Black Friday Code: DIGEST35
Virtual Clinic STORE
Virtual Clinic STORE
Articles
Evidence based
Evidence Based

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

Our team of licensed nutritionists and dietitians strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

What Happens If You Don’t Take Thyroid Medication?

Written by Michael Ruscio on November 25, 2024

Kellie Blake

Written by Michael Ruscio on November 25, 2024 — Reviewed by Kellie Blake Kellie Blake

It’s becoming increasingly clear to me that thyroid medication is often overprescribed, especially for some cases of hypothyroidism. 

Medication is necessary if you have overt (or true) hypothyroidism or hyperthyroidism, but many people (especially women and folks over age 60) are prescribed medication when they have subclinical versions of these thyroid abnormalities 1 2 3. In this context, taking thyroid medication is like using a sledgehammer on a finishing nail—it’s too much and not helpful for solving the problem at hand. It can even be damaging in some instances.

That said, if you do need medication, it’s really important that you take it, so finding out if you truly need it should be step one. A blood test from your healthcare provider should get you the results you need to determine whether you have a thyroid condition that would actually benefit from medication.

In the United States, hypothyroidism is diagnosed eight times more often than hyperthyroidism, and the vast majority of my clients with thyroid issues have hypothyroidism. So, I’ll briefly touch on hyperthyroidism, but I’ll mostly focus on hypothyroidism and its treatments to help answer questions about what happens if you need but don’t take thyroid medication 4.

Let’s first understand how to determine if you really need thyroid medication. If you do need it but aren’t taking it, I’ll explain the risks. And then, for people on thyroid replacement hormones who discover they need a lower dose or don’t need them at all, I’ll go over safe ways to taper or wean off thyroid medication with a doctor’s supervision.

Do You Need Thyroid Medication?

There are four main categories of thyroid disease. Overt and subclinical hypothyroidism (or underactive thyroid) and overt and subclinical hyperthyroidism (or overactive thyroid). The overt (or true) versions of each category require medication, but the subclinical versions are usually temporary and go away with time and possibly some diet and lifestyle adjustments.

I’ll break down each category into its lab values, symptoms, potential causes, and appropriate treatment.

what happens if you don't take thyroid medication

Overt (True) Hypothyroidism

Diagnosed when: TSH is above 4.5 and free T4 is below 0.8.

Going by lab values, when thyroid-stimulating hormone (TSH) is above 4.5 and free thyroxine (T4) is below 0.8, someone has overt hypothyroidism 5 6.

If TSH is above 4.5 and free T4 is below 0.8, and thyroid peroxidase (TPO) antibodies are above 500, that’s overt hypothyroidism with Hashimoto’s thyroiditis 5 7 8. Hashimoto’s is an autoimmune attack on the thyroid gland that sometimes, but not always, leads to hypothyroidism 5 7 8 9. 

The most common symptoms of overt hypothyroidism, listed below, may overlap with other conditions. It’s possible to have a combination of these symptoms, so getting blood work is important.

Symptoms of hypothyroidism may include 5 10 11 12 13 14:

  • Tiredness
  • Constipation
  • Dry skin
  • Cold intolerance
  • Weight gain
  • Hoarseness
  • Mood changes
  • Muscle pain

The top two causes of overt hypothyroidism are a lack of dietary iodine (which is now rare in the U.S.) and Hashimoto’s thyroiditis 5. While a deficit in dietary iodine can be addressed without medication, autoimmunity takes a bit more effort to resolve. But it is possible to manage it with diet and supportive supplements.

Even though Hashimoto’s is the most common cause of overt hypothyroidism 5, not all hypothyroid patients have or will develop Hashimoto’s thyroiditis, and not all Hashimoto’s patients develop hypothyroidism 9.

For example, roughly 5–19% of the U.S. population has Hashimoto’s, but only 0.3% of people in the U.S. have overt hypothyroidism 8 9 15 16 17. In fact, only 9–19% of people with TPO antibodies (which attack the thyroid gland) go on to develop true hypothyroidism 9. Those people typically have TPO antibodies that are higher than 500 9, but a Hashimoto’s diagnosis occurs when that number is just above 35.

Great ways to bring TPO numbers down are by eating an anti-inflammatory diet 18 19 20 21 22—reducing sugar, processed foods, trans fats, gluten, and alcohol—and adding in selenium 23 24 and vitamin D supplements 25 26.

Other, less common, factors can also increase the chances of developing true hypothyroidism. They include 5:

  • Certain prescription medications, including some cancer medications
  • Thyroid radioactive iodine therapy (for Graves’ disease, or hyperthyroidism)
  • Thyroid surgery
  • Radiotherapy to neck or head
  • Central hypothyroidism from disorders of the pituitary gland or hypothalamus
  • Giving birth
  • Subacute granulomatous thyroiditis (de Quervain disease, which is usually self-limiting)

Overt Hypothyroidism Treatment

People with overt thyroiditis do need conventional medical intervention to get their thyroid levels where they need to be. Thyroid hormone replacement medication—aka levothyroxine or LT4, brand name Synthroid—helps bring thyroxine (T4) numbers to healthy levels.

