This is probably one of the most common questions that I get asked on a daily basis!
And the answer is almost always yes.
Even though it may not seem intuitive, your body can still benefit from the use of thyroid-specific supplements even if you do NOT have a thyroid (or if it’s been destroyed).
The reason for this is actually quite simple and it’s something we are going to go into detail below.
This article will help you understand why thyroidectomy and post-RAI patients can still benefit from thyroid supplements, how your thyroid can still be slowed down by certain issues, and why just because you are taking thyroid medication doesn’t mean that your body is getting what it needs.
Let’s jump in:
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You Are Hypothyroid Now
If you do not have a thyroid or if it’s been destroyed by radioactive iodine you should consider yourself to be hypothyroid.
This may seem confusing to you at first, especially when you consider that most people who have either of those procedures listed above do so for the condition of hyperthyroidism (usually), but it’s true.
Once your thyroid has been removed (either surgically or damaged through radioactive iodine) it no longer works and you are now