Are your medications and vitamins messing with your Thyroid levels? drug induced hypothyroidism is a common problem for people with thyroid disease. Various medications and even vitamins can throw off your thyroid levels making it even more challenging to stabilizing your thyroid function. In this article, we review the most common medications and vitamins that can cause hypothyroidism or lead to a scenario in which you are being overmedicated with thyroid replacement.

Transcript 

Today’s article, I want to build on that knowledge and help you understand some of the medications and even vitamins that can alter and skew your thyroid levels making it that much more difficult to stabilize your thyroid. Drug induced hypothyroidism is common problem for many people with thyroid disease especially when they are taking medications other than just thyroid. A few weeks back I did a video on the “Symptoms of being overmedicated with thyroid replacement” as well as the “5 Causes of Elevated  TSH” and “Treatment options for High TSH” If you haven’t read these articles or watched the videos, be sure to go back and view these if interested.

Four Ways Your Medications Affect Your Thyroid Levels and lead to Drug Induced Hypothyroidism.

1. Some Medications altering the production of thyroid hormones
2. Some Medications affecting the release of thyroid hormones from the thyroid gland
3. Some medications affect how well you might absorb thyroid hormones
4. Some medications can interfere with how the liver converts inactive T4 thyroid hormone into T3 active thyroid hormone.

For the overwhelming majority of patients with hypothyroidism, coexisting health problems is a common occurrence and medications used to treat these coexisting health problems can interfere with thyroid hormone levels and cause drug induced hypothyroidism. Always keep your doctor well informed of all the medications and vitamin you may be taking.

Treating thyroid disease is very complex and involves looking at more than just TSH and Free T4. If one month your doctor in increasing your thyroid hormone medication and the next month they are lowering your thyroid hormone medication, it might be time to consider drug induced hypothyroidism as a possible contributing factor to your thyroid disease.

So. Let’s jump into some of the medications, vitamins and minerals that can skew your thyroid hormone levels and lead to thyroid overdose.

#1 Antacids and Drug Induced Hypothyroidism

Digestive problem like GERD or acid reflux often go hand in hand with thyroid disease and the use of antacids can interfere with thyroid medication leading to drug induced hypothyroidism.

Most people who have had thyroid problems for any length of time suffer with acid reflux or suffer with bloating, SIBO, and poor digestion of fats and proteins. Whether you take prescribed antacids or you take it over the counter, these antacids will impair thyroid hormone absorption as well as cause a B12 deficiency. So if you have to take antacids or you take a calcium supplements, be sure to take these 1-2 hours after your thyroid medication.

If you were taking antacids long term and you recently stopped using antacids, you could now potentially absorb more thyroid hormone. This could potentially lead to more thyroid hormone circulating in your blood.

1. Overlooked Symptoms of Low Stomach acid and Hypochlorhydria
2. 5 ways To Naturally Improving Symptoms Of Low Stomach Acid
3. Causes of Low Stomach Acid 
4. Tips to improve your Acid reflux when you have Thyroid Disease

#2 Iron Anemia and Drug Induced Hypothyroidism

Many patients with thyroid disease and autoimmune thyroid disease struggle with Iron deficiency anemia, and the two of these conditions are interwoven much more than you might think.

Research shows that about 50% of people with thyroid disease at some point struggle with iron deficiency. Iron deficiency anemia is a common type of anemia — a condition in which blood lacks adequate healthy red blood cells. Red blood cells carry oxygen to the body’s tissues. As the name implies, iron deficiency anemia is due to insufficient iron. Without enough iron, your body can’t produce enough of a substance in red blood cells that enables them to carry oxygen (hemoglobin). As a result, iron deficiency anemia may leave you tired and short of breath.

We know that hypothyroidism can cause iron deficiency anemia and we also know that iron deficiency anemia can also cause hypothyroidism. But to expand on that, iron deficiency anemia causes hypothyroidism by impairing the enzyme thyroid peroxidase- Now here is why this is important…. Thyroid peroxidase is one of the enzymes needed to make thyroid hormones. This enzyme uses both Iodine and Iron in order to make thyroid hormones.