Adding certain functional medicine treatments to the conventional approach can help support thyroid function as well as the systems—primarily the digestive one—that affect it. In addition to prescription medication, functional medicine treatments might include the following:

Subclinical Hypothyroidism

Diagnosed when: TSH is mildly high (4.5–10 mIU/L) but T4 is in normal range (0.8–1.8 ng/dL).

Thyroid labs showing a mildly high TSH (4.5–10 mIU/L) with a normal free T4 (0.8–1.8 ng/dL) indicate subclinical hypothyroidism or a mildly underactive thyroid 5 7 8. However, these numbers tend to vary a bit for people who are 60 or older because their TSH levels rise naturally 1 6 41 42. The following chart shows how to identify subclinical hypothyroidism in older adults and avoid misdiagnosis when their TSH matches that of younger patients who qualify for subclinical hypothyroidism.

what happens if you don't take thyroid medication

Another thing to look out for is a “sluggish thyroid.” That’s a term some functional and integrative practitioners sometimes use to refer to lab findings that are in the “suboptimal half” of the normal range for TSH, free T4, and even T3. For example, a TSH of 4.1 and a free T4 of 1.0 (which are very common) might get called sluggish thyroid. However, sluggish thyroid is not an actual diagnosis, and variations within normal thyroid hormone ranges are nothing to worry about. 

Although subclinical hypothyroidism doesn’t typically cause symptoms, it can. The most common symptoms of subclinical hypothyroidism may include 43:

  • Dry skin
  • Hair loss
  • Constipation 
  • Loss of appetite
  • Weight gain
  • Brain fog
  • Anxiety
  • Fatigue
  • Irregular menstrual cycles

Subclinical Hypothyroidism Treatment

It’s not uncommon for well-meaning doctors to prescribe levothyroxine to patients with subclinical hypothyroidism 3. However, in up to 74% of cases, a mildly underactive thyroid will resolve on its own over time or with dietary and lifestyle improvements 3. 

Both research and my clinical experience tell me that many people take levothyroxine for no reason 44 45 and get unpleasant symptoms that look like hyperthyroidism as a result 46 47.

Appropriate treatments for most people with subclinical hypothyroidism overlap with the functional add-ons for true hypothyroidism, minus the hormones. Before they take any medication, I’ll have my subclinical hypothyroid clients consider dietary changes, probiotics, bedtime improvements, and stress reduction techniques that should reduce any inflammation that may be contributing to their symptoms. Then, we’ll retest their thyroid in 2–3 months.

If their numbers haven’t normalized, we’ll incorporate the nutrients selenium and inositol 48 49 50. Again, after trying these nutrients for 2–3 months, we’ll retest. If abnormal TSH levels persist, I’ll ask my clients to speak with their doctor about thyroid hormone treatment. It is possible, after all, that they may have developed a true thyroid hormone deficiency. It’s also possible that they just need a temporary nudge from thyroid hormone medication.

Similarly, if my clients with subclinical hypothyroidism are pregnant or working through infertility, I recommend that they consult with their doctor about using thyroid medication, which can help when used temporarily 2 51. 

Overt (True) Hyperthyroidism

Diagnosed when: Blood test results show low TSH (<0.4 mIU/L) and high free T4 and/or T3 6 52. 

To find out which type of hyperthyroidism is present, a doctor may run a 24-hour radioactive iodine uptake test and look for thyroid antibodies (against TSH-receptors, thyroid peroxidase, thyroid stimulating immunoglobulin, thyrotropin-binding inhibiting immunoglobulin, and thyroglobulin). Graves’ disease, a type of thyroid autoimmunity, is the most common type of hyperthyroidism.

 The most common symptoms of overt hyperthyroidism are 47:

  • Weight loss despite a higher appetite 
  • Heart palpitations 
  • Nervousness
  • Tremors
  • Difficulty breathing
  • Becoming easily fatigued
  • Diarrhea
  • Muscle weakness
  • Heat intolerance 
  • Sweating more than usual
  • Irregular menstrual cycles

Factors that up the risk of overt hyperthyroidism commonly include:

  • Too much dietary iodine 47
  • Iodine deficiency (which can lead to both hypo- and hyperthyroidism) 47
  • A family history of hyperthyroidism 47
  • Being female (it’s 10 times more likely to occur in women than men) 47
  • Metabolic syndrome and insulin resistance are associated with increased incidence of goiter and thyroid cancer 53

Treatment for Overt Hyperthyroidism

Conventional treatment for overt hyperthyroidism includes taking radioactive iodine or antithyroid medication, or having part of the thyroid gland removed 47.

Functional approaches to improve the effectiveness of conventional therapies may include: 

  • Dietary improvements 22 29 54
  • Improving gut health 55 56 57 58
  • Taking one or more of the following supplements, as directed by a healthcare practitioner:
  • Light therapy 39 40

Subclinical Hyperthyroidism

Diagnosed when: Thyroid labs show that TSH is low (<0.4 mIU/L), but free T4 and free T3 are normal 46 52. 

