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Part 4 of Top 10 Prescribed Medications: Levothyroxine (4)


Levothyroxine is the 4th most prescribed medication in the United States, used for treating low thyroid (hypothyroid). Most cases of hypothyroidism are caused by auto-immune thyroiditis, formerly called as Hashimoto's. A person can also become hypothyroid after surgical or radioactive removal of the thyroid gland due to thyroid cancer or hyperthyroidism. Hypo means low, the opposite is hyper, or high. The thyroid is a gland in the neck that makes hormones affecting all aspects of metabolism. Metabolism describes the chemical processes which occur in order to turn food into energy. Because hypothyroidism affects the body's metabolism, it's important to restore thyroid function. The most common symptoms associated with a low thyroid are associated with the decreased ability to make energy - (weight gain), fatigue, hair loss, constipation, and chilliness.

Thyroid stimulating hormone (TSH), released from the pituitary gland in the brain, TSH is the screening test for checking thyroid. TSH stimulates the thyroid gland to make and release thyroid hormone. When thyroid hormone is released, adequate levels in the blood inhibit the release of TSH from the pituitary. When TSH is high, thyroid is considered low, and when TSH is low, thyroid is considered high. Confirmatory tests are done on T4 and T3, the actual thyroid hormone.

Why is hypothyroidism so common? What causes hypothyroidism? In autoimmunity, our body attacks the processes that produce thyroid hormone. It seems incomprehensible our thyroid gets attacked by our own bodies, why would our body do this to us?

One theory is a genetic predisposition with exposure to a trigger such as infection, toxin, or, commonly, pregnancy that prompts the immune system. A common cause of hypothyroidism discovered in the early 1900s was iodine deficiency; thus, iodine became the first nutrient added to food when it was added to table salt in 1940. Conversely, new theories suggest this iodine fortification in our foods has possibly resulted in the autoimmune thyroiditis we're seeing today. Overall, it's still a conundrum and many theories provide a good argument. A great resource for learning more about these theories, as well as hypothyroidism, is Ryan Drum, PhD, AKA "Fucus man". Dr. Drum has studied the thyroid in depth and provides insight into why hypothyroidism is common enough to result in Levothyroxine being the 4th most prescribed medication.

Blood tests revealing elevated levels of TSH but showing normal thyroid function are common. Early hypothyroidism often behaves this way, or an acute physical or mental stress reaction can also result in the thyroid slowing down temporarily. It is important to assess these cases individually. Levothyroxine is not as overprescribed as Vicodin, but it is recommended prematurely at times.

It's important to manage hypothyroidism and not ignore it. Many clients would prefer to avoid pharmaceuticals, but if thyroid function continues to be low, medication can be paramount for health span. See a provider with experience in assessment of thyroid levels, and make sure further workup of thyroid hormone, at least T4 and T4, has been done. I often see medication recommendations based on TSH alone.



  • Iodine rich foods such as seaweed/kelp, seafood and dairy should be included in the diet, but no need to over-do it. Try different types of seaweed like wakame, nori, kombu, and others. Bladderwrack is the seaweed that's classic treatment for thyroid dysfunction. In addition to sushi, seaweed can be added to soups or cooked with beans and rice. Wakame is the seaweed used in miso soup.

  • Selenium rich foods such as Brazil nuts, meats, fish and poultry should be consumed regularly. Only 3-4 Brazil nuts are necessary for the daily recommended dose of Selenium.

  • Strategies following restrictive dietary habits promoted by popular books on Hashimoto's, etc., shouldn't be practiced longer than 3 months. Many people feel great when starting a restrictive diet, thinking the foods eaten before must be allergens. Usually, the reason people feel better is because they're eating food made by nature and not in factories. I've never seen long-term restriction of whole food groups improve health outside a definitive diagnosis like gluten with Celiac disease.

