Hypothyroidism Medication and Gut Health: What You Should Know

Hypothyroidism medication: Thyroid gland model with an SOS placard

If you’re taking hypothyroidism medication but still struggling with thyroid symptoms, you may wonder if there’s a better thyroid medication option for you. In our experience, this is the wrong question to ask when looking to improve your thyroid health.

Many patients with hypothyroidism and Hashimoto’s thyroiditis don’t know that they are actually treating two different but related thyroid conditions: 

  • Hypothyroidism is a lack of adequate thyroid hormone. It can usually be completely treated with standard thyroid hormone replacement medication such as levothyroxine (Synthroid). 
  • Thyroid inflammation (thyroiditis) and thyroid autoimmunity are present in those with Hashimoto’s disease. These conditions are not corrected by thyroid hormone replacement and need different approaches.

When the role of thyroid inflammation and autoimmunity are not understood as a separate condition, both patients and healthcare providers tend to focus on trying alternative hypothyroidism medications in an effort to resolve stubborn thyroid symptoms. This is a common mistake that leads to much frustration among thyroid patients. Thyroid hormone replacement does not treat immune dysfunction and thyroid inflammation.   

In this article, we’ll explore the role of hypothyroidism medication in an overall thyroid treatment plan. We’ll also discuss how gut health improvements can calm the immune system, reduce inflammation, and reduce symptoms.

3 Steps to Thyroid Treatment: A Snapshot

Hypothyroidism medication: 3 Steps to Thyroid Treatment infographic by Dr. Ruscio

From a broad perspective treating hypothyroidism and autoimmune thyroid conditions involves a multifaceted approach. Addressing thyroid function can be broken down into three foundational treatment steps:

  1. Take a standard thyroid medication like levothyroxine (Synthroid, Levoxyl).
  2. Use gut healing therapies to resolve symptoms, reduce inflammation, and reduce autoimmunity.
  3. Retest thyroid hormone levels and adjust thyroid medications if needed. 

Imagine your furnace isn’t working well in the winter. You might plug in some electric heaters to replace the heat that’s not being produced. That’s an effective solution if there are no other problems with your furnace. 

Taking thyroid hormone replacement helps to raise thyroid hormone levels, like the space heaters help to raise the heat that’s not being produced by your furnace. 

But imagine now that your furnace is also producing dangerous levels of carbon monoxide, blowing mold and dust into your living room, and making horrible squealing noises. This is similar to the symptoms that stem from an unhealthy gut.  

You could plug in more electric heaters, but obviously, that’s not the correct solution for these other problems. In the same way, taking thyroid hormone replacement won’t correct problems of inflammation and autoimmunity. These problems need a different type of solution.

For many thyroid patients, underlying issues in the gut contribute to thyroid-like symptoms, inflammation, and autoimmunity. Restoring gut health can help relieve symptoms, support thyroid health, and in some cases, reduce the need for thyroid hormone medication. 

Before we discuss the three steps for getting hypothyroidism medication right, let’s take a quick look at why you should focus on gut health when you’re treating a thyroid condition.

4 Reasons Why You Should Focus on Gut Health, Not Just Hypothyroidism Medication

Hypothyroidism medication: Thyroid symptoms vs gut symptoms infographic by Dr. Ruscio

There are a few reasons why focusing on gut health can improve your symptoms. Let’s take a closer look. 

Your Thyroid Symptoms May Actually Be Gut Symptoms

It’s pretty common for hypothyroid patients to struggle with weight gain, brain fog, fatigue, and other symptoms, even while taking thyroid hormone replacement medication. In this situation, symptoms are likely not caused by low thyroid hormone. Instead, they may be signs of inflammation and immune dysfunction that are rooted in poor gut health.

That’s why it’s crucial to address gut health before tinkering with thyroid medication changes. It’s easy to confuse symptoms of hypothyroidism with symptoms of poor gut health. Research shows that gut conditions produce symptoms that are very similar to thyroid conditions and that gut conditions are more common:

  • Mood disorders, fatigue, weight gain, constipation, and brain fog are not only symptoms of thyroid disorders. They are also prevalent in gut disorders [1, 2, 3, 4, 5, 6]. 
  • Gut disorders, particularly irritable bowel syndrome (IBS), are more common than thyroid disorders. 4.6% of people are diagnosed with hypothyroidism [7], while 10-15% are diagnosed with IBS [8]. 

Improved Gut Health May Improve Hypothyroidism

Thyroid disorders and gut disorders are commonly found in the same patients. It’s worth noting that gut disorders may be present even when you don’t have apparent gut symptoms like diarrhea, bloating, abdominal pain, and constipation.

Research has found that gut health treatments can improve thyroid conditions: 

  • One fascinating study showed TPO antibodies (the critical marker of autoimmune thyroid disease) dropped an average of 2,029 when Hashimoto’s thyroiditis patients were treated for H. pylori (a bacterial infection in the gut) [9]. 
  • Other studies show that treating H.pylori improves thyroid-stimulating hormone (TSH) levels [10, 11, 12].
  • Patients treated for gut pathogens had reductions in thyroid-stimulating hormone (TSH) levels, inflammatory markers, and thyroid antibodies [13].
  • Studies have shown that a gluten-free diet improved thyroid medication effects [14] for patients with food intolerances, and lactose restriction decreased TSH levels [15]. 

The results of these studies are impressive and support the effectiveness of treating gut health for patients with thyroid disorders.

Hypothyroidism medication: Table showing the conditions occurring with thyroid disease

You May Be Absorbing Thyroid Medication Poorly

If you’re suffering from leaky gut, inflammation, or other gastrointestinal disorders, this could affect your body’s ability to absorb thyroid medications.

