Hypothyroidism – Getting off Medication

Where is your Thyroid?

If anyone you know suffers from a thyroid function disorder, and wants to get off medication, this real-life case is an encouraging read.

Too Much Medicine Too Often
I have not (yet) written about it formally, explicitly or separately but those I mentor know only too well that I am not at all a fan of modern pharmaceuticals for solving most problems. I believe they have their place in our survival but I also know that they are prescribed and used more than is justified for maximizing one’s Healthspan.

 

Enter Mrs T
So, about 18 months ago, when a lady I had started mentoring, let us call her Mrs T, disclosed that she had been on external supplementation of thyroxine for hypothyroidism for the previous 13 years, our mini-project was to get her off that daily pill. She absolutely hated [her words] that aspect of her life – popping a pill daily. She was made to believe that she was going to have to grin and bear it, quite possibly, forever. Fortunately, she had faith in me, and that was a good starting condition.

 

Caveat: Please note that this case revolved around a condition that was brought into control and then reversed, with intelligent lifestyle changes. Other autoimmune and non-autoimmune thyroid and non-thyroid illnesses and other individuals will necessarily have different healing plans, and different rates of success over time. You are different from me, and I am different from Mrs T – please use science sensibly to improve your health. Please use this conversation as general guidance and do not use it as a specific treatment plan.

 

Thyroid Disorders on the Rise

One might debate the details of the precise extent of increase in the incidence of thyroid disorders. Or, about the reasons for the increase. But, what is clear is that, in most societies, there is an increase in the actual prevalence of it. You can familiarize yourself easily with the thyroid gland and its function [and malfunction] with these easy-to-read pages.

Your thyroid gland is butterfly shaped and in your neck, producing just the right amount of various thyroid hormones to keep your body’s metabolic processes humming along at the right pace. With primary hypothyroidism, Mrs T was producing too little thyroid hormone on her own. The medication prescribed was meant to make up for that shortfall.

 

Our goal

To get Mrs T’s natural thyroid function back on track so that she would have thyroid hormone levels within-rangewithout having to take any medication.

 

Stepwise Loop – Plan and Execution

The overall plan and its execution was to:

  • quantify the impact of the medication that was helping her stay in balance
  • wean her off the medication in a systematic manner
  • make lifestyle changes that would work to bring her body back to greater harmony which would ensure adequate thyroid hormone production
  • assess her thyroid function by measuring levels of certain chemicals in her blood at the appropriate times
  • tweak the thyroxine medication dose back up if ever needed (hopefully not)

 

Quantify the Impact of the Medication

I considered three parts to this:

  • the biological half-life of this specific medication [can vary in the range 37-10 days for hyponormal-hyper thyroid]
  • the time the typical human body takes to adjust to a new level of this specific medication [can vary between 4-to-6-to-8 weeks]
  • the actual size and date of every dose [because the dose was not going to be the same every day]

What happens in popular culture is that one goes to a doctor, and the doctor presumes that patients want an easy fix, a ‘typical dose’ is advised, which is later tweaked in a fairly simplistic manner when the symptoms or blood indicators change. The passage of time for various parts of the process can often be ignored and there is typically not much emphasis on lifestyle changes. Lifestyle changes might be mentioned as a throwaway comment, but typically for hypothyroidism, patients are put on medication fairly soon after diagnosis.

I built a quantitative model of the medication level within Mrs T’s body based on her actual intake of external thyroxine. This was an important reference framework because a single dose of thyroxine, in theory, contributes [in a small way] to the total level within your blood even a month later! And on any given day, any thyroxine consumed in the last 60 days will have a lingering effect. The actual dose [date, size of dose] was recorded and used. This is because the dose was not going to be the same every day, and because there might be weeks when a specific ‘skipped dose’ was taken on a different day.

Model Impact of Actual Thyroid Medication

 

Weaning off Medication in a Systematic Manner

Our plan was to reduce her weekly total dosage in steps, holding each level fixed for 8 weeks, before going to the next (lower) level. We did this by ‘skipping days’ rather than reducing the daily dosage. Skipping days was a protocol possible because of the half-life of the medication being many days, rather than a few hours. The idea was to train the thyroid pathways of her endocrine system to function better while giving the body enough time to adjust to the new levels of external medication. A quick internet browse will give you a long list of side-effects of the medication that a typical hypothyroid patient is on. We were also aware that removing such medication too quickly might have additional or different negative effects.

