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  • Writer's pictureGavin Guard, Medical Director

Thyroid medication alternatives and what gets in the way

Updated: Jan 22, 2022

Key Takeaways

  • Levothyroxine is the most common thyroid replacement therapy

  • There are alternatives to Levothyroxine that may lead to benefits

  • Work on your gut to improve your thyroid health


Autoimmune thyroid disease happens to be the most common autoimmune condition. The treatment for this is thyroid replacement therapy. Most commonly, the medication of choice is Levothyroxine.

But what happens when you keep increasing your thyroid dose and you still don’t feel well?

Let’s examine some alternatives to consider and how to address the root cause of your symptoms.

Other thyroid medication options

Up to 48% of those with hypothyroidism are either under- or over- treated with medication.

Thus, finding the ideal type and dose of thyroid replacement therapy is crucial for a better quality of life.

A new study points to the promising option of a liquid thyroid replacement medication. A common brand is called Tirosint. The authors point to impaired intestinal absorption as a chief cause of symptoms despite adequate thyroid replacement therapy. Switching the medication type to a liquid type may bypass this problem and lead to improvement in thyroid levels and symptoms.

A review of multiple other studies revealed that patients receiving normal Levothyroxine saw improvement in their thyroid levels after switching to a liquid form of the drug at the same dose.

Why you might not be absorbing your thyroid medication

So what are some reasons why you may not be absorbing your thyroid medication? Fortunately, we have good research to answer this question.

1) Impaired stomach acid production

A bacterial infection (H. pylori) and autoimmunity against the cells of the stomach can lead to low stomach acid. This can impair thyroid medication absorption. Patients with an impaired stomach acid production need up to 34% more of their thyroid dose.

To further prove this point, researchers took 5 patients who had both low thyroid and autoimmunity against their stomach These patients received normal Levothyroxine tablets, and upon the switch to the same dosage of liquid thyroid medication, their thyroid levels normalized in all patients. Four patients were then switched back to Levothyroxine tablets at the same dosage, and thyroid levels worsened again.

2) Poor diet

Your diet can also impact your thyroid levels. It looks like eating things that your immune system is sensitive to or that you don’t have the capabilities to breakdown seem to be important factors. For example, those with lactose intolerance need more thyroid medication. You can work through a step-wise approach to finding the right diet that works for you. This is one of the first things I help patients do.

3) Gut infection/altered microbiome

To catch you up to speed, the “microbiome” is the collection of microorganisms that live in our gut. This includes bacteria, parasites, viruses, etc. When we have an imbalanced microbiome, this can affect our thyroid health and response to thyroid medication. For example, research shows a mild but significant relationship between H. pylori infection and thyroid antibodies. When the infection is treated, thyroid antibodies tend to decrease. Furthermore, patients with H. pylori infection seem to respond better to liquid thyroid forms. This is corroborated by the beneficial effects after treatment of parasitic infections as well.

Heal your gut to improve your thyroid levels and symptoms

As you can see here, there are multiple reasons why you might not be absorbing your thyroid medication or need a different medication form. Oftentimes, it comes down to fixing your gut to ameliorate these issues and restore your thyroid health.

A majority of the patients I see at my clinic, Root Integrated Care, have digestive complaints. When we fix their gut, they often see improvement in their thyroid, skin, hormonal, and sleep health. You can schedule a free 15-minute Health Strategy Session to see how I may be able to help you.

The Bottom Line

Again, a good portion (up to 48%) of hypothyroid patients are inadequately treated. If you are still experiencing thyroid symptoms despite increasing your dose, you may want to inquire about either a different form of thyroid medication or fixing the root cause of the issue which is often found in the gut.

I hope you found this information useful and helpful in your journey back to a healthier and happier life.

Like what you are reading? Learn more about how to take control of your health by signing up for the "5 Minute Health Makeover" below where I coach you through 3 pivotal strategies for better health.

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