What Happens When You Don't Take Your Thyroid Medication?

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I had an interesting discussion with a friend of mine. Her 20-something daughter, diagnosed with autoimmune Hashimoto's thyroiditis and hypothyroidism, had decided not to take the thyroid medication her doctor prescribed. The daughter said that since starting her treatment, her irregular, scanty periods had become regular. She liked less frequent periods, and so she decided to stop taking her thyroid hormone replacement medication.

She felt that the benefits she'd noticed since starting treatment—losing weight, less hair loss, more energy—were just not worth it.

She's not alone in refusing to take her prescribed medications. I've heard from other patients who don't take their thyroid medications.

There are some common reasons that you may decide you don't want to take your any thyroid medication—whether thyroid hormone replacement, or antithyroid drugs. For example, do you find yourself saying any of the following: 

  • "I don't feel any different/better, so why keep taking it?"
  • "I didn't start having symptoms until I started taking the medication."
  • "I don't like taking any prescription medications."
  • "I can't afford it."
  • "I have side effects I don't like when I take the medication."
  • "I can't remember to take it every day."
  • "I'd rather just take natural remedies, like herbs or vitamins."

If you're hyperthyroid, you may have the following additional reasons why you don't want to take your prescribed antithyroid drugs:

  • "I'm worried about the side effects." (Antithyroid drugs do have a very small risk of serious side effects.)
  • "I actually like how I feel when I'm hyperthyroid much more than when I'm hypothyroid."

If you don't take your prescribed medication, what can happen? Let's take a look. 

Hypothyroid? The Risks of Not Taking Your Thyroid Hormone Replacement Medication

If you are hypothyroid—whether due to Hashimoto's, Graves' disease treatment, thyroid surgery, or congenital hypothyroidism—failing to take your thyroid hormone replacement medication (i.e., levothyroxine, or natural desiccated thyroid) can pose many risks to your health.

These risks include the following:

Ultimately, if deprived of thyroid hormone for a long period, and if your thyroid has been surgically removed, or is not producing thyroid hormone for other reasons,you face a very dangerous condition—myxedema coma—which can ultimately be fatal. 

Of particular importance, thyroid cancer patients who fail to take their thyroid hormone replacement medication at the prescribed dosage actually increase their risk of thyroid cancer recurrence.

Hyperthyroid? The Risks of Not Taking Your Antithyroid Medication

If you are hyperthyroid—whether due to Graves' disease, or toxic nodules, among other reasons—failing to take your antithyroid medication—for example, methimazole or propylthiouracil/PTU—can pose a number of risks to your health, including:

  • Debilitating weight loss or weight gain
  • Dramatically increased appetite and thirst
  • Nervousness and anxiety
  • Panic attacks
  • Heat intolerance, sweating
  • Fatigue
  • Diarrhea
  • Menstrual irregularities
  • Goiter/enlarged thyroid
  • Muscle weakness
  • Insomnia
  • Rapid pulse
  • High blood pressure
  • Heart palpitations
  • Nausea and vomiting
  • Menstrual irregularities
  • Itching
  • Tremors
  • Hair loss
  • Protruding eyes

Failing to treat hyperthyroidism can increase your risk of stroke or heart attack. A subset of untreated people with hyperthyroidism also develop a very dangerous condition known as thyroid storm, which has a high fatality rate. 

Rethinking Your Excuses For Not Taking Medication

Clearly, there are sensible health reasons to take your prescribed thyroid medication. But if you are not taking medications, here are some thoughts.

"I don't feel any different/better, so why should I take it?"
Don't expect thyroid hormone medications to work like an aspirin for a headache. If you have just started taking thyroid hormone replacement medication or antithyroid drugs, it can take a few days to a few weeks to even start noticing a difference in how you feel. If you have been taking your medication for a number of months, and you still don't feel well, you may need a dosage adjustment or a change in medication—not a complete stop in your medication regimen. Read Help, I'm Hypothyroid and I Still Don't Feel Well for more ideas and information.

"I didn't start having this symptom until I started taking the medication."
Some hypothyroid patients have adrenal fatigue, and when they begin thyroid hormone replacement medication, symptoms actually worsen because the underlying adrenal problem have not been addressed. Read Adrenal Fatigue/Adrenal Exhaustion for more information. Also, if the primary new symptom you're experiencing is hair loss, note that levothyroxine can cause hair loss in some patients. To avoid hair loss, you may need a different medication. This topic is discussed at greater length in Hair Loss Solutions For Thyroid Patients.

"I don't like taking any prescription medications, I'd rather just take natural remedies, like herbs or vitamins."
Unfortunately, there isn't a natural or herbal replacement for thyroid hormone. Just like a diabetic needs insulin, a crucial hormone for survival, you need thyroid hormone. Read Can Your Hypothyroidism Be Treated Naturally?

"I can't afford it."
Thyroid medication is not particularly expensive. Even if you pay out of pocket, the most costly thyroid medications shouldn't run more than around $30 a month, and can be as low as $4 a month for generics. And you may even be eligible for brand name prescription drugs through various low-cost programs. Read How to Get Free or Low-Cost Prescription Drugs.

"I have side effects I don't like when I take the medication."
If you are experiencing unwanted side effects, your first stop is your doctor. You may need a dosage change, or even a different medication, to avoid certain side effects.

"I can't remember to take it every day.
If you can remember to brush your teeth everyday, you can remember to take your thyroid medication. If the main reason you're not taking your medication is that you just can't remember your pill every day, it's time to figure out a way to ensure you take your medication.

You'll find a number of helpful suggestions in 10 Creative Ways to Remember to Take Your Thyroid Pill. So many people also have smart phones these days, and most of our phones and organizers can be programmed to give us a daily reminder call or alarm. This may be just what you need to remember to take your medication.

"I'm worried about the side effects of antithyroid drugs."
Certainly, keep in mind that the risk of serious side effects is extremely small, and far less than the risks of remaining hyperthyroid. They are also most likely to occur within the first three months of treatment, so that is the time to be most vigilant. If you develop a sore throat or fever, or other signs or symptoms of infection in those first few months, contact your doctor right away. If you are on long-term antithyroid drug therapy, you may wish to ask your doctor to regularly schedule bloodwork to evaluate your white blood cell count as well.

Also, any serious risks from antithyroid drugs are reduced even more with lower dosages of these drugs. One option, if you're concerned, is to consider complementing the antithyroid drug regimen with a natural antithyroid protocol. Richard Shames, MD has outlined a protocol -- which includes a variety of herbs, supplements, minerals and foods known to slow down the thyroid -- in the book Living Well With Graves' Disease and Hyperthyroidism.

"I actually like how I feel when I'm hyperthyroid." -
Some patients do like the feeling of being hyperthyroid, but unfortunately, they may not realize the strain this condition is putting on their heart, bones, and overall health. Liking the feeling of hyperthyroidism is similar to being addicted to a stimulant such as nicotine or caffeine. Untreated hyperthyroidism can have serious consequences to your health. Some patients who like this feeling of being hyperstimulated may have underlying adrenal fatigue or exhaustion that should be addressed. The article on Adrenal Fatigue/Adrenal Exhaustion has more information.

Moving Forward

Ultimately, if you aren't comfortable taking your thyroid medication, the solution may lie in getting a new thyroid doctor. Having a practitioner you can trust may help you get on track with the right treatment. You may also want to read these reader comments about not taking thyroid medication. Sometimes people who have been there have the best words of wisdom.

Sources:

Braverman, MD, Lewis E., and Robert D. Utiger, MD. Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text. 9th ed. Philadelphia: Lippincott Williams & Wilkins (LWW), 2005.

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