If symptoms occur at all, the most common ones are milder than those of the overt type. They may include 46:

  • Irregular heartbeat
  • Heat intolerance
  • Insomnia
  • Increased appetite
  • Diarrhea
  • Weight loss
  • Hair loss
  • Sweating
  • Abnormal periods
  • Hand tremors

Factors that may lead to or increase a person’s risk of subclinical hyperthyroidism may include 46:

  • Getting treated for thyroid cancer 
  • Using thyroid hormones for weight loss
  • Taking too much thyroid hormone replacement therapy for hypothyroidism

Treatment for Subclinical Hyperthyroidism

Subclinical hyperthyroidism is typically resolvable and transient, meaning it usually clears up on its own without treatment or with general improvements in health. Even so, it may take up to 3–6 months for symptoms to resolve 46.

Treatment options include setting right any obvious and correctable contributors, such as a suboptimal cancer treatment approach, poor diet, or stressful lifestyle. Once those changes are in place, it’s important to recheck thyroid levels every 3 months. Very rarely, a doctor may suggest trying antithyroid medications, radioiodine therapy, or thyroid surgery, but these should be last-ditch options 46.

Key Takeaway: Typically, only the overt or true types of hypo- and hyperthyroidism require medication. Subclinical thyroid disease usually resolves on its own or with simple adjustments to diet and lifestyle.

What Happens if You Don’t Take Thyroid Medication?

If you need thyroid medication for any type of thyroid condition, it’s definitely not a good idea to go without it, especially for very long. A missed dose here and there is probably not harmful, but you may experience symptoms of your thyroid disorder if you’re not taking them as you should. 

Long-term untreated thyroid issues can increase your risk of heart disease, bone problems, fertility issues, organ failure, and even premature death in some cases.

Hypothyroidism

Not taking medication for overt hypothyroidism highly increases the risk of illness, coma, heart failure, and death 5. 

Though medication isn’t required, even unaddressed subclinical hypothyroidism could progress to overt hypothyroidism, which may then raise the risk of cardiovascular disease, congestive heart failure, and cognitive decline 71.

On the flip side, as you and your doctor manage your hypothyroidism medication, make sure you’re not taking too much thyroid hormone. 

A Note on Gut Health and Medication

Sometimes poor gut health can limit the absorption of thyroid medication, requiring a higher dose to be effective. One way we help clients improve how well their hypothyroid medications work is to make sure they are taking steps to improve and maintain their gut health. Factors that can lower the effectiveness of thyroid medication for hypothyroidism include 72: 

  • Reduced stomach acid (from a Helicobacter pylori infection, PPI use, antacid use, autoimmune gastritis, or history of gastric bypass) 
  • Leaky gut
  • Malabsorption (common in ulcerative colitis, Celiac disease, autoimmune gastritis, and other gut disturbances) 
  • SIBO (small intestinal bacterial overgrowth)

When taking thyroid hormones for hypothyroidism, a gut-centered approach can help to improve the absorption and effectiveness of the medication and potentially reduce the necessary dose.

Hyperthyroidism

Not treating overt hyperthyroidism increases the risk of extreme hyperthyroidism, also called a thyroid storm. This involves rapid heart rate, diarrhea, excessive sweating, anxiety, fever, and multiple organs malfunctioning. A thyroid storm requires immediate treatment, or it can be life-threatening.

Over the long term, untreated or undertreated hyperthyroidism may raise the risk of acute cardiovascular events, atrial fibrillation (irregular heart rate), ischemic stroke (blood clot blocking blood flow to the brain), osteoporosis, infertility, abnormal menstrual cycles, and death 47.

Similarly, not keeping an eye on subclinical hyperthyroidism can allow it to develop into overt hyperthyroidism over time and increase the risk of atrial fibrillation, osteoporosis, hip fractures, or death 47.

Key Takeaway: When a thyroid disorder requires medication, it’s very important to take it. Addressing subclinical thyroid conditions is also important to prevent them from becoming overt. Improvements in gut health may make it easier to absorb thyroid medication, which could make it more effective. 

How to Taper or Wean Off Hypothyroid Medication Safely 

I’ll start this section by saying that nothing in this article (nor anything on my site) is meant to replace your relationship with your doctor. I do not offer medical advice unless you are my client. Any time you change the dosing of a prescription medication, you should be under your provider’s close supervision.

In particular, people with hypothyroidism have the potential to take more thyroid hormone than they need for a number of reasons. For example, maybe their doctor has prescribed too high a dose, they accidentally (or intentionally) took more than their prescribed dose, or they’ve improved their gut health and can absorb their medication better. 

Taking too much thyroid hormone may be especially common in people with subclinical hypothyroidism who probably don’t need thyroid hormone replacement 1 2. 

If you start to notice symptoms that suggest your thyroid meds are too much, you can talk with your provider about titrating down. If your lab results and symptoms support you reducing or going off medication, then you and your doctor can consider doing so together. 

It’s important to know that stopping your medication suddenly may result in negative side effects 73. Fortunately, as the following table shows, there’s a range of weaning options that research indicates are safe and effective 73. They may be helpful to consider with your doctor if appropriate. 

