Latest / Health with Hashimoto’s - Thyroid or Immune Education for Autoimmune Thyroid Disease / 131 // Everything You Need to Know About Starting Synthroid or Levothyroxine

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131 // Everything You Need to Know About Starting Synthroid or Levothyroxine · Health with Hashimoto’s - Thyroid or Immune Education for Autoimmune Thyroid Disease

• 0:00
  Over 82 million prescriptions of levothyroxine or Synthroid are prescribed every
• 0:05
  single year just in the United States.
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  And chances are, if you are listening to this podcast, Health with Hashimoto's,
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  you might have Hashimoto's, you might have hypothyroidism, and you might be
• 0:16
  one of the people who are taking a prescription of levothyroxine.
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  So I thought we should chat about what it is, how to take it to make sure that
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  you're taking it correctly and just talk about it in general,
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  especially for new listeners who are maybe brand new to Synthroid or Levothyrox.
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  So if we have not met yet, I'm Esther.
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  I am a registered nurse. I'm a holistic health educator. I have four boys.
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  I homeschool two of them. Two of them go to a charter school.
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  My husband and I and boys live in Minnesota where it is cold and dark, but I love it.
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  I've been a nurse for over 20 years now and worked in the emergency department most of my career.
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  And so I can tell you without even second guessing myself that levothyroxine
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  is one of the most common medications prescribed because when checking people
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  into the emergency department, we always ask about their med list.
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  And so many people are on levothyroxine. Like my fingers can type it out just by muscle memory.
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  So many people are on it. And I also learned while working in the ER,
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  that it is the number one medication that people say, I have to take the brand name Synthroid.
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  I cannot take a generic levothyroxine. And I was like, okay.
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  You know, enough people told me that, that I didn't look it up.
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  I just said, okay, a lot of people are mentioning this, you know,
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  different states. I worked in multiple different states. Like this is a common thing.
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  It must be real, right? And I never questioned why.
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  I honestly didn't even know a lot about levothyroxine. I knew that it was for
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  hypothyroid, but I couldn't tell you a ton about it.
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  In the emergency department, I don't have to worry about when I give a medication
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  and I'm not giving people their daily medications. That's what you do when somebody
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  is admitted to the hospital.
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  And in the emergency department, ideally, we are not admitting patients.
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  We're not keeping them for days at a time.
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  Now, of course, emergency departments are way overloaded and there is some of
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  that and it's not cool, but that's the broken healthcare system.
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  Today, we're talking about you, your health, and your Synthroid or your Levothyroxine.
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  So it is a very common medication and why do people take it?
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  Let's start with that question.
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  Why do people take Synthroid or Levothyroxine? Now, in this episode,
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  I will probably say Synthroid.
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  You might be taking a different version.
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  All levothyroxines are T4. So Synthroid is a T4 medication.
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  As I have said before, if you've listened to the first couple of episodes.
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  Like one through 10, you got all the basics.
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  And then I repeated a lot of those most common things in episodes like 100 through 110.
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  I tried to give you the basics. So if you've listened to those,
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  you know that your thyroid produces T4.
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  In your body, that T4 is converted to T3, which is what your cells need to use.
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  That's the active form of the thyroid medication.
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  So Synthroid is the T4.
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  And when do you use it? When is it prescribed? It's prescribed when your TSH is out of whack.
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  Now your TSH is your brain telling your body, I need more thyroid hormone. I need more energy.
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  And so then your thyroid reacts by producing more T4, at least ideally, right?
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  So if your TSH is too high, that means your brain is like hitting the light switch a lot of times.
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  You know, when your power goes off, you hit the light switch a couple of times
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  to see if it'll turn back on. Well, that's your TSH.
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  Your light switch is turning back on. Your body is like flipping that light
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  switch up saying, hey, can I have more energy? Can I have more energy?
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  So ideally, if your TSH is over three, then your provider is helping you address
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  why your body is not getting enough thyroid hormone.
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  Why is your brain asking for more T4?
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  And at that time, your provider might prescribe some Synthroid or Levothyroxine.
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  Now they might also prescribe a blend.
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  So Levothyroxine is just T4. There are other forms.
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  The biggest one is armor, and that is a blend of T4 with T3.
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  Like I said, your body, your thyroid produces T4, and then the rest of your
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  body converts that to T3 so that your body, your cells can use it.
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  So some people, if that conversion is not happening well, then you will be on
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  a blended medication so you get the T4 and the T3.
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  That is up to your provider on how he or she wants to prescribe and how you
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  are responding to your medications.
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  So we talked about Synthroid. It is T4. And why do you have it?
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  It's because usually your TSH is elevated.
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  Sometimes it's if your T4 is too low, like clearly on your labs,
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  we can see that you don't have enough T4.
