoped thyroid meds would address, but you’re still not feeling great.
Pulling back from targeting and treating something that is not the real source of the problem may help you find what’s actually causing your symptoms. It’s important to look into other areas of the body that may be the true source here.
It is much more likely that this has something to do with a gut issue or maybe a female hormone imbalance. That’s a good thing because these imbalances are often easily treated.
Find What Works for You
If the idea of stopping your thyroid medication seems warranted and your numbers justify rethinking this, it’s worth taking a closer look.
The research supports the idea that those with subclinical hypothyroid levels, those who are no longer trying to conceive, and even those with Hashimoto’s can potentially stop thyroid medication.
These medications are not without its side effects and also may be keeping you from getting to the root of some other issue.
You can find more information about thyroid disease and how this may be influenced by the gut or other systems in my book Healthy Gut, Healthy You. Also, in your journey to the root cause of your symptoms, our functional healthcare clinic is here to support you. Feel free to reach out for a consultation.
Burgos N, Toloza FJK, Singh Ospina NM, Brito JP, Salloum RG, Hassett LC, et al. Clinical Outcomes After Discontinuation of Thyroid Hormone Replacement: A Systematic Review and Meta-Analysis. Thyroid. 2021 May;31(5):740–51. DOI: 10.1089/thy.2020.0679. PMID: 33161885. PMCID: PMC8110016.
Livadas S, Bothou C, Androulakis I, Boniakos A, Angelopoulos N, Duntas L. Levothyroxine replacement therapy and overuse: A timely diagnostic approach. Thyroid. 2018 Nov 30; DOI: 10.1089/thy.2018.0014. PMID: 30351232.
Patil N, Jialal I. Hypothyroidism. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2018. PMID: 30137821.
Feller M, Snel M, Moutzouri E, Bauer DC, de Montmollin M, Aujesky D, et al. Association of Thyroid Hormone Therapy With Quality of Life and Thyroid-Related Symptoms in Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-analysis. JAMA. 2018 Oct 2;320(13):1349–59. DOI: 10.1001/jama.2018.13770. PMID: 30285179. PMCID: PMC6233842.
Mooijaart SP, Du Puy RS, Stott DJ, Kearney PM, Rodondi N, Westendorp RGJ, et al. Association Between Levothyroxine Treatment and Thyroid-Related Symptoms Among Adults Aged 80 Years and Older With Subclinical Hypothyroidism. JAMA. 2019 Nov 26;322(20):1977–86. DOI: 10.1001/jama.2019.17274. PMID: 31664429. PMCID: PMC6822162.
Biondi B, Cappola AR, Cooper DS. Subclinical hypothyroidism: A review. JAMA. 2019 Jul 9;322(2):153–60. DOI: 10.1001/jama.2019.9052. PMID: 31287527.
SWEENEY LB, STEWART C, GAITONDE DY. Thyroiditis: An Integrated Approach – American Family Physician. Am Fam Physician. 2014 Sep 15;90(6):389–96.
Amouzegar A, Gharibzadeh S, Kazemian E, Mehran L, Tohidi M, Azizi F. The Prevalence, Incidence and Natural Course of Positive Antithyroperoxidase Antibodies in a Population-Based Study: Tehran Thyroid Study. PLoS ONE. 2017 Jan 4;12(1):e0169283. DOI: 10.1371/journal.pone.0169283. PMID: 28052092. PMCID: PMC5215694.
Rao M, Zeng Z, Zhao S, Tang L. Effect of levothyroxine supplementation on pregnancy outcomes in women with subclinical hypothyroidism and thyroid autoimmuneity undergoing in vitro fertilization/intracytoplasmic sperm injection: an updated meta-analysis of randomized controlled trials. Reprod Biol Endocrinol. 2018 Sep 24;16(1):92. DOI: 10.1186/s12958-018-0410-6. PMID: 30249251. PMCID: PMC6154908.