Note that stopping thyroid hormone medication may be easier if your original dose is 56 micrograms/day or less, and you’ve been on it for 4.6 years or less 73.

OptionAppropriate starting doseDifferent science-backed strategies for safely quitting levothyroxine (LT4)
1Lower (56 mcg or less)Cut the original dose in half during week 1 and stop altogether at the start of week 2 74.
2HigherCut the original dose in half and take it for 4 weeks, then cut that dose in half and take for 4 weeks, etc., until you reach 12.5 micrograms (mcg)/day or less; then stop 74.
3LowerCut the original dose in half, take that for 2 months, and then stop 74.
4HigherCut the original dose by 25 mcg every 2 months, stopping no later than 6 months 74.
5HigherSlowly cut the original dose by 12.5–50 micrograms over 3 months until you’ve reached 12.5 mcg or less; then stop 74.
6Any doseStop levothyroxine (LT4) and switch to liothyronine (LT3) for 2–4 weeks and then gradually taper off LT3 for 2 weeks 75.

As you move through this process, listen to your body and pay attention to your symptoms. If anything arises, report those changes to your medical provider 73. For example, if you and your doctor decide to try the first option, but you don’t feel right at the start of week 2, they will be able to help you switch to a different schedule. 

Note that each option may be better suited to particular dosages. For example, the first and third options may be fine if you’re on a lower dose, like 56 micrograms (mcg) per day or less, whereas the second, fourth, and fifth options may be better if you’re on a higher dose 73. 

Although the science on the negative effects of stopping suddenly is generally observational and not exactly conclusive, some studies have found that some people can have severe reactions to a sudden discontinuation of levothyroxine 75 76 77 78 79. Therefore, I do not recommend stopping suddenly. 

When it Comes to Thyroid Meds, Don’t Wing It

Understanding your thyroid numbers is the most important step in the process of determining whether or not you need to be taking thyroid medication. With a doctor’s help, you can easily assess thyroid problems, even if the numbers change slightly over time. If your numbers reach a threshold indicating a need for prescription medication, take those results seriously, and work with your doctor to start medication for overt hypothyroidism or overt hyperthyroidism.

If your numbers suggest subclinical hypo- or hyperthyroidism, it’s a good idea to begin paying attention to your diet, gut health, and stress levels. As I’ve found with many clients, working on gut function is a reasonable place to start as we make a plan to retest their thyroid levels in a few months. 

If you’d like more tailored guidance on your thyroid health journey, we’d love to help you get started. Reach out to our clinic to set up a consultation.

The Ruscio Institute has developed a range of high-quality formulations to help our clients 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. The information on DrRuscio.com is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.

Dr. Michael Ruscio is a DC, natural health provider, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