Some studies show that there can be a 30-50% decrease in Thyroid peroxidase activity depending on the severity of the iron anemia.

So if you correct your iron deficient anemia, your thyroid hormone production is going to improve and go up because Thyroid peroxidase activity is going to be more efficient.

As a reminder be sure to get your thyroid levels monitored and adjusted more frequently as you are correcting iron deficiency anemia. Remember any supplemental thyroid hormone you are getting from your medication plus improvement in your thyroid peroxidase activity could potentially flood your system with too much thyroid hormone leading to Hyperthyroid symptoms such as hot flashes, anxiety, irritability insomnia, jittery etc.

Understanding Iron Anemia And Its Connection To Thyroid Disease 

#3 Biotin and Drug Induced Hypothyroidism

Many women with thyroid disease lose their hair, nails become weak and brittle and their skin becomes dry, cracks and it loses its youthfulness. So many women, (and understandably so), will go to the internet and ask Dr google, “what are natural supplements to help with hair loss, or natural supplements to grow healthy nails”, and what pops up? Biotin otherwise known as B7 or Vitamin H.

Biotin has been shown to help hair, skin and nails- and if your biotin levels are low, it does a great job of doing this. But what if your biotin levels are not low and you start taking biotin to treat the symptoms of hair loss and brittle nails. Now you are creating a state of excess biotin and that creates a problem when you go into have a blood draw. While biotin be great for hair skin and nails, you need to be aware of its ability to interfere with hormone testing.

Biotin does not affect the actual thyroid levels like iron, calcium, antacids, but rather, Biotin can affect the test itself, so it creates a false level.

Higher doses of biotin especially for prolonged periods of time, can make you look like you have Graves disease or Hyperthyroidism on paper and if you don’t stop Biotin a few days prior’s to test or your doctor misses this, your doctor might think you are hyperthyroid.

Biotin doesn’t only interfere with TSH, T3, and T4 levels, Biotin can affect Cortisol levels, parathyroid hormone (PTH) levels, Ferritin, vitamin D, B12 and folate.

So think about how you might be misdiagnosed or mistreated if you are taking something that interferes with testing and your doctor does not know you are taking biotin. So, a couple of things, be sure to stop any Biotin supplementation 2-3 days before testing any of those markers and if you are taking biotin, be sure to tell your doctor or remind your doctor prior to testing.

#4 Estrogen Replacement Therapy, HRT, And Birth Control Pills:

If you are taking thyroid medication and you are also on the pill or supplemental estrogen, what I am going to share with you is super important. The pill and estrogen replacement frequently causes drug induced hypothyroidism.

Estrogen from the pill, increases something called Thyroid binding globulin (TBG). Thyroid-binding globulin (TBG) is a protein that’s produced by the liver. Its purpose is to bind to the thyroid hormones, thyroxine (T4) and triiodothyronine (T3), produced by the thyroid gland and carry them through your bloodstream so they can regulate your metabolism and perform other important functions. When you increase Thyroid Binding Globulin, you don’t have as much thyroid hormone floating around in your blood.

While this can certainly cause low thyroid function and contribute to low thyroid symptoms, this becomes especialy important when you stop taking estrogen or when you stop birth control pills.

If you are taking birth control pills or you are using estrogen replacement therapy and you are concerned about the effects these medications have on your thyroid, you may want to check out a video I did on this topic called, “The Pill dirty little secret and how it disrupts thyroid function”

#5 Dopamine Agonists and Drug Induced Hypothyroidism

Dopamine agonists are drugs designed to raise dopamine levels- These can be drugs that your doctor puts you on for clinical depression, ADHD, Parkinson’s disease, PCOS (Polycystic Ovarian Syndrome) and RLS (restless leg syndrome). All common conditions affecting men and woman with thyroid disease and Hashimotos autoimmune thyroid disease.  Patients who have High prolactin levels are often prescribed medications designed to increase dopamine levels.

