And most often, thyroid hormone doses need to be increased when a woman learns she is pregnant. If you feel nervous about taking medication during pregnancy, keep in mind that you are simply replacing a hormone that your body is not making in adequate amounts.
Ideally, you should take your thyroid medication in the morning and wait 30 minutes to an hour before eating. If you absolutely must eat sooner than that, make sure you do this consistently.
This helps ensure that the drug is properly absorbed in the intestine so you get your full dose. That said, some foods should only be eaten at least three to four hours after thyroid medication.
Examples include calcium-enriched foods such as high-calcium orange juice and Greek yogurt, as well as fiber-rich foods. Goitrogens are substances found in some foods that may have an anti-thyroid effect. However, experts don't agree on whether foods such as cruciferous vegetables can interfere with the overall effectiveness of your treatment. Examples of foods that are highly recommended as part of a healthy, cancer-prevention diet include:.
You shouldn't try to completely avoid these foods, but you may want to spread them out so you aren't eating large amounts during any single meal. The same appears to be true with soy foods. Eating them in moderation when you have thyroid disease appears to be key. Coffee can also interfere with the way your body absorbs thyroid medication. If you can't wait an hour to have your early morning coffee, there are a few options you may wish to discuss with your doctor.
Coffee doesn't seem to affect Tirosint , a gel-capsule form of levothyroxine. If you are taking a different brand of levothyroxine and don't want to change, you can also talk to your doctor about whether you should take your thyroid medication at bedtime.
Like food, other medications should be taken at least an hour after you take thyroid medications. This will help avoid any problems with absorption. But with some drugs, waiting even longer is important. For example, you should wait at least four hours before or after taking thyroid replacement medications before using antacids.
There are many medications that can interact with thyroid hormones, either increasing or decreasing the amount available to your body. Common examples include:. Women taking estrogen— hormone replacement therapy HRT or the birth control pill —may need more thyroid replacement hormone. Estrogen increases the body's production of a protein that makes thyroid hormone inactive.
To compensate for this, the dose of thyroid hormone may need to be increased slightly. After a woman starts or stops taking oral contraceptives or hormone replacement therapy , the doctor should test their thyroid levels to determine if it is affecting how the thyroid works. Be sure that the doctor prescribing your thyroid medication and monitoring your thyroid disease is aware of these and any other drugs you are taking.
Brand-name levothyroxine is typically consistent, in terms of potency, from refill to refill. That is not always the case, however, with different generics. For some people, the variation in consistency from one maker of generic levothyroxine to another can have a negative impact on proper thyroid replacement. If you do switch medications, either brand names or generics, it's important to follow up with your doctor to have your thyroid tested.
This is usually done six weeks after the change is made. Then the doctor should check it about every six weeks thereafter until your levels are stable. While the reference ranges for thyroid tests often give a thyroid-stimulating hormone TSH range of 0.
Talk to your doctor about what the optimal TSH level is for you as an individual and whether or not your current thyroid hormone replacement medication needs to be adjusted.
A person who continues to have hypothyroidism symptoms with a high-normal TSH, for example, may benefit from getting their TSH closer to 1. Also note that, for some people, it may be a good idea to check additional thyroid tests, such as T4, free T4, T3, free T3, and thyroid autoantibodies even if TSH is normal. Taking your thyroid medicine the right way can help your body effectively absorb it.
Consistently taking it at the right time as well as avoiding food too soon after taking it are all important things you should remember. It's also important to be careful when taking other medications along with thyroid medication. And if you switch brands or generic manufacturers, you may need to get your thyroid levels tested.
If you're not careful, you can end up getting less thyroid medication than you need. Check with your doctor to make sure you are on a dose that is ideal for you to begin with. In addition, the dose of thyroid hormone that you require can change at different times in your life. Paying attention to any symptoms you are experiencing can give you clues as to whether you may be overmedicated or undermedicated. Symptoms, after all, are our bodies' way of alerting us that something's not right.
Losing weight with thyroid disease can be a struggle. Our thyroid-friendly meal plan can help. Sign up and get yours free! Hypothyroidism and the heart. Methodist Debakey Cardiovasc J. American Thyroid Association. Serum thyrotropin levels following levothyroxine administration at breakfast. Various possible toxicants involved in thyroid dysfunction: A review. J Clin Diagn Res. Thyroid hormone profile in patients ingesting soft gel capsule or liquid levothyroxine formulations with breakfast.
Int J Endocrinol. National Library of Medicine. Updated July 15, Updated February 15, Q and A: Thyroxine preparations. Leng O, Razvi S. Hypothyroidism in the older population. Thyroid Res. Management of endocrine disease: pitfalls on the replacement therapy for primary and central hypothyroidism in adults. European Journal of Endocrinology. Select basic ads. Create a personalised ads profile.
Select personalised ads. Apply market research to generate audience insights. Measure content performance. Develop and improve products. List of Partners vendors. If you been diagnosed with hypothyroidism , it's virtually certain that you've been prescribed the drug levothyroxine marketed under the brand names Synthroid, Levoxyl, and others —a synthetic hormone that replenishes the thyroid hormone thyroxine, also known as T4.