➕ References

  1. 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.
  2. Myneni R, Chawla HV, Grewal AS, Vivekanandan G, Ndakotsu A, Abubacker AP, et al. Thyroxine replacement for subfertile females with subclinical hypothyroidism and autoimmune thyroiditis: A systematic review. Cureus. 2021 Aug 4;13(8):e16872. DOI: 10.7759/cureus.16872. PMID: 34513447. PMCID: PMC8411998.
  3. Abu-Helalah M, Alshraideh HA, Al-Sarayreh SA, Al-Hader A. Transient high thyroid stimulating hormone and hypothyroidism incidence during follow up of subclinical hypothyroidism. Endocr Regul. 2021 Dec 7;55(4):204–14. DOI: 10.2478/enr-2021-0022. PMID: 34879182.
  4. Strikić Đula I, Pleić N, Babić Leko M, Gunjača I, Torlak V, Brdar D, et al. Epidemiology of hypothyroidism, hyperthyroidism and positive thyroid antibodies in the croatian population. Biology (Basel). 2022 Mar 2;11(3). DOI: 10.3390/biology11030394. PMID: 35336768. PMCID: PMC8945477.
  5. Patil N, Jialal I. Hypothyroidism. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2018. PMID: 30137821.
  6. Thayakaran R, Adderley NJ, Sainsbury C, Torlinska B, Boelaert K, Šumilo D, et al. Thyroid replacement therapy, thyroid stimulating hormone concentrations, and long term health outcomes in patients with hypothyroidism: longitudinal study. BMJ. 2019 Sep 3;366:l4892. DOI: 10.1136/bmj.l4892. PMID: 31481394. PMCID: PMC6719286.
  7. Bohuslavizki KH, vom Baur E, Weger B, Krebs C, Saller B, Wetlitzky O, et al. Evaluation of chemiluminescence immunoassays for detecting thyroglobulin (Tg) and thyroid peroxidase (TPO) autoantibodies using the IMMULITE 2000 system. Clin Lab. 2000;46(1–2):23–31. PMID: 10745978.
  8. Siriwardhane T, Krishna K, Ranganathan V, Jayaraman V, Wang T, Bei K, et al. Significance of Anti-TPO as an Early Predictive Marker in Thyroid Disease. Autoimmune Dis. 2019 Jul 28;2019:1684074. DOI: 10.1155/2019/1684074. PMID: 31467701. PMCID: PMC6699358.
  9. 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.
  10. Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017 Sep 23;390(10101):1550–62. DOI: 10.1016/S0140-6736(17)30703-1. PMID: 28336049. PMCID: PMC6619426.
  11. Carlé A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Andersen S, et al. Hypothyroid Symptoms Fail to Predict Thyroid Insufficiency in Old People: A Population-Based Case-Control Study. Am J Med. 2016 Oct;129(10):1082–92. DOI: 10.1016/j.amjmed.2016.06.013. PMID: 27393881.
  12. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012 Dec;22(12):1200–35. DOI: 10.1089/thy.2012.0205. PMID: 22954017.
  13. Chiovato L, Magri F, Carlé A. Hypothyroidism in context: where we’ve been and where we’re going. Adv Ther. 2019 Sep 4;36(Suppl 2):47–58. DOI: 10.1007/s12325-019-01080-8. PMID: 31485975. PMCID: PMC6822815.
  14. Wilson SA, Stem LA, Bruehlman RD. Hypothyroidism: diagnosis and treatment. Am Fam Physician. 2021 May 15;103(10):605–13. PMID: 33983002.
  15. Gordin A, Maatela J, Miettinen A, Helenius T, Lamberg BA. Serum thyrotrophin and circulating thyroglobulin and thyroid microsomal antibodies in a Finnish population. Acta Endocrinol. 1979 Jan;90(1):33–42. DOI: 10.1530/acta.0.0900033. PMID: 760358.
  16. Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002 Feb;87(2):489–99. DOI: 10.1210/jcem.87.2.8182. PMID: 11836274.
  17. Friedrich N, Schwarz S, Thonack J, John U, Wallaschofski H, Völzke H. Association between parity and autoimmune thyroiditis in a general female population. Autoimmunity. 2008 Mar;41(2):174–80. DOI: 10.1080/08916930701777629. PMID: 18324487.
  18. Marum AP, Moreira C, Saraiva F, Tomas-Carus P, Sousa-Guerreiro C. A low fermentable oligo-di-mono saccharides and polyols (FODMAP) diet reduced pain and improved daily life in fibromyalgia patients. Scand J Pain. 2016 Aug 22;13:166–72. DOI: 10.1016/j.sjpain.2016.07.004. PMID: 28850525.
  19. Altobelli E, Del Negro V, Angeletti PM, Latella G. Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients. 2017 Aug 26;9(9). DOI: 10.3390/nu9090940. PMID: 28846594. PMCID: PMC5622700.
  20. Abbott RD, Sadowski A, Alt AG. Efficacy of the Autoimmune Protocol Diet as Part of a Multi-disciplinary, Supported Lifestyle Intervention for Hashimoto’s Thyroiditis. Cureus. 2019 Apr 27;11(4):e4556. DOI: 10.7759/cureus.4556. PMID: 31275780. PMCID: PMC6592837.
  21. Esposito T, Lobaccaro JM, Esposito MG, Monda V, Messina A, Paolisso G, et al. Effects of low-carbohydrate diet therapy in overweight subjects with autoimmune thyroiditis: possible synergism with ChREBP. Drug Des Devel Ther. 2016 Sep 14;10:2939–46. DOI: 10.2147/DDDT.S106440. PMID: 27695291. PMCID: PMC5028075.