If you have to take a drug that raises dopamine levels, such as those drugs for depression, PCOS, ADHD, RLS, keep in mind that they can affect your Thyroid levels and cause drug induced hypothyroidism. Dopamine is an important chemical messenger involved in reward, motivation, memory, attention and even regulating body movements.

High levels of dopamine, can suppress your TSH (Thyroid stimulating Hormone) and also suppress the release of thyroid hormones (T3 and T4) from the thyroid gland.

suppressing TSH can leave you in a low thyroid state and struggling with the low thyroid symptoms such as weight gain, depression, fatigue, brain fog, hair loss, chronic pain, etc.

#6 Non-Steroidal Anti-Inflammatory Drugs: (NSAID’s) and Drug Induced Hypothyroidism

NSAID’s are another common culprit behind drug induced hypothyroidism. Many people who have Hashimotos and thyroid disease also suffer with Rheumatoid arthritis, Psoriatic arthritis, Fibromyalgia, chronic pain. Sometime this pain comes in the form of painful menstrual cramps, sometime its chronic headaches and sometimes it is the chronic neck, back and shoulder pain. All of these can lead to one reaching for Non-Steroidal Anti-Inflammatory Drugs like Aspirin, Motrin, Advil, to relieve the pain. If you use these on a regular basis daily, weekly or on a monthly basis be aware of drug induced hypothyroidism. Not only can these medications affect your thyroid gland, they are also know to cause gastrointestinal bleeding, leaky gut, gut dysbiosis, gut inflammation, and they cause drug induced hypothyroidism.

 

Check out this video below on The Connection between Chronic pain, Fibromyalgia and Thyroid Disease

#7 Testosterone-

While not technically a drug, High or low levels of testosterone can cause drug induced hypothyroidism. Most if not all women with thyroid disease or hashimotos suffer with sex hormonal imbalances. One of the most common hormone imbalances in woman with thyroid disease is either too much or too little testosterone. Some of the symptoms associated with low testosterone in women include:

• affected sexual desire
• affected sexual satisfaction
• depressed mood
• lethargy
• muscle weakness

Woman can also suffer with too much testosterone as in the case of androgenic PCOS. Woman who struggle with insulin resistance and menopause are especially vulnerable to fluctuating testosterone levels.

If your testosterone levels are high (either naturally (PCOS) or because you are taking testosterone) replacement, keep in mind that testosterone will reduce Thyroid-binding globulin (TBG) causing elevations in Free T3 and Free T4 levels. This could cause symptoms such as insomnia, trembling, hair loss, heart palpitations, agitation. Here we see that both problems with Estrogen and testosterone influence this Thyroid-binding globulin (TBG).

So, any time you are taking thyroid replacement along side testosterone replacement be sure to have your Thyroid binding globulin (TBG) levels tested and your thyroid levels monitored very closely. Thyroid binding globulin, is not a routine thyroid marker and is only part of a complete thyroid panel.

Before we move on to the next medication, remember that if you have Hashimotos autoimmune thyroid disease, you are already at risk for fluctuating thyroid levels due to the immune systems attack on the thyroid gland.

But now if we throw in some of the things we have been talking about in today’s article such as the use of antacids, SIBO, PCOS, iron deficiency, estrogen replacement therapy or birth control pills, pain pills, acid reflux medications, antidepressants that affect dopamine levels, you quickly see how easy it is for your doctor to miss what’s really going on.

This is the danger in not addressing the Root cause of these problems and why only throwing medications at these conditions. This is why its important to look at the Big picture and not just chase thyroid symptoms without digging into the Root cause.

Interested in learn more about my approach to hypothyroidism, Graves and Hashimotos click here

#8 Iodine and Iodides–

While many doctors speak about Iodine deficiency causing hypothyroidism, I want you to be aware that excess Iodine is equally problematic. Excess Iodine also has been shown to cause Hashimotos disease.

