Why thyroid medication is often necessary

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  1. Rebecca’s avatar

    I’ve just recently been diagnosed as hypothyroid and very likely with Hashimoto’s (I tested positive for antibodies). My TSH was not very elevated – always hung around in the middle of the range but on a couple of tests went to the higher end of the range. Unfortunately I live in British Columbia where the range is very wide for TSH – .3 to 5.5. I finally found out about testing for Free T3 and Free T4 and that’s when the FT3 came back very slightly below the range. My FT4 is nothing to write home about either. I’ve since found out that TSH fluctuations are par for the course with Hashi’s, so it’s possible that I’ve had a TSH out of range in the past but just didn’t luck out enough to get tested that day.
    I will tell everyone I know who is having symptoms of hypo to get all three (plus antibodies) tested and to not give up until they do. I’ve been very likely dealing with this since I was 12 and I got unexplained hives on my legs for 2 years and developed pompholyx on my hands, which persists seasonally to this day. Hives are often a sign that Hashi’s is developing. I’m 38 now and have suffered fatigue and weight gain, infertility and a bunch of other issues my whole adult life. I’m super happy to finally have a diagnosis but I know it’s just the beginning of things now. Thanks for your site, I’ve learned a ton since I stumbled across it!

  2. Rachel’s avatar

    Thanks so much for this series on thyroid issues.  Your blog is one that I regularly follow as I try to learn all I can about allergies, asthma, and autoimmune disease.  I just started a Paleo diet about 2 months ago, and while I feel great, I still need to be on medication for all three problems.  In fact, I’ve been on Synthroid for 20 years, Allegra for about 4 years (just seasonally), and Advair for 8 months.  While I’m very hopeful that someday I will be able to get off the allergy and asthma medications, I wonder whether it’s even possible to do without Synthroid.  Do you have any experience with this?  How long does it take for the body to heal?

  3. Chris Kresser’s avatar

    As I said in the article, it may never be possible (or desirable) to stop taking Synthroid – presuming it’s the right medication for you. To answer that question, you need to know what the underlying mechanism is. There’s no “one-size fits all” approach to thyroid medication, as I’ll explain in the next post. But if you have chronically high TSH without medication, and/or Hashimoto’s, it’s likely that you’ll always need replacement.

  4. lynn’s avatar

    I LOVE your work, but am not so keen on this article. A person can be extremely hypothyroid for YEARS or DECADES even, and the TSH will not rise. A better way to diagnose hypothyroidism is antibodies testing and FT4 and FT3 levels: http://nahypothyroidism.org/diagnosistreatment/ and http://www.stopthethyroidmadness.com/tsh-why-its-useless/

  5. Chris Kresser’s avatar

    Lynn: I’ve written about that at length in this series. Please see all of the articles at https://thehealthyskeptic.org/thyroid. In particular, see this article: https://thehealthyskeptic.org/5-thyroid-patterns-that-wont-show-up-on-standard-lab-tests

  6. lynn’s avatar

    I know you have because I read all these great articles. Which is mainly why I am confused by your high TSH = thyroid meds stance. I have always had a ‘normal’ TSH, yet my antibodies were through the roof. I balance my blood sugar, am gluten free and low carb, and treat my adrenals. Yet I still am sick as a dog without my thyroid medicine. So, I really don’t get the emphasis on TSH in this post. It is a dangerous lab, which leaves people very ill for decades, as it takes so long to rise if the thyroid is not functioning correctly.

  7. Chris Kresser’s avatar

    I see what you’re saying now.  Perhaps I should have been more clear.  I didn’t mean to imply that high TSH is the only time meds may be helpful.  Just that it’s a clear indicator that they’re necessary.  I’m aware that many people with TSH in the normal lab range will benefit from thyroid meds.

  8. lynn’s avatar

    Can you do a small edit then? *wink*
    P.S. I have loved this series.

  9. Chris Kresser’s avatar

    I changed this paragraph:

    Persistently elevated TSH is a sign that the body needs more thyroid hormone than it can produce on its own. This is one clear sign that it’s time for replacement medication. But it isn’t the only one. Some people with TSH in the normal lab range still find that they benefit from replacement.

  10. lynn’s avatar

    I’m getting very checky here, but how about:
    “It turns out that thyroid medication meets these criteria in cases of hypothyroidism with chronically elevated TSH, low free thyroid hormone levels or high antibodies. These markers indicate that the body is not producing enough thyroid hormone to meet metabolic needs. And thyroid hormone is so important to the proper function of the body that the benefits of replacing it far outweigh any potential side effects of the medication”.

  11. Chris Kresser’s avatar

    I don’t agree with that statement, because I don’t believe that everyone with high antibodies needs to be on replacement.  Antibodies fluctuate throughout the course of disease and aren’t necessarily indicative of the autoimmune attack.  Antibodies simply mark a tissue for destruction themselves; they don’t do the destroying.  Nor do I necessarily believe replacement is necessary for people with low FT3 or FT4.  It’s possible they may have elevated TBG secondary to estrogen dominance.  In that case, correcting the estrogen dominance may be sufficient to reverse the symptoms without replacement.

  12. Lynn’s avatar

    I have spent a LOT of time on thyroid boards during the past two years. During that time I have seen many people come and go. Many will turn up desperately hoping that if their sex hormones optimise, their adrenals heal or they go off gluten, they will be ‘cured’. Experience has shown me however that this just does not happen. Optimising sex hormones often means people need less thyroid and going off gluten really makes a MASSIVE difference (I never got properly well until I went off gluten) but it is the rare person whose thyroid starts to function properly after they have taken these steps. Instead, they waste years trying to ‘heal’ and ‘cure’ themselves, when they could have had proper thyroid function restored instead.
    I think eliminating gluten would PREVENT hypothyroidism. I also think optimising adrenal and sex hormone status could also play a preventative role. However, experience with people who have gotten well has shown me that once the antibodies get high enough and the frees low enough; the thyroid will rarely come back online. Even if it does, should a person really have to waste years of their life being miserable and waiting for it to do so?

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