  22. Krysiak R, Szkróbka W, Okopień B. The Effect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto’s Thyroiditis: A Pilot Study. Exp Clin Endocrinol Diabetes. 2019 Jul;127(7):417–22. DOI: 10.1055/a-0653-7108. PMID: 30060266.
  23. Gärtner R, Gasnier BCH. Selenium in the treatment of autoimmune thyroiditis. Biofactors. 2003;19(3–4):165–70. DOI: 10.1002/biof.5520190309. PMID: 14757967.
  24. Wichman J, Winther KH, Bonnema SJ, Hegedüs L. Selenium Supplementation Significantly Reduces Thyroid Autoantibody Levels in Patients with Chronic Autoimmune Thyroiditis: A Systematic Review and Meta-Analysis. Thyroid. 2016 Dec;26(12):1681–92. DOI: 10.1089/thy.2016.0256. PMID: 27702392.
  25. Zhang J, Chen Y, Li H, Li H. Effects of vitamin D on thyroid autoimmunity markers in Hashimoto’s thyroiditis: systematic review and meta-analysis. J Int Med Res. 2021 Dec;49(12):3000605211060675. DOI: 10.1177/03000605211060675. PMID: 34871506. PMCID: PMC8711703.
  26. Jiang H, Chen X, Qian X, Shao S. Effects of vitamin D treatment on thyroid function and autoimmunity markers in patients with Hashimoto’s thyroiditis-A meta-analysis of randomized controlled trials. J Clin Pharm Ther. 2022 Jan 3; DOI: 10.1111/jcpt.13605. PMID: 34981556. PMCID: PMC9302126.
  27. Konrad P, Chojnacki J, Kaczka A, Pawłowicz M, Rudnicki C, Chojnacki C. [Thyroid dysfunction in patients with small intestinal bacterial overgrowth]. Pol Merkur Lekarski. 2018 Jan 23;44(259):15–8. PMID: 29374417.
  28. Jia X, Zhai T, Zhang J-A. Metformin reduces autoimmune antibody levels in patients with Hashimoto’s thyroiditis: A systematic review and meta-analysis. Autoimmunity. 2020 Sep;53(6):353–61. DOI: 10.1080/08916934.2020.1789969. PMID: 32741222.
  29. Asik M, Gunes F, Binnetoglu E, Eroglu M, Bozkurt N, Sen H, et al. Decrease in TSH levels after lactose restriction in Hashimoto’s thyroiditis patients with lactose intolerance. Endocrine. 2014 Jun;46(2):279–84. DOI: 10.1007/s12020-013-0065-1. PMID: 24078411.
  30. Yoon S-J, Choi S-R, Kim D-M, Kim J-U, Kim K-W, Ahn C-W, et al. The effect of iodine restriction on thyroid function in patients with hypothyroidism due to Hashimoto’s thyroiditis. Yonsei Med J. 2003 Apr 30;44(2):227–35. DOI: 10.3349/ymj.2003.44.2.227. PMID: 12728462.
  31. Tajiri J, Higashi K, Morita M, Umeda T, Sato T. Studies of hypothyroidism in patients with high iodine intake. J Clin Endocrinol Metab. 1986 Aug;63(2):412–7. DOI: 10.1210/jcem-63-2-412. PMID: 3722332.
  32. Kasagi K, Iwata M, Misaki T, Konishi J. Effect of iodine restriction on thyroid function in patients with primary hypothyroidism. Thyroid. 2003 Jun;13(6):561–7. DOI: 10.1089/105072503322238827. PMID: 12930600.
  33. Talebi S, Karimifar M, Heidari Z, Mohammadi H, Askari G. The effects of synbiotic supplementation on thyroid function and inflammation in hypothyroid patients: A randomized, double‑blind, placebo‑controlled trial. Complement Ther Med. 2020 Jan;48:102234. DOI: 10.1016/j.ctim.2019.102234. PMID: 31987229.
  34. Wang S, Wu Y, Zuo Z, Zhao Y, Wang K. The effect of vitamin D supplementation on thyroid autoantibody levels in the treatment of autoimmune thyroiditis: a systematic review and a meta-analysis. Endocrine. 2018 Mar;59(3):499–505. DOI: 10.1007/s12020-018-1532-5. PMID: 29388046.
  35. Krysiak R, Kowalcze K, Okopień B. Selenomethionine potentiates the impact of vitamin D on thyroid autoimmunity in euthyroid women with Hashimoto’s thyroiditis and low vitamin D status. Pharmacol Rep. 2019 Apr;71(2):367–73. DOI: 10.1016/j.pharep.2018.12.006. PMID: 30844687.
  36. Drutel A, Archambeaud F, Caron P. Selenium and the thyroid gland: more good news for clinicians. Clin Endocrinol (Oxf). 2013 Feb;78(2):155–64. DOI: 10.1111/cen.12066. PMID: 23046013.
  37. Köhrle J. Selenium and the thyroid. Curr Opin Endocrinol Diabetes Obes. 2015 Oct;22(5):392–401. DOI: 10.1097/MED.0000000000000190. PMID: 26313901.
  38. Gärtner R, Gasnier BCH, Dietrich JW, Krebs B, Angstwurm MWA. Selenium supplementation in patients with autoimmune thyroiditis decreases thyroid peroxidase antibodies concentrations. J Clin Endocrinol Metab. 2002 Apr;87(4):1687–91. DOI: 10.1210/jcem.87.4.8421. PMID: 11932302.
  39. Höfling DB, Chavantes MC, Juliano AG, Cerri GG, Knobel M, Yoshimura EM, et al. Low-level laser in the treatment of patients with hypothyroidism induced by chronic autoimmune thyroiditis: a randomized, placebo-controlled clinical trial. Lasers Med Sci. 2013 May;28(3):743–53. DOI: 10.1007/s10103-012-1129-9. PMID: 22718472.