Inflammation is a hallmark symptom in gastrointestinal disorders like small intestinal bacterial overgrowth (SIBO), irritable bowel syndrome (IBS), and bacterial infections like H. pylori. Gut inflammation hinders thyroid medication (levothyroxine) absorption [16, 10, 11, 12, 17]. 

Once gastrointestinal health improves, your body may absorb thyroid medication better [11, 17]. 

When thyroid medication absorption improves, the body can go from the right amount of thyroid hormone to getting too much thyroid hormone. While you may be familiar with hypothyroid symptoms, it’s essential to monitor for hyperthyroid symptoms as gut health improves. 

Common hyperthyroidism symptoms include:

  • Feeling restless and jittery
  • Insomnia
  • Tremors
  • Racing heart rate
  • Increased body temperature
  • Irritability and anxiousness
  • Weight loss

If you notice these side effects as your gut health improves, follow up with your healthcare provider. It’s important to retest thyroid hormone levels and adjust the amount of thyroid hormone medication as needed.

Hypothyroidism medication: Hypothryoid vs hyperthyroid symptoms infographic by Dr. Ruscio

Thyroid Medication Is Overprescribed

An unfortunate reality today is misdiagnosis of hypothyroidism, leading to overmedication. 

One study showed that 61% of patients were taking thyroid hormone medication unnecessarily [18]. In this study, patients taking Synthroid (levothyroxine) for years stopped their medication for 6-8 weeks. On testing, 60.8% of patients had normal thyroid hormone levels, meaning they did not require thyroid medication. 

We regularly see patients taking thyroid medication even when their thyroid hormone level tests are in the normal reference range. Thyroid symptoms alone should never be the reason for prescribing thyroid hormone replacement therapy. As we’ve already pointed out, symptoms like fatigue, constipation, poor mood and brain fog may be due to poor gut health rather than low thyroid function.

Patients that paused thyroid medication infographic by Dr. Ruscio

3 Steps to Treat Thyroid Issues

As noted earlier, there are three high-level steps to fully treating thyroid conditions: 

1. Take Standard Thyroid Medication

Thyroid medication works by bringing thyroid hormone levels back to normal levels. For most patients, this is all that’s needed to treat hypothyroidism. If you take thyroid hormone replacement and your lab tests are normal, you have resolved your hypothyroidism. If your symptoms persist, however, look to step 2 for answers. 

Start with a standard thyroid medication recommended by your healthcare provider, and work with this professional to determine the right dosage through lab testing. 

It’s important to follow guidelines given by your doctor to support effective treatment. 

The FDA recommends taking levothyroxine (Synthroid, Levoxyl, L Thyroxine) on an empty stomach at the same time each day. It’s also recommended that thyroid medications are not taken with certain supplements like calcium and antacids, which may affect thyroid medication absorption.

2. Use Gut Healing Therapies

Gut treatments that improve thyroid health infographic by Dr. Ruscio

If you’re taking thyroid medication, your thyroid-stimulating hormone (TSH) and thyroxine (free T4) levels are normal, and you’re still experiencing symptoms, addressing your gut health may be key to relieving your symptoms.

There are three foundations to improving gut health.

  1. Follow an anti-inflammatory diet focused on whole, unprocessed foods. The Paleo Diet is a great place to start. 
  2. Restore balance to your gut microbiota by taking quality probiotic supplements.
  3. Address lifestyle factors like too much stress or a lack of sleep.

For some patients, these foundational steps may be all that’s needed to restore gut health and reduce thyroid-like symptoms. 

Other patients may require additional support to diagnose and address specific conditions like SIBO, bacterial infections, leaky gut, and food sensitivities. Download our Gut-Thyroid Guide to learn more.

3. Retest Thyroid Hormone Levels and Adjust Medications

With improved gut health, your thyroid medication dose might need to be adjusted as your body becomes able to absorb more thyroid medication. Levels of thyroid hormones can easily be tested with a TSH blood test. 

Some healthcare providers recommend complex approaches to thyroid blood tests. However, we suggest a fairly simple approach:

  • The most important indicator used to assess hypothyroidism is TSH (thyroid-stimulating hormone) levels. TSH blood tests are a cost-effective way to monitor levels of thyroid hormones and evaluate if your thyroid hormone medication dose should be adjusted. 
  • Thyroxine (free t4) testing helps determine if a patient has central hypothyroidism (myxedema), a rare but severe disorder caused by dysfunction in the pituitary gland.

Thyroid Peroxidase (TPO) is an antibody that can indicate if a patient has Hashimoto’s thyroiditis, an autoimmune thyroid disease. In general, as gut health improves, TPO levels should go down. TPO levels below 500 are a clinical win for patients with Hashimoto’s disease — there is no reason to attempt to reduce antibodies to zero. 

While lab test results and lab values are important, how you feel is even more important. At our center for functional medicine, we work closely with each patient to assess thyroid test results and improve symptoms.

Bottom Line

Hypothyroidism medication helps normalize thyroid hormone levels when your thyroid gland doesn’t produce enough hormones. However, if you’re taking hypothyroidism medication and continue to experience symptoms like constipation, brain fog, and fatigue, you likely have an underlying gut issue that needs to be addressed. 

Thyroid medication is an important piece in an overall treatment plan that should also include evaluating and restoring gut health. 

For more information on hypothyroidism medication, thyroid health and gut health, schedule an appointment with our practitioners at the Austin Center for Functional Medicine.


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