Thyroxine Dose Reduction Table

 

Lifestyle Changes – Return to Harmony

Thyroid Dose Reduction

Compared with others in her social circles and socio-economic group, Mrs T was already leading a generally healthy lifestyle when I met her. But, like you have heard me say so many times, there is always room for improvement. Even when we think there is no room! We introduced numerous changes, gradually, one after another, in her lifestyle. For some components of lifestyle, the level of intensity was raised or lowered; for other components the quantity was raised or lowered. The changes made were typically gradual because our focus was on the target of complete withdrawal of medication [see: Hormesis, your Best Friend]. Any negative changes in mood from a malfunctioning thyroid might also lead to longer term failure in the plan, because of any sudden unwillingness to continue on our journey.

As you might remember from The Wellness Tree, the focus on action for harmonious living needs to be multi-factorial. And, accordingly, our goals are not just physical, but also mental, emotional and spiritual.

 

Measuring Thyroid Function

Given that there can be significant differences in reliability, I prefer to work with numbers from only good quality pathology laboratories. For Mrs T, it was relatively easy to get reliable measures, at relevant intervals, for the levels of:
Thyroid Stimulating Hormone (TSH)
Free Triiodothyronine (Free-T3, FT3)
Free Thyroxine (Free-T4, FT4)

These were measured approximately every 8 weeks. [Read: Laboratory Evaluation of Thyroid Function, JAPI (2011)]

Thyroid Levels Being “Normalized”

 

Tweaking Medication Up

20th March 2017 – the last dose!

During the period, there was no need to increase the total weekly dose. Of specific interest to us was scheduled readings P1 and P2 (labelled in the graphic). These were ‘slightly above the normal range’. Immediately prior to those scheduled times Mrs T had been through numerous changes in her environment. These included global travel, with drastic weather variations, sizable time zone changes, changes in diet, and noticeably higher business/family stress. In both cases, P1 and P2 , the readings were repeated after a few days of settling back into her ‘normal and relaxed’ lifestyle. They were then ‘within range’. [Read: Interpretation of Thyroid Function Tests, Lancet (2001)]

 

Other Data Recorded

As we were returning the body to a state of greater harmony through lifestyle changes, we recorded a large amount of additional information about Mrs T’s daily life. (A quick scan, right now, of her electronic log tells me that the number of fields of data is close to 100.) Most of this is quantitative but some of it is qualitative. [Though I often argue that even qualitative information can be sensibly quantified, and doing so makes the combined approach even more useful.]

 

Large Number of Side-Benefits

Improving in many ways

Improving lifestyle manifests itself in many ways within us. Although Mrs T was not overweight, she lost unrequired body fat. Equally important, she gained very useful muscle mass. Many of her blood markers for a long Healthspan also improved over the period. The very fact that she knows she is not on daily pills of any kind has already created a positive shift in her mood. The lifestyle changes that made that possible are also, typically, mood enhancing too! Since the time we started incorporating the changes, Mrs T has become a regular student of the guitar. She has become fluent in a foreign language that she was never exposed to in school and is taking advanced proficiency classes in that too. Increased Wellness!

 

Potential for Relapse

Mrs T continues to have a thyroid gland that is functioning within-range. However, given her history, there is always a possibility of a relapse to illness levels. We continue to check her blood levels on a regular, but not as frequent, basis. As time goes by and she benefits from the cumulative effects of all the positive changes, the probability of a relapse moves closer to zero!

 

Key Takeaways for You

Life can be short but making your Healthspan longer can be fun and rewarding. Moving away from your natural state can lead to a long list of problems in the short and long run. On the other hand, moving back to your natural state can only lead to a longer Healthspan. Working towards a longer and even higher quality Healthspan than you are moving towards currently can be time efficient if you are smart about it. In fact, it might even save you money and, if you do it right, will be fun!

Puru

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Dr Purnendu Nath [is not a medical doctor but] spends his waking hours focusing on helping individuals and organizations reach their goals, to make the world a better place. He speaks, writes and advises on topics such as finance, investment management, discipline, education, self-improvement, exercise, nutrition, health and fitness, leadership and parenting.

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