Over Sixty-Five? Have Subclinical Hypothyroidism? Taking Levothyroxine? Better Think Twice

Amy Rothenberg ND
FieldNotes From Natural Medicine
3 min readApr 11, 2020

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Photo by Matthew Bennett on Unsplash

In a well-designed 2017 clinical trial, it was confirmed that supplementing adults over sixty-five, diagnosed with subclinical hypothyroidism with levothyroxine, offers no clinical benefit. In a follow-up study, older patients who have isolated elevations in thyroid stimulating hormone (TSH) and are given thyroid replacement therapy to bring their TSH to the normal range, have an increased risk of death relative to controls. The conclusion here is that treating older people in our population who have isolated elevated TSH with levothyroxine is in fact, a dangerous proposition.

Overmedicating our older patients is common and presents many challenges. Levothyroxine should only be prescribed when clearly indicated and with great care. Many older people are prescribed this drug based on lab work alone or perhaps with mild symptoms like fatigue or constipation. We know that as we age, the body adapts in a number of ways, perhaps an elevated thyroid stimulating hormone is one of these compensatory physiological responses to the aging process. All providers need to be aware that aggressive attempts to bring the TSH into a “normal” range with this population, especially those who are not symptomatic, is a bad idea.

It is also important to underscore that some older patients DO have hypothyroidism and DO require treatment, though symptoms are often less notable than in younger counterparts or seem part of other comorbidities. For those who are symptomatic in addition to having blood work out of the normal range, working with a licensed naturopathic doctor (ND) can give you many options for treatment in addition to medication, as indicated.

If autoimmune disease is the main cause of thyroid dysfunction, NDs work to help control inflammation and eliminate autoimmune triggers. Working to reduce thyroid antibodies, if possible, is the main goal of treatment. If the thyroid is just not producing enough thyroid hormone, NDs address lifestyle and environmental factors that may be contributing to low production.

NDs rarely use medication as an initial or stand-alone treatment. NDs individualize treatment using diet, nutritional supplementation, botanical medicine as more. NDs are trained in the pharmacological…

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Amy Rothenberg ND
FieldNotes From Natural Medicine

American Association of Naturopathic Physician’s 2017 Physician of the Year. Teacher, writer and advocate for healthy living. www.nhcmed.com