  40. Höfling DB, Chavantes MC, Juliano AG, Cerri GG, Romão R, Yoshimura EM, et al. Low-level laser therapy in chronic autoimmune thyroiditis: a pilot study. Lasers Surg Med. 2010 Aug;42(6):589–96. DOI: 10.1002/lsm.20941. PMID: 20662037.
  41. Fu J, Wang Y, Liu Y, Song Q, Cao J, Peichang W. Reference intervals for thyroid hormones for the elderly population and their influence on the diagnosis of subclinical hypothyroidism. J Med Biochem. 2023 Mar 15;42(2):258–64. DOI: 10.5937/jomb0-39570. PMID: 36987412. PMCID: PMC10040197.
  42. Zhang Y, Sun Y, He Z, Xu S, Liu C, Li Y, et al. Age-specific thyrotropin references decrease over-diagnosis of hypothyroidism in elderly patients in iodine-excessive areas. Clin Endocrinol (Oxf). 2021 Sep 28; DOI: 10.1111/cen.14589. PMID: 34585413.
  43. Carlé A, Karmisholt JS, Knudsen N, Perrild H, Thuesen BH, Ovesen L, et al. Does Subclinical Hypothyroidism Add Any Symptoms? Evidence from a Danish Population-Based Study. Am J Med. 2021 Sep;134(9):1115-1126.e1. DOI: 10.1016/j.amjmed.2021.03.009. PMID: 33872585.
  44. 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.
  45. Ross DS. Treating hypothyroidism is not always easy: When to treat subclinical hypothyroidism, TSH goals in the elderly, and alternatives to levothyroxine monotherapy. J Intern Med. 2022 Feb;291(2):128–40. DOI: 10.1111/joim.13410. PMID: 34766382.
  46. Tsai K, Leung AM. Subclinical hyperthyroidism: A review of the clinical literature. Endocr Pract. 2021 Mar;27(3):254–60. DOI: 10.1016/j.eprac.2021.02.002. PMID: 33588063.
  47. Mathew P, Rawla P. Hyperthyroidism. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 30725738.
  48. Pace C, Tumino D, Russo M, Le Moli R, Naselli A, Borzì G, et al. Role of selenium and myo-inositol supplementation on autoimmune thyroiditis progression. Endocr J. 2020 Nov 28;67(11):1093–8. DOI: 10.1507/endocrj.EJ20-0062. PMID: 32669509.
  49. Filipowicz D, Majewska K, Kalantarova A, Szczepanek-Parulska E, Ruchała M. The rationale for selenium supplementation in patients with autoimmune thyroiditis, according to the current state of knowledge. Endokrynol Pol. 2021;72(2):153–62. DOI: 10.5603/EP.a2021.0017. PMID: 33970480.
  50. Nordio M, Basciani S. Myo-inositol plus selenium supplementation restores euthyroid state in Hashimoto’s patients with subclinical hypothyroidism. Eur Rev Med Pharmacol Sci. 2017;21(2 Suppl):51–9. PMID: 28724185.
  51. Deshauer S, Wyne A. Subclinical hypothyroidism in pregnancy. CMAJ. 2017 Jul 17;189(28):E941. DOI: 10.1503/cmaj.161388. PMID: 28716849. PMCID: PMC5515647.
  52. Pokhrel B, Bhusal K. Graves Disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. PMID: 28846288.
  53. Yildirim Simsir I, Cetinkalp S, Kabalak T. Review of factors contributing to nodular goiter and thyroid carcinoma. Med Princ Pract. 2020;29(1):1–5. DOI: 10.1159/000503575. PMID: 31542786. PMCID: PMC7024874.
  54. Virili C, Bassotti G, Santaguida MG, Iuorio R, Del Duca SC, Mercuri V, et al. Atypical celiac disease as cause of increased need for thyroxine: a systematic study. J Clin Endocrinol Metab. 2012 Mar;97(3):E419-22. DOI: 10.1210/jc.2011-1851. PMID: 22238404.
  55. Bertalot G, Montresor G, Tampieri M, Spasiano A, Pedroni M, Milanesi B, et al. Decrease in thyroid autoantibodies after eradication of Helicobacter pylori infection. Clin Endocrinol (Oxf). 2004 Nov;61(5):650–2. DOI: 10.1111/j.1365-2265.2004.02137.x. PMID: 15521972.
  56. Ribichini D, Fiorini G, Repaci A, Castelli V, Gatta L, Vaira D, et al. Tablet and oral liquid L-thyroxine formulation in the treatment of naïve hypothyroid patients with Helicobacter pylori infection. Endocrine. 2017 Sep;57(3):394–401. DOI: 10.1007/s12020-016-1167-3. PMID: 27848196.
  57. Bugdaci MS, Zuhur SS, Sokmen M, Toksoy B, Bayraktar B, Altuntas Y. The role of Helicobacter pylori in patients with hypothyroidism in whom could not be achieved normal thyrotropin levels despite treatment with high doses of thyroxine. Helicobacter. 2011 Apr;16(2):124–30. DOI: 10.1111/j.1523-5378.2011.00830.x. PMID: 21435090.
  58. Centanni M, Gargano L, Canettieri G, Viceconti N, Franchi A, Delle Fave G, et al. Thyroxine in goiter, Helicobacter pylori infection, and chronic gastritis. N Engl J Med. 2006 Apr 27;354(17):1787–95. DOI: 10.1056/NEJMoa043903. PMID: 16641395.
  59. Duntas LH. The evolving role of selenium in the treatment of graves’ disease and ophthalmopathy. J Thyroid Res. 2012 Jan 19;2012:736161. DOI: 10.1155/2012/736161. PMID: 22315699. PMCID: PMC3270443.