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  But typically, it's because of your TSH.
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  And then how do you know if you need Synthroid or another medication?
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  Again, we're looking at your labs, but also your symptoms.
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  Now there's a lot of, I don't know, talk in my circles, the circles that I go
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  through of like, can you just rely on labs?
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  Because I get people asking me like, my labs are kind of normal, but I feel really bad.
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  Or other people will say that they're feeling great and their labs are abnormal.
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  Either way, you have to have this delicate dance between your labs and your symptoms.
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  And it is up to your provider to listen to you and to look at the whole picture.
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  We can't just look at the data and we can't just look at the symptoms.
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  You have to look at both. I cannot tell you how many times in my 20 years as
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  a nurse, 20 plus, I've been told, don't just look at the monitor.
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  You have to look at your patient.
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  It's the same thing with labs. You can't just look at your labs.
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  You have to look at the whole picture.
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  If your provider is looking at just the labs, it is time to look for another
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  provider. And there are a lot of options out there.
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  Personally, I go to, I say go, I quote, go to a virtual nurse practitioner.
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  I love my quote clinic. So telehealth NP is where I go.
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  And there are several different nurse practitioners there. You can just type it in telehealth NP.
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  I'll try to put the link down in the show notes. And everybody I have seen there looks at both.
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  They will ask me about my labs and I get my labs drawn either at a local clinic
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  or I will order my own labs. And I do have an episode about that.
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  It is episode 39. I explain how to get your own labs, how to order your own labs.
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  This is available in almost all 50 states.
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  I cannot say that it's available in all countries.
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  Everybody regulates a little bit differently.
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  So episode 39 is how to order your own labs. Anyway, I go, quote,
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  go to my virtual nurse practitioner.
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  They ask about the labs, they upload them or give them all of the data.
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  They ask about my symptoms and then they put those two together to look at the whole picture.
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  I love this. I did go to a clinic in person at the end of 2024 and I got my
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  labs drawn and they came back and my TSH was elevated.
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  And at that point in time, I encountered the broken medical system because the
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  nurse practitioner, no, the PA that I had seen, I really loved her.
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  I loved her view of my health.
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  I loved our conversation. She was asking really good questions.
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  She was looking at the whole picture. But when my labs came back elevated,
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  she kicked me off to an endocrinologist.
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  She was not going to prescribe because our healthcare system is broken and everybody is in silos.
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  So she couldn't prescribe my levothyroxine.
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  She had to send me to an endocrinologist. So I called endocrinology through
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  the clinic where I have my insurance.
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  And they're like, oh, we can get you in in about two and a half months. I was like, yeah, no.
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  So I looked at my typical nurse practitioner, telehealthnp.com,
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  I think it's .com, and they could get me in like the next day.
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  So where do you think I went? Of course, I went to the one that's looking at the whole picture.
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  They asked me about my labs, they asked me about my symptoms,
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  and then they prescribed what I needed. I didn't have to wait two and a half
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  months to go see an endocrinologist.
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  Okay, so there's my little rant for this episode.
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  See somebody who will look at the whole picture, who will look at your labs,
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  who will listen to your symptoms, and who can prescribe. Is that an endocrinologist a lot of times?
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  Yes. Is it always an endocrinologist? Nope, as my story just indicated.
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  So how long does it take to feel better after starting Synthroid?
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  That is the next question.
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  First of all, what kind of symptoms are you going to have? Well,
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  if your TSH is elevated, you're going to have a lot of those hypothyroid symptoms.
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  So you're going to feel really sluggish. That might be physical fatigue.
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  It might be mental fatigue. It might be depression. It might be your metabolism is down.
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  There's a lot of different things that people experience when their thyroid function is down.
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  And again, if your thyroid function is down, your TSH, how much your brain is
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  asking for more thyroid, that's going to be elevated.
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  So if your TSH is elevated, then your thyroid function is down and you're going
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  to want to start on, or maybe your provider will want you to start on some levothyroxine.
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  How long does it take to feel better?
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  Generally, about six to eight weeks or maybe four to six weeks.
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  It's in that one to two month range where we expect to see some changes And
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  then your provider is going to want you to redo your lab work to see how your
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  body is responding, especially when.
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  Personally, now this is not coming from a typical provider that I saw,
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  you know, this is me talking to you with a lot of reading and common sense.
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  We want to know if your T4 from the medication is being converted to T3, right?
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  Of course, because when your body or the medication has T4, then your body is
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  supposed to convert that to T3, which is the active form of thyroid hormone.
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  And that's what your body uses.
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  So if you started supplementing or taking a medication that's T4,
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  we want to make sure that it's being used appropriately by your body.
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  So this is the point where you need to have some labs done, including a reverse T3.