Wang X, Zhang Y, Tan H, Bai Y, Zhou L, Fang F, et al. Effect of levothyroxine on pregnancy outcomes in women with thyroid autoimmunity: a systematic review with meta-analysis of randomized controlled trials. Fertil Steril. 2020 Dec;114(6):1306–14. DOI: 10.1016/j.fertnstert.2020.06.034. PMID: 32912635.
Hennessey JV, Malabanan AO, Haugen BR, Levy EG. Adverse event reporting in patients treated with levothyroxine: results of the pharmacovigilance task force survey of the american thyroid association, american association of clinical endocrinologists, and the endocrine society. Endocr Pract. 2010 Jun;16(3):357–70. DOI: 10.4158/EP0362.OR. PMID: 20551006.
Stott DJ, Rodondi N, Kearney PM, Ford I, Westendorp RGJ, Mooijaart SP, et al. Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism. N Engl J Med. 2017 Jun 29;376(26):2534–44. DOI: 10.1056/NEJMoa1603825. PMID: 28402245.
Jabbar A, Ingoe L, Junejo S, Carey P, Addison C, Thomas H, et al. Effect of levothyroxine on left ventricular ejection fraction in patients with subclinical hypothyroidism and acute myocardial infarction: A randomized clinical trial. JAMA. 2020 Jul 21;324(3):249–58. DOI: 10.1001/jama.2020.9389. PMID: 32692386.
Flynn RW, Bonellie SR, Jung RT, MacDonald TM, Morris AD, Leese GP. Serum thyroid-stimulating hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term thyroxine therapy. J Clin Endocrinol Metab. 2010 Jan;95(1):186–93. DOI: 10.1210/jc.2009-1625. PMID: 19906785.
Kluesner JK, Beckman DJ, Tate JM, Beauvais AA, Kravchenko MI, Wardian JL, et al. Analysis of current thyroid function test ordering practices. J Eval Clin Pract. 2018;24(2):347–52. DOI: 10.1111/jep.12846. PMID: 29105255.
Eghtedari B, Correa R. Levothyroxine. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. PMID: 30969630.
Sheehan MT. Biochemical Testing of the Thyroid: TSH is the Best and, Oftentimes, Only Test Needed – A Review for Primary Care. Clin Med Res. 2016 Jun;14(2):83–92. DOI: 10.3121/cmr.2016.1309. PMID: 27231117. PMCID: PMC5321289.
Samuels MH, Kolobova I, Antosik M, Niederhausen M, Purnell JQ, Schuff KG. Thyroid Function Variation in the Normal Range, Energy Expenditure, and Body Composition in L-T4-Treated Subjects. J Clin Endocrinol Metab. 2017 Jul 1;102(7):2533–42. DOI: 10.1210/jc.2017-00224. PMID: 28460140. PMCID: PMC5505196.
Mathew V, Misgar RA, Ghosh S, Mukhopadhyay P, Roychowdhury P, Pandit K, et al. Myxedema coma: a new look into an old crisis. J Thyroid Res. 2011 Sep 15;2011:493462. DOI: 10.4061/2011/493462. PMID: 21941682. PMCID: PMC3175396.
Jung KY, Kim H, Choi HS, An JH, Cho SW, Kim HJ, et al. Clinical factors predicting the successful discontinuation of hormone replacement therapy in patients diagnosed with primary hypothyroidism. PLoS ONE. 2020 May 29;15(5):e0233596. DOI: 10.1371/journal.pone.0233596. PMID: 32469958. PMCID: PMC7259697.
Pak K, Cheon GJ, Kang KW, Kim S-J, Kim I-J, Kim EE, et al. The effectiveness of recombinant human thyroid-stimulating hormone versus thyroid hormone withdrawal prior to radioiodine remnant ablation in thyroid cancer: a meta-analysis of randomized controlled trials. J Korean Med Sci. 2014 Jun;29(6):811–7. DOI: 10.3346/jkms.2014.29.6.811. PMID: 24932083. PMCID: PMC4055815.
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