Did you know that many people diagnosed with hypothyroidism and start on thyroid medication don’t always feel better?
Hypothyroidism occurs when you have low levels of thyroid hormones T4 and T3 circulating. On blood work, this could look like elevated levels of thyroid stimulating hormone (TSH) and low or low-normal levels of T4 and T3 (1).
The thyroid hormones produced by your thyroid gland (thyroxine and triiodothyronine) exert an effect on all of your cells (1). As fewer levels of this hormone get made, your cellular processes and functions begin to slow down, hence why you might experience sluggishness and fatigue.
You would think that starting on a thyroid medication might be the answer to all of your hypothyroid symptoms like:
- Weight Gain
- Thinning Hair
- Mood Changes
- Constipation
- Low Energy
- Menstrual Cycle Abnormalities
Now, there is usually a bit of a period whereby you need to get adjusted to the dose. But what happens when you are on thyroid medication for years and still feeling lousy?
Well, there are many reasons why you might not be feeling 100% on your medication, and here are just a few reasons why:
1. Being on oral birth control pills or using estrogen creams: if you start taking oral birth control pills or using estrange creams after having been on thyroid medication, you might need to adjust your thyroid medication dose. Oral estrogens can increase levels of a protein called thyroid-binding globulin (TBG) (2,3). As the name implies, TBG binds to your free thyroid hormones, leaving your cells with very little access to your thyroid hormones. Without sufficient levels of thyroid hormones to get into your cells, it can exacerbate your hypothyroid symptoms. Having your thyroid levels checked after starting an estrogen cream or oral birth control can help to ensure you are at the correct dose, but more importantly, that you are feeling better.
2. Use of proton pump inhibitors: proton pump inhibitors (PPIs), like omeprazole and Nexium, have been shown to increase levels of thyroid stimulating hormone (TSH) (4). Recall that TSH is the hormone your thyroid gland needs to create thyroid hormones. Using PPIs reduces stomach acid levels, lowering your body’s ability to absorb your thyroid medication (4,5). With lower absorption levels, your body thinks it doesn’t have enough thyroid hormones, so your TSH levels continue to rise.
3. Your daily cup of joe: coffee has a similar mechanism of action as PPI’s. Caffeine reduces your body’s ability to absorb thyroid medication (6). Again, if you are not drinking your medicine, your body will think there isn’t enough T4 and T3, and TSH levels will increase. No need to give up your coffee, but you might need to change the time you drink it. For some, caffeine might not be the missing piece, so I am always a fan of running a comprehensive thyroid panel to understand your thyroid wellness better.
If you fit into one or more categories, I recommend speaking to your provider to see what adjustments your thyroid medication may need.
If you have been on thyroid medication for years and still struggle with feeling good, you might need to do a deeper dive into your thyroid and cellular health with functional wellness testing.
At our wellness center, a complete thyroid evaluation consists of the following lab markers:
- Thyroid Stimulating Hormone (TSH)
- Free T4
- Free T3
- Reverse T3
- Thyroid antibodies (thyroid peroxidase and thyroglobulin)
- Thyroxine Binding Globulin
- Cortisol
This comprehensive thyroid panel allows us to determine how hard your thyroid works, what your thyroid type is, and if your sluggish thyroid is due to Hashimoto’s.
If you have already done in-depth thyroid testing with a functional medicine practitioner, I suggest Organic Acid Testing. Organic Acid (OAT) Testing, can assess your cellular health by looking at nutrient levels, toxin exposures, and digestive health, which are all related to the health of your thyroid.
Want to learn more about how we support patients with hypothyroidism and Hashimoto’s? Schedule your complimentary consultation to speak with one of our healthcare providers.
Sources:
- U.S. National Library of Medicine. (n.d.). Thyroid problems | hypothyroidism | hyperthyroidism. MedlinePlus. Retrieved July 1, 2022, from https://medlineplus.gov/thyroiddiseases.html#:~:text=Your%20thyroid%20is%20a%20butterfly,how%20fast%20your%20heart%20beats.
- Fenneld. (2022, October 12). Can birth control cause thyroid problems? Cleveland Clinic. Retrieved January 3, 2023, from https://health.clevelandclinic.org/can-birth-control-cause-thyroid-problems/#:~:text=Birth%20control%20pills%20(oral%20contraceptives,to%20bind%20to%20thyroid%20hormone.
- Dr. Jolene Brighten. (2021, February 5). The Pill & Thyroid Connection – how the pill sabotages thyroid health. Dr. Jolene Brighten. Retrieved January 3, 2023, from https://drbrighten.com/birth-control-thyroid-connection/
- Elsevier Inc. (2006, July 12). Effect of Proton Pump Inhibitors on Serum Thyroid-Stimulating Hormone Level in Euthyroid Patients Treated with Levothyroxine for Hypothyroidism. Define_me. Retrieved January 12, 2023, from https://www.endocrinepractice.org/article/S1530-891X(20)41850-6/fulltext
- Osgood, D. S. (2022, March 27). 5 medications that mess with your thyroid. GrassRoots Functional Medicine. Retrieved January 2, 2023, from https://grassrootsfunctionalmedicine.com/featured-post/medications-mess-with-thyroid/
- Shomon, M. (2022, April 20). Why thyroid medication and coffee don’t mix. Verywell Health. Retrieved January 3, 2023, from https://www.verywellhealth.com/coffee-and-thyroid-medication-3233255
