From the start, I’ve had a great group of doctors treating me during the pre-cancer diagnosis, cancer treatment and post-cancer visits.  Looking back, I realize that living in Baltimore and being referred to the Endocrine team at the Johns Hopkins University School of Medicine was a BIG blessing.  After all, I had so many questions and wanted as much information as I could get from the experts at JHU. 

Since I had a thyroidectomy, I needed to take a thyroid hormone medication to replace my thyroid gland function.  So one of the questions I had was “What are the patient guidelines for thyroid hormone therapy?”  I have heard and read about all kinds of “rules” when it comes to guidelines patients are supposed to follow.  I came across the guidelines that were sent to me from JHU the other day.  Warning:  Before making any changes to your thyroid hormone therapy, always check with your doctor.  I am not a medical professional (I’m just a thyroid cancer survivor trying to help others by sharing my experience.)  The guidelines below will hopefully bring you some awareness and serve as a “conversation piece” for you to have with your doctor.

  •  Take your medication consistently at the same time, ideally in the morning OR at bedtime on an empty stomach. If a dose is missed you can make it up at a later time or the next day.
  •  Separate your thyroid hormone by 4 hours from iron containing multi-vitamins, iron tablets, calcium supplements, antacids, and soy products.
  •     Thyroid medication doses vary from 0.025 mg to 0.3 mg tablets. Your medication dose is embossed on the color-coded tablet. Your doctor will select a dose appropriate for your situation.
  •  Take the same brand of thyroid hormone regularly, since all preparations are not the same. Generic forms of thyroid hormone are not recommended.  If you switch to another preparation, a blood test should be done in 4-6 weeks to confirm the adequacy of your new medication.
  • Sometimes it is necessary to “fine tune” a dosing schedule by adding or subtracting a weekly tablet.
  • There are other medications that may affect your requirements for thyroid hormone. Notify your doctor if you start or stop the following medications: estrogen replacement (HRT), oral contraceptives, cholestyramine (Questran®) , cholestipol (Colestid®) , aluminum hydroxide gel (Amphogel®), sucralfate (Carafate®), phenytoin (Dilantin®), carbemazapine (Tegretol®), phenobarbital, valproic acid (Depakene®), rifampin (Rifadin®), raloxafene (Evista®), sertraline (Zoloft®), amiodarone (Cordarone®) .
  • Thyroid hormone is safe to take during pregnancy. If you become pregnant while taking thyroid hormone, notify your doctor immediately. It is important to monitor your blood work frequently during pregnancy since the dose may need to be increased.  A TSH (thyroid stimulating hormone) blood test will confirm if you are on the correct dose of medication. It is usually done 4-6 weeks after thyroxine is begun or after your dose of medication is changed.  You do not have to be fasting for this test and it maybe done anytime of the day. You should take your medication the day of this testing.

Side effects of thyroid hormone are usually related to an incorrect dose. Your doctor has selected this strength based on your weight, diagnosis, and goal of treatment. Frequent dose adjustments are not regularly required. 

Possible symptoms of thyroid hormone excess (too high a dose of medication) include:

  • Palpitations (rapid heart beat)
  • Heat intolerance
  • Hand tremors
  • Anxiety
  • Insomnia
  • Fatigue
  • Difficulty concentrating
  • Frequent stools, diarrhea
  • Unexplained weight loss 

Possible symptoms of thyroid hormone deficiency (too low a dose of medication) include:

  • Fatigue
  • Cold intolerance
  • Constipation
  • Dry skin
  • Weight gain
  • Coarse skin
  • Impaired memory
  • Depression