Can celiacs take levothyroxine?

People with celiac disease often have to be careful about the medications they take, as some contain ingredients derived from gluten sources. Levothyroxine, a synthetic thyroid hormone, is commonly prescribed for hypothyroidism. Celiacs may wonder if it’s safe for them to take levothyroxine.

What is Levothyroxine?

Levothyroxine is a synthetic version of thyroxine (T4), one of the thyroid hormones produced naturally by the thyroid gland. It is used to treat hypothyroidism, a condition where the thyroid does not produce enough hormones on its own. The medication helps restore normal thyroid hormone levels, relieving symptoms of hypothyroidism like fatigue, weight gain, dry skin and hair, and sensitivity to cold.

Common brand names for levothyroxine in the United States include Synthroid, Levoxyl, Unithroid, and Tirosint. It is available in tablet form by prescription only.

Is There Gluten in Levothyroxine?

The active drug in levothyroxine itself does not contain gluten. However, the inactive ingredients used in the tablet formulations may contain gluten. These inactive ingredients help bind and stabilize the medication.

Many popular brands of levothyroxine do contain gluten in the form of pregelatinized starch derived from wheat. This includes brands like Synthroid, Levoxyl, and Unithroid.

However, there are some gluten-free versions available including Tirosint and the generic levothyroxine produced by Lannett. Always check the inactive ingredients listed on the medication bottle or packaging to see if the product contains pregelatinized starch, starch, or other gluten-containing binders.

Risks of Levothyroxine for People with Celiac Disease

For people with celiac disease, consuming gluten triggers an autoimmune reaction that damages the small intestine. Even small amounts of gluten from medications can contribute to this ongoing immune attack on the intestinal villi.

Potential risks of taking levothyroxine formulas containing gluten include:

  • Persistent intestinal damage and poor absorption
  • Continued inflammation and irritation of the gut
  • Increased antibodies against gluten (anti-TTG, EMA, etc.)
  • Ongoing symptoms like diarrhea, gas, and abdominal pain
  • Increased risk of malnutrition and nutrient deficiencies
  • Higher chance of related autoimmune disorders
  • Greater likelihood of osteoporosis and fractures

Even if symptoms seem well controlled on a gluten-free diet, traces of gluten from medications may impede deeper healing of the intestinal villi. This can prevent full recovery of the gut lining.

Gluten-Free Options for Levothyroxine

The good news is that there are some safer options for celiacs who need to take levothyroxine:

  • Tirosint: This is a gelcap form of levothyroxine that has no gluten-containing binders. The gelcap allows the T4 to dissolve so no starches are needed to bind it. Tirosint is considered the gold standard for celiacs, but it is more expensive.
  • Lannett generic levothyroxine: The generic levothyroxine made by Lannett uses magnesium stearate as its binding ingredient instead of wheat starch, making it gluten-free.
  • Compounded T4 thyroid hormone: A compounding pharmacy can make a personalized gluten-free levothyroxine formula just for you. This option allows for very customized dosing as well.

Speak to your doctor about getting a prescription for one of these safer options. Some insurance companies may require a prior authorization or exception to cover the higher cost.

Tips for Taking Levothyroxine with Celiac Disease

Here are some tips for safely taking levothyroxine with celiac disease:

  • Always check labels and packaging for gluten-containing ingredients.
  • Request a gluten-free version like Tirosint or Lannett generic from your doctor.
  • Take levothyroxine on an empty stomach at least 30-60 minutes before eating.
  • Avoid high fiber foods, calcium supplements, and coffee near the time you take levothyroxine as these can inhibit absorption.
  • Get TSH levels monitored regularly to make sure your dose is optimized.
  • Report any recurring symptoms or side effects to your doctor.
  • Have antibodies tested periodically to assess any intestinal inflammation.

Other Thyroid Medications

In addition to levothyroxine, other thyroid medications may be used for hypothyroidism or thyroid cancer treatment. Here is an overview of some common options:

Liothyronine (T3)

Liothyronine provides the T3 thyroid hormone, which is the active form. Brand names include Cytomel and Triostat. Like levothyroxine, these also carry a risk of gluten exposure. However, gluten-free compounded T3 can be obtained.

Thyroid Desiccated Powders

Desiccated thyroid supplements like Armour Thyroid and Nature-Throid contain T3 and T4 derived from porcine sources. Although the powder itself is gluten-free, contamination during manufacturing is possible. Those highly sensitive should use caution.

Thyroid Extracts

Thyroid extracts are made from animal thyroid glands, like porcine sources. Brands like Thyroid and Thyrar contain both T3 and T4 hormones. These carry a moderate risk of gluten cross-contamination.

Radioactive Iodine

Radioactive iodine therapy is used to destroy overactive thyroid tissue, like with Graves’ disease. The radioactive iodine itself does not contain gluten. However, patients follow a strict low-iodine diet which eliminates wheat and other grains prior to treatment.

Bottom Line on Levothyroxine

Standard levothyroxine medication often contains gluten. However, there are safer options available for people with celiac disease. Speak to your doctor about switching to a gluten-free version of levothyroxine like Tirosint, Lannett generic, or a compounded formula. With the right preparation and monitoring, levothyroxine can be taken safely by most celiacs for hypothyroidism treatment.

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