But if you are on levothyroxine and still not feeling well, another drug known as Cytomel liothyronine may help. Cytomel is the synthetic form of the hormone triiodothyronine, known as T3, which is equally important to healthy metabolic function.
Some endocrinologists also endorse the use of natural desiccated thyroid NDT , a drug derived from dried glands of pigs or cows that has T3 and T4 along with other thyroid gland protein such as thyroglobulin. Thyroxine T4 and triiodothyronine T3 are the two major hormones produced by the thyroid gland. Their role is to regulate metabolism the conversion of oxygen and calories into energy.
T3 is considered the active form of thyroid hormone. It is derived from T4, the "storage hormone," through a process known as monodeiodination , in which T4 loses an atom of iodine to become T3.
That means if you don't have enough T4, your body can't make enough T3. Adding T4 through levothyroxine increases your levels and enables adequate production of T3. For many people with hypothyroidism, this is enough to get their thyroid hormone levels back in the ideal range.
However, for some people, the standard therapy isn't enough to get rid of their symptoms. While T3 drugs like Cytomel may seem the ideal choice for hormone replacement therapy, T3 is rapidly absorbed in the intestines and can build up quickly, leading to symptoms of hyperthyroidism overactive thyroid. After that spike, the level then drops quickly, along with your body's ability to create T4. Because of that, you have to take Cytomel several times a day, but even that doesn't level out your T3 levels in an ideal way.
By contrast, T4 drugs like levothyroxine are absorbed more gradually and can maintain a consistent level in the blood, providing the body with all the T4 it needs to synthesize T3.
Another concern is that T3 drugs can affect the T4 blood tests used to monitor the effectiveness of hormone replacement therapy. For these reasons, many healthcare providers consider T3 drugs unnecessary. Plus, therapy with both T4 and T3 makes it difficult to maintain a normal T4-to-T3 ratio, which is between and In fact, several clinical trials have compared T4 alone to T4 plus T3 and found that the combination also contributes to mild hyperthyroidism.
Current guidelines from the American Thyroid Association recommend that people with hypothyroidism be treated initially with T4 alone. Adding T3 should be considered in people who continue to have symptoms of hypothyroidism, and whose T3 levels remain in the low end of the normal range.
Some healthcare providers have found success in treating their thyroid patients with natural desiccated thyroid , also known as NDT. NDT is derived from the dried desiccated thyroid glands of pigs or cows and provides T3, T4, and other thyroid hormones found in the human thyroid gland.
NDT is marketed under various brand names in the United States, including:. In addition to hypothyroidism, Cytomel is used for:. The endocrinology community continues to debate the use of T3 for treating hypothyroidism. Despite resistance from many medical practitioners, a growing body of research is shedding light on the appropriate use of T3 drugs in people with hypothyroidism.
Among them:. With the exception of triggering hyperthyroid symptoms, side effects from Cytomel are rare and generally mild. Symptoms of hyperthyroidism include:. Other possible side effects include:. If any of these side effects become severe or don't go away over time, let your healthcare provider know. Less common side effects that can be serious and require immediate medical attention include:. With any medication, it's important for you and your healthcare provider to consider the potential risks along with the possible benefits.
Antacids and the cholesterol-lowering drugs Colestid colestipol and Questran cholestyramine can interfere with the absorption of Cytomel. To avoid this, always separate the doses of Cytomel and the other drugs by at least four hours. Cytomel is known to interact with certain common medications. Cytomel should not be used in people with:. Cytomel is not absorbed in fetal tissue and is therefore considered safe during pregnancy. While liothyronine can be passed through breastmilk, the amount secreted is so small as to be considered harmless.
Cytomel is available in 5-microgram mcg , mcg, and 50 mcg doses. The recommended dosage depends on the condition being treated and the level of thyroid gland dysfunction. For hypothyroidism that hasn't responded adequately to levothyroxine alone, your healthcare provider will likely start you on a once-a-day 5-mcg dose of T3 and increase it every week or two until tests show your thyroid hormones are in the desired range.
The starting dosage should be lower—5 mcg per day—in:. Proper dosing of Cytomel is relatively difficult and should aim to maintain the normal T4 to T3 ratio of about Combination therapy should ideally be managed by an endocrinologist. Cytomel quickly absorbs into your system. The biological half-life is 2. Cytomel reaches its maximum activity in your body within two to three days after you start taking it, meaning you should notice a difference in your symptoms quite soon.
If you don't feel as well as you think you should, even if your thyroid test results fall within the normal range, speak with your healthcare provider.
While you may be interested in trying a T3 drug, know that some healthcare providers may recommend that you stick with levothyroxine alone, given that it is the standard of care for hypothyroidism per guidelines set forth by the American Association of Clinical Endocrinologist AACE and American Thyroid Association ATA. However, given the newer, promising research into Cytomel for some people with hypothyroidism, your healthcare provider may be open to a discussion about the possible benefits.
Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.
Losing weight with thyroid disease can be a struggle. Our thyroid-friendly meal plan can help. Sign up and get yours free! Madan R, Celi FS. Combination therapy for hypothyroidism: Rationale, therapeutic goals, and design.
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