While it is true that Iodine is needed to make thyroid hormones, iodine excess results in hypothyroidism- elevated TSH and low T4 and low T3 levels.

This excess Iodine can come from CT scans, MRI’s and other contrast diagnostic imaging, it can come from your Thyroid supplements, in can come from Kelp, it can come from milk, and of course if can come from Iodized salt– the kind that you might have on your kitchen table.

I would advise anyone with thyroid problems or even thyroid symptoms to think twice about using salt and taking supplements that contain Iodine until you have tested your thyroid antibodies. You could be creating a fire storm! again, Thyroid antibody testing is not part of a routine thyroid test and can only be evaluated in a complete thyroid panel.

Here you can see a few studies showing how Iodine contrast like that used in imaging causing inflammation and swelling of the thyroid gland.

And finally here is another study showing why you must exercise caution with Iodine when you have or suspect Hashimoto’s disease.

#9 Niacin/B3 aka Nicotinic acid:

Your body needs thyroid hormones to make cholesterol and to get rid of the cholesterol it doesn’t need. When thyroid hormone levels are low (hypothyroidism), your body doesn’t break down and remove LDL cholesterol as efficiently as it could. as a result LDL cholesterol can then build up in your blood. People with mildly low thyroid levels, called subclinical hypothyroidism, can have higher than normal LDL cholesterol. A 2012 study found that high TSH levels alone can directly raise cholesterol levels, even if thyroid hormone levels aren’t low. So what does all this have to do with Niacin or nicotinic acid?

Niacin is often prescribed to patients who have high cholesterol and it can be very effective in lowering various lipid markers. Several studies show that Niacin is incredibly effective in lower LDL cholesterol, lowers Triglycerides, it lowers LDL-P which is the number of particles that lead to atherosclerosis.

Niacin can be amazing for so many people, but with all of this said, Niacin can also cause drug induced hypothyroidism by decreasing total T3 and Total T4 levels as well as decreasing Thyroid binding globulin.

Check out this video for more information about thyroid disease and high cholesterol

#10 Glucocorticoids:

Glucocorticoids are drugs like cortisone, prednisone, hydrocortisone, These are drugs that are used to reduce allergy symptoms, reduce inflammation in cases like rheumatoid arthritis, Lupus, RA, histamine intolerance/MCAS and in the treatment of hives– These are all common problems I see with patients who have thyroid disease and hashimotos.

Steroids like the ones I just mentioned, can affect your thyroid and cause drug induced hypothyroidism in a number of ways. Studies have shown that steroids can suppress TSH levels. Other studies have showed they can impair the conversion of T4 into T3- Other studies show that steroids can increase Reverse T3 levels.

So what I want you to consider here is that while steroids are used to treat the inflammation associated with hyperthyroidism and Hashimotos thyroiditis, they reduce the T4 to T3 conversion- and can further cause a drug induced hypothyroidism.

So here again if you stop using steroids, and you are taking thyroid hormones, this could cause a surge of thyroid hormones leading to thyroid overdose symptoms.

#11 Fiber

IBS and Small Intestine Bacterial Overgrowth (SIBO) is common in patients with hypothyroidism and many patients are consequently told to increase their fiber. Sounds harmless enough right? well herein lies a vicious cycle.

Fiber can exacerbate gut health by contributing to SIBO by feeding the bacteria and SIBO can contribute to thyroid dysfunction by increasing inflammation, damaging the intestine and reducing how your body absorbs nutrients.

The microbiome has been identified as an important factor in health and is linked to many diseases. An imbalanced microbiome increases the risk of Hashimoto’s thyroiditis and Graves’ disease.  As important as fiber is to the health of the gut its something you should exercise some caution about if you struggle with SIBO symptoms.

Current dietary recommendations call for 25 grams of fiber daily for women, and 38 grams for men.  The one thingI want to point out about fiber especially for those with bacterial overgrowth is that sometimes Fiber can worsen your IBS.