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  Not all people are going to order this. In fact, they probably won't if it's
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  a traditional health, broken healthcare care provider.
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  They just don't know. Or it's not recommended by their computer system that spits out the lab sets.
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  Maybe they're just going to order the TSH. When I am having this checkup,
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  when I'm looking to see, hey, how is the Synthroid working in my body?
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  I want to see, yes, my TSH. Of course, I want to see that.
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  But I also want to see my free T4. I want to see my free T3.
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  I want to see my reverse T3.
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  I want to see all of these because I want to know, you know,
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  if how much T4 I have now in my body, now that I'm supplementing with a medication.
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  I want to see how much T3 I have in my body, how much is being converted,
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  how much of that T4 is being converted.
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  I also really want to see my reverse T3 because the reverse T3 is how much of
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  that T4 was converted to the brake system.
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  Instead of converting it to the gas pedal, the T3.
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  Your body can convert the T4 to the brake system, which is, hold on,
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  we need to prioritize rest, we need to prioritize sleep, we need to prioritize time to heal.
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  So I am not going to convert to We don't need more gas.
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  We need to slow down and heal.
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  And that number to me is very significant.
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  That number to me, it says, I need to prioritize helping my body heal.
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  So I want to see that reverse T3. Now, every provider is not going to do that.
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  That is up to you to ask for it.
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  And hopefully your provider is on board.
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  So that is going back to that question of how long does it take to feel better?
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  How long until your labs change?
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  Sometimes it can take people like up to a year to get their dose dialed in.
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  And then it could even change after that. So you're going to,
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  you know, be on your dose of Synthroid for one to two months,
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  you're going to get your labs checked, and then it might adjust your Synthroid
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  levels beyond one or two months, and then, you know, check it.
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  Now there's different things that can play into this. If you have gone through
• 13:11
  the Holistic Hashimoto's course, then you know different ways that you can support
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  your body so that your body can do what your body is supposed to do, which is heal.
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  And so if you feel like your body is getting stronger, healthier.
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  Like your thyroid might be doing better, you might have had a stable synthroid
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  dose for months or even years.
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  And all of a sudden, you feel like you might be over medicated.
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  And that's because your thyroid is working a little better. That is always the
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  goal. Or maybe you implemented some new therapy.
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  We're going to talk about red light therapy in a couple episodes.
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  And research tells us that when you're using red light therapy,
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  your thyroid can start working better and people have been able to reduce or
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  even eliminate their Synthroid dose.
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  So I already talked about the symptoms of low thyroid.
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  And then if you're looking at too much thyroid hormone, they would be opposite.
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  So, you know, if I just said you might have too much thyroid,
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  if you're taking Synthroid or Levothyroxine and you're healing,
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  well, then you would be feeling things like the number one thing I hear about is heart palpitations.
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  So like your heart fluttering or it feels, it just feels wrong in your chest.
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  That is It's probably the number one thing I hear. Also just your heart going too fast.
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  You know, hypothyroid. We talked about depression. Well, hyperthyroid,
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  a lot of times people feel more anxious and people will feel excessively sweaty.
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  People will have their metabolism go too high. And I know you're thinking,
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  oh, great, Esther, I want that.
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  I want to lose weight. There are healthier ways to lose weight.
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  Giving yourself too much thyroid hormone is not healthy. we do not want that.
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  So let's get your thyroid hormone in an ideal range.
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  Okay, so the next question would be, how do you take your levothyroxine or your Synthroid?
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  And a lot of people wonder, can I take it with coffee? So let's answer both of those questions.
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  Number one, you want to take your levothyroxine to mimic what your body would do.
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  And your body releases T4 T4 in the morning is right before you wake up in that time.
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  And that's actually one of the things that helps your body wake up is the release
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  of different hormones, including T4.
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  And it tells your body, hey, it's time to get up. It's time to wake up.
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  So you want to mimic that.
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  You're going to take your Synthroid right when you wake up.
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  Personally, my husband and I have two different sleep schedules. He works overnight.
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  And so a lot of times when he is not working, he will come to bed really late
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  at night or, you know, really early in the morning.
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  And if I wake up when he comes to bed, I will take it then because it's about
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  an hour or two before I'm going to get up.
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  And so I'll just take my Synthroid at that time.
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  I always, I don't know about you, but my little medication bottle,
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  it has the cap that's reversible.
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  And I think, you know, one side is easier to open, but I reverse it.
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  So it's a little cup at the top of the cap and I pop my Synthroid in there.
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  And that way in the morning, I don't have to remember, did I take it or not?
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  I look at my little cap of the medication bottle and if it has a little Synthroid
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  in it, then I know I haven't taken it yet.
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  If it's empty, then I know that in the early morning hours when I wasn't quite awake, I took it.