  • Hashimoto's and Celiac are often co-morbidities, so assessing gluten tolerance may be beneficial. Blood tests are the first step in diagnosing Celiac disease, an autoimmune that damages the lining of the small intestine if gluten is consumed.

    • You can also do your own experiment through elimination/challenge. Stop eating gluten (wheat, rye, barley) for 4-6 weeks, then challenge it by having a little, and if no reactions, have something with more gluten the next day.

      • Be sure to challenge gluten with healthy versions of gluten for accurate results, e.g. challenge with beef and barley soup instead of pizza. Pizza makes everyone over 35 years old gassy and bloated. Note - if you remove gluten, it will make diagnostic testing for Celiac inaccurate - your body will not present the antibodies to gluten when there is no gluten in the system. It can be nice to know for sure if you can comfortable enjoy a baguette in France.

  • Soy is often implicated in hypothyroidism due to goitrogenic effects - goitrogens are compounds that interfere with normal thyroid function. The evidence here is mixed, but it exists, and thyroid function significantly decreased when the soy came from soy powder. Consuming soy in the form of soy sauce, occasional tofu, tempeh, or miso is likely harmless. Soy in the form of concentrated protein powders or soy oil, as in all man-made foods, should be minimized or avoided altogether.

  • Cruciferous vegetables such as broccoli, cabbage, cauliflower, kale, bok choy, etc. are also implicated as goitrogens. The evidence is mixed, but it looks like when these vegetables are cooked, they improve thyroid function. There is more nutrition in cooked vegetables anyway, plants have cell walls, cooking breaks these cells walls. Nutrients are inside the plant cells.


Exercise is hard but still necessary when in the process of regulating the thyroid. Upon starting an exercise program, the thyroid must adapt to the increased metabolism, causing fluctuations in thyroid hormone. The thyroid regulates over time. Be gentle with yourself - perhaps you advance more slowly than preferred, but you will still advance. On recovery days, fit in some restorative yoga (here's a great video) or take a gentle walk.

When exercising, close attention should be paid to the breath. If breathing becomes labored or difficult, stop for a bit. Exhale through the mouth, inhale through the nose, and resume activity when more comfortable.


Incredible stress reactions can quickly increase TSH to levels where medication is recommended immediately. If the stress passes, thyroid levels often return to normal. Acute stress reactions put our bodies in defense, often lowering metabolism as a protective mechanism. Surgeries, endurance athletics, and other serious mental or physical traumas can temporarily alter thyroid function.

Breathing exercises can be used through all these situations to improve the body's resilience, which will regulate thyroid function with or without medication. For an explanation of the breath, see Part 3 on hypertension

Faith or religion can carry followers through stressful situations, resilience comes from faith in the Lord. If you're involved with faith, prioritize it through attending faith events with like-minded individuals, reading scripture, meditating, and praying.


For a variety of reasons, hypothyroidism often comes with insomnia that may reversed with treatment or continue. TSH can fluctuate in those with chronic insomnia, or even new parents, as this promotes the chemical stress response in the body. If you have insomnia, it's important to address it. Insomnia assumes you are taking the time to sleep, but are unable to achieve sleep.

Sleep Hygiene is a set of practices intended to develop your circadian rhythm, or sleep-wake cycle, in a way which you're awake during desired active hours and sleeping when you set aside the time. This happens over time with adherence to the sleep hygiene practices. Lifestyle changes are not like drugs, the circadian rhythm takes longer than a day or 2 weeks to work. Here are the components of sleep hygiene:

  • Have a set wake time and wake at this time everyday, even on weekends, and set a corresponding bed time.

  • Have a bedtime routine to get your mind into the idea of sleep.

  • Creating a healthy sleep environment that includes dim lights and the ideal thermostat temperature

  • Shutting off all electronics at least 60 minutes before bed

  • Limiting caffeine intake several hours before bedtime

  • Getting enough physical activity earlier in the day

  • Reducing stress levels

  • Avoiding large meals with high-fat content before bed

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