  60. Marcocci C, Kahaly GJ, Krassas GE, Bartalena L, Prummel M, Stahl M, et al. Selenium and the course of mild Graves’ orbitopathy. N Engl J Med. 2011 May 19;364(20):1920–31. DOI: 10.1056/NEJMoa1012985. PMID: 21591944.
  61. Bacic-Vrca V, Skreb F, Cepelak I, Mayer L, Kusic Z, Petres B. The effect of antioxidant supplementation on superoxide dismutase activity, Cu and Zn levels, and total antioxidant status in erythrocytes of patients with Graves’ disease. Clin Chem Lab Med. 2005;43(4):383–8. DOI: 10.1515/CCLM.2005.069. PMID: 15899653.
  62. Zheng H, Wei J, Wang L, Wang Q, Zhao J, Chen S, et al. Effects of Selenium Supplementation on Graves’ Disease: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2018 Sep 26;2018:3763565. DOI: 10.1155/2018/3763565. PMID: 30356415. PMCID: PMC6178160.
  63. Xu B, Wu D, Ying H, Zhang Y. A pilot study on the beneficial effects of additional selenium supplementation to methimazole for treating patients with Graves’ disease. Turk J Med Sci. 2019 Jun 18;49(3):715–22. DOI: 10.3906/sag-1808-67. PMID: 31023005. PMCID: PMC7018306.
  64. Wertenbruch T, Willenberg HS, Sagert C, Nguyen T-B-T, Bahlo M, Feldkamp J, et al. Serum selenium levels in patients with remission and relapse of graves’ disease. Med Chem. 2007 May;3(3):281–4. DOI: 10.2174/157340607780620662. PMID: 17504200.
  65. Cho YY, Chung YJ. Vitamin D supplementation does not prevent the recurrence of Graves’ disease. Sci Rep. 2020 Jan 8;10(1):16. DOI: 10.1038/s41598-019-55107-9. PMID: 31913301. PMCID: PMC6949266.
  66. Benvenga S, Ruggeri RM, Russo A, Lapa D, Campenni A, Trimarchi F. Usefulness of L-carnitine, a naturally occurring peripheral antagonist of thyroid hormone action, in iatrogenic hyperthyroidism: a randomized, double-blind, placebo-controlled clinical trial. J Clin Endocrinol Metab. 2001 Aug;86(8):3579–94. DOI: 10.1210/jcem.86.8.7747. PMID: 11502782.
  67. Benvenga S, Amato A, Calvani M, Trimarchi F. Effects of carnitine on thyroid hormone action. Ann N Y Acad Sci. 2004 Nov;1033:158–67. DOI: 10.1196/annals.1320.015. PMID: 15591013.
  68. Vonhoff C, Baumgartner A, Hegger M, Korte B, Biller A, Winterhoff H. Extract of Lycopus europaeus L. reduces cardiac signs of hyperthyroidism in rats. Life Sci. 2006 Feb 2;78(10):1063–70. DOI: 10.1016/j.lfs.2005.06.014. PMID: 16150466.
  69. Beer AM, Wiebelitz KR, Schmidt-Gayk H. Lycopus europaeus (Gypsywort): effects on the thyroidal parameters and symptoms associated with thyroid function. Phytomedicine. 2008 Jan;15(1–2):16–22. DOI: 10.1016/j.phymed.2007.11.001. PMID: 18083505.
  70. Auf’mkolk M, Ingbar JC, Kubota K, Amir SM, Ingbar SH. Extracts and auto-oxidized constituents of certain plants inhibit the receptor-binding and the biological activity of Graves’ immunoglobulins. Endocrinology. 1985 May;116(5):1687–93. DOI: 10.1210/endo-116-5-1687. PMID: 2985357.
  71. Gosi SKY, Garla VV. Subclinical Hypothyroidism. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. PMID: 30725655.
  72. Caron P, Grunenwald S, Persani L, Borson-Chazot F, Leroy R, Duntas L. Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults. Rev Endocr Metab Disord. 2022 Jun;23(3):463–83. DOI: 10.1007/s11154-021-09691-9. PMID: 34671932. PMCID: PMC8528480.
  73. 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.
  74. 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.
  75. 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.
  76. An JH, Song K-H, Kim D-L, Kim SK. Effects of thyroid hormone withdrawal on metabolic and cardiovascular parameters during radioactive iodine therapy in differentiated thyroid cancer. J Int Med Res. 2017 Feb;45(1):38–50. DOI: 10.1177/0300060516664242. PMID: 27856930. PMCID: PMC5536594.
  77. Carlwe M, Schaffer T, Sjöberg S. Short-term Withdrawal of Levothyroxine, Induced Increase of Thyroid-stimulating Hormone and an Increase Ratio of Triiodothyronine to Thyroxine. Eur Endocrinol. 2013 Mar 15;9(1):37–9. DOI: 10.17925/EE.2013.09.01.37. PMID: 30349609. PMCID: PMC6193514.
  78. van Veelen NM, Fischli S, Beeres FJP, Eisenhut T, Babst R, Henzen C, et al. Compartment syndrome of the leg after thyroid hormone withdrawal; two cases and a systematic review of the literature. BMC Endocr Disord. 2020 Jun 5;20(1):80. DOI: 10.1186/s12902-020-00555-y. PMID: 32503586. PMCID: PMC7275613.
  79. 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.

➕ Links & Resources

Further Reading: 

Getting Started

Book your first visit

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

Transform your health

Every product is science-based, validated by real-world use, and personally vetted by Dr. Ruscio, DC.

Shop Now
Description Description