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  So you're going to take it first thing in the morning. You're going to take
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  it with water. You're not going to take it with any other medications.
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  You're not going to take it with any other supplements. You're not going to
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  take it with any caffeine.
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  That includes your coffee. It also includes tea.
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  You're not going to take your Synthroid with caffeine because it changes the
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  absorption rate. It changes your gut.
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  So you take your Synthroid with water.
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  And then comes, I think, the hardest part is you have to wait an hour.
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  Now for me, I am not a morning person. I put my alarm clock until the very last
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  second. I know exactly how long it takes me to get up, get dressed,
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  get my breakfast, and get the kids out the door to school.
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  I know exactly like down to the minute.
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  And when I started on Synthroid, I was really upset about it because now I couldn't do that anymore.
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  I am a person who needs breakfast. I don't function on no breakfast.
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  And so extending that out was, that was the hardest part for me.
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  And that's when I was brainstorming with my husband, I was like,
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  how can I do this? Because I need to eat breakfast.
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  And he's the one who suggested, why don't you take it when you wake up in the
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  middle of the night when I come to the bed?
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  And so that's worked perfectly. On nights when I sleep solid through the night
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  and I don't wake up, then I do have to wait that hour before breakfast.
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  Now, some pharmacists or some places will tell you that 30 minutes is all you
• 17:57
  have to wait before you eat.
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  If you look at the research, they have done research on if you take your Synthroid
• 18:03
  at bedtime, four hours after your last intake, or if you take it 30 minutes
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  before eating or 60 minutes before eating in the morning.
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  There is a difference in how your body reacts to those three things.
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  And all of the research that I have looked at about these things indicates that
• 18:21
  60 minutes on an empty stomach is the ideal way to take your Synthroid.
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  But also consistently is the ideal way to take your Synthroid.
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  So if you always take it at bedtime on an empty stomach, it's been four hours
• 18:35
  since your last meal, then you want to make sure that you're always doing it that way.
• 18:39
  And then you're checking your labs to make sure that that is good and you're
• 18:43
  keeping the same schedule, which leads me to what if you miss a dose?
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  If you miss a dose, you want to get back on your schedule as soon as possible.
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  So let's say you normally take your medication at six o'clock in the morning
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  and at 10 o'clock in the morning, you realize, oh my goodness,
• 18:59
  I missed my Synthroid. You're going to take it right then.
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  If you realize like at bedtime that you missed it, maybe you're not going to
• 19:06
  take it then because you're going to take it in the morning.
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  You want to take it as close to when you remember, but also as close to your
• 19:13
  normal time as possible.
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  It is really important for your body's function that you're taking your Synthroid at the normal time.
• 19:20
  And I'll answer one more frequently asked question before I sign off.
• 19:23
  We could definitely continue this conversation over in the school community,
• 19:27
  S-K-O-O-L.com. come over to the Health with Hashimoto's community and ask your
• 19:32
  Synthroid questions there because you know a lot of people in there have personal
• 19:35
  experience and I am in there too answering questions.
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  So the last question I will answer
• 19:39
  about Synthroid or Libothyroxine is how long do I need to take this?
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  For a lot of people it is the rest of their life because if your thyroid is
• 19:46
  not producing enough thyroid hormone you need thyroid hormone to function.
• 19:50
  Every single cell in your body needs the thyroid hormone in order to like turn on.
• 19:55
  It's like the ignition switch. So you need to have the thyroid hormone.
• 19:59
  If your thyroid is not producing it itself, then you need to supplement with
• 20:03
  that prescription medication.
• 20:05
  So to answer that question, you might be taking it for the rest of your life.
• 20:09
  If you heal, if your thyroid starts doing what your thyroid is supposed to do.
• 20:14
  Then at that time you can check your labs, you can talk to your provider,
• 20:18
  you can wean down on your Synthroid and maybe go off of it entirely.
• 20:22
  But that is only if your thyroid is working because you absolutely need thyroid
• 20:27
  hormone to function well.
• 20:29
  Do not take yourself off of your Synthroid. Always look for your labs.
• 20:34
  Always have a conversation with your provider.
• 20:36
  You do need thyroid hormone in order to function. So make sure that you are doing things safely.
• 20:43
  Come over to the school community and let's have a conversation about this.
• 20:46
  Don't forget that next week we are meeting with the pharmacist over in the school community.
• 20:52
  The pharmacist who talked about LDN. He can answer all of your questions about LDN live.
• 20:59
  Make sure to come over to the school community so that you can get in on that
• 21:03
  opportunity. I will see you over there.
• 21:05
  This podcast is for informational and educational purposes only.
• 21:09
  Please discuss any concerns and plans with your trusted healthcare professional.
• 21:13
  If you found this episode helpful, will you please share it with a friend? I'll see you next week.
• 21:18
  Music.