So, 30 year old Mrs. Sneha comes to me for a regular thyroid follow up. She's been a hypothyroid since 2 years and has been on 6 monthly follow ups. I go ahead and order the thyroid test and notice that things were a little out of control. While she claimed that she has been on regular meds, her reports didn't seem so. Her TSH ( thyroid stimulating hormone) levels were still on the higher side. On probing, she admitted that she's been skipping her thyroid meds for quite some time and while she had to get the routine consultation, she restarted the medications a week ago. This led to a normal free T3 and free T4 levels, the TSH was still on a lower side as she had been off medicines for a few months.

So, yes, your doctor does get to know when you skip your medicines and restart them just before your visit.

So, what is the big deal with skipping thyroid hormone medications anyway?

Thyroid hormone, like any other hormone (except female sex hormone) is released everyday in our body. Our body requires thyroid hormone on a daily basis in fixed amounts more or less. This thyroid hormone is important for regulating the various functions in our body like: Maintaining temperature , maintaining weight, regulating fat levels, keeping you active, alert, maintaining skin, hair , healthy heart and many more.

If you have a condition called hypothyroidism, your thyroid gland produces lesser thyroid hormone than needed and hence you need replacement from external source in the form of thyroid medicines.

Why do I need to take my thyroid medication everyday?

Well, its like brushing teeth. Even though you have done it yesterday, you need to do it again today. While the life of thyroid hormone ranges from 9 to 10 days when you are hypothyroid, you still need to take it everyday because despite the half life, you need roughly fixed amounts of thyroid hormone everyday. This is important for normal functioning of your various organ systems like digestive system, cardiovascular system etc.

So, what will happen if I skip my dose for a day?

Nothing. If you skip your thyroid hormone for a day, you will neither notice and physical changes nor will it reflect in your lab results. However, this habit if continued over a long periods in the form of alternating doses is not good as our body needs thyroid hormone on a daily basis.

Once you miss a single dose of thyroid hormone, make sure to take two tablets on the subsequent day to compensate for the previous day and to maintain adequate blood levels of thyroxine.

What if I skip my dose for a week?

While clinically you might not get nay symptoms during the one week of skipping medication, its important to restart same dose of medication as the half life of Thyroxine is 3 to 4 days and won't last for longer in your blood. You can safely restart same dose.

What if I miss my Thyroid dose continuously for weeks?

In this case, it is advised to take a thyroid test and find out the level of thyroid stimulating hormone (TSH). A lower target of normal TSH is advisable in terms of better control. In case you have been skipping your doses for weeks, you might need to be switched to a higher dose transiently until your TSH typically comes down to normal limits and then you can be resumed back to the normal doses.

What if I am sick while I have discontinued my medication?

If you are sick with minor illnesses like cold, loose stools, headaches, flu etc., continue taking your thyroid medications until your doctor advise otherwise. In case of serious illnesses, ask your physician regarding the dose adjustments.

Investigation for TSH done during this phase may reveal false low levels of TSH, hence , avoid getting your routine TSH levels done until you recover from your illness fully.

What if I'm pregnant?

Always always get your TSH levels done during planning your pregnancy.

In case you are pregnant, you need to consult soon after detecting your pregnancy. The requirement of thyroxine increases by 20 to 40 percent during pregnancy and needs to be optimized as per weight. Pregnancy is a dynamic state meaning your blood volume expands and your weight keeps fluctuating on a weekly basis that warrants frequent adjustment of doses on a monthly to 6 weekly basis.

So, never ever skip your medication during planning pregnancy or during pregnancy. In case you have been skipping, consult without delay for adjusting the increasing dose demand due to skipping the medicine as well as the increase in demand due to pregnancy.

In case of extremely poorly controlled thyroid levels, there is also some risk of miscarriage, apart from the harmful effects on the fetus. So, its always better to keep recurring follow ups with your physician during pregnancy.

What are some foods that I can have to help my Hypothyroidism?

Consume foods rich in Iodine like eggs, milk, curds, Banana, strawberry, prunes for better Iodine levels which help your body naturally synthesize thyroid due to their Iodine content.

What medicines should I be careful about while on my thyroid medicine?

If you are on drugs for acidity like antacid, or on antibiotics like Rifampicin, anti-epileptic drugs Carbamazepine, Phenytoin, oral anti coagulants like Warfarin or any other long term drug therapy, it is vital to inform your physician as these drugs might impair the absorption or might reduce the blood levels of the drugs . This means that after starting the drug , one might need to further increase and re-adjust your Thyroxine doses.

Hope this helps. :)