I test many of my thyroid patients for SIBO.

For more info about the relationship between SIBO and Thyroid disease click here 

Final Reminders

1. Remember when it comes to tackling the Root cause of poor thyroid function and autoimmunity, it is so much more than just looking at thyroid levels and play the hormone replacement game.
2. If you have thyroid hormone labs drawn or taken in the morning, always have them drawn in the morning. If your doctor has you taking them 6 days on and 1 day off, and you go to the lab on Monday morning, your levels may be lower than if you had them taken Tuesday or Wednesday. So just keep this in mind when you look at your thyroid levels from one test to the next. Try to minimize as many variables as possible. This will give you the most accurate lab testing of your thyroid levels.
3. Thyroid disease is very complex with many aspects of treatment requiring consideration. Your doctor needs to be a good investigator, they need to run the proper testing and they need to have a handle on the the many aspects that can affect your thyroid lab markers like we talked about today. It is too easy to be overmedicated in this day and age, especially if your doctor is not looking at the root cause.
4. Don’t settle for thyroid replacement unless you have exhausted all other approaches.
5. Keep in mind that you cant fix what you don’t know. The more clues you have about what’s wrong inside your body, the easier it will be to understand where your body needs help and how to best support it for the years to come.
6. If you need help getting to the root cause of why your thyroid is failing or why you are struggling with autoimmune thyroid disease and the triggers that cause it, or why your levels are all over the place from month to month, visit the start here button. Here you will find a short questionnaire that you can complete.  Once we know a bit more about your health concerns, and goals we can help point you in the right direction
7. Whether you need help with improving your diet or going beyond diet and digging deeper into the causes of autoimmunity and thyroid dysfunction, we can help!

 

 

 

Additional Articles/Videos Read and Recommended by Viewers

1. Symptoms of being overmedicated with thyroid replacement
2. 5 Causes of Elevated  TSH
3. Treatment options for High TSH
4. The Connection between Chronic pain, Fibromyalgia and Thyroid Disease
5. 7 ways the Pill and Synthetic Hormones Cause Anxiety and Depression 
6. Nutritional Deficiencies Caused By The Pill and Synthetic Hormones 
7. Signs and Symptoms of A Toxic Liver
8. How the Pill and Synthetic Hormones cause IBS and Gut Dysbiosis 
9. How the Pill and Synthetic Hormones can cause Inflammatory Bowel Disease and Crohn’s 
10. How the Pill Can Cause Leaky Gut and Why Testing is Important 
11. The Pill and Synthetic Hormones link to Small Intestinal Bacterial Overgrowth and Yeast Overgrowth 
12. The Pill and Synthetic Hormones connection to Gallbladders Disease Gall stones and Surgery-
13. The Pill and Thyroid Disease- Why The Pill causes Weight gain, Depression, Fatigue and more 
14. Overlooked Symptoms of Low Stomach acid and Hypochlorhydria
15. 5 ways To Naturally Improving Symptoms Of Low Stomach Acid
16. Causes of Low Stomach Acid 
17. Tips to improve your Acid reflux when you have Thyroid Disease
18. Cholesterol and TSH thyroid levels

Resources

1. West J Med. 2000 February; 172(2): 102–106, How Medications Affect Thyroid Tests
2. Fröhlich, E., Wahl, R. (2019). Microbiota and Thyroid Interaction in Health and Disease. Trends in Endocrinology & Metabolism. doi:10.1016/j.tem.2019.05.008
3. Patil A. D. (2014). Link between hypothyroidism and small intestinal bacterial overgrowth. Indian journal of endocrinology and metabolism, 18(3), 307–309. https://doi.org/10.4103/2230-8210.131155
4. Santin, A. P., Furlanetto, T. W. (2011). Role of estrogen in thyroid function and growth regulation. Journal of thyroid research, 2011, 875125. https://doi.org/10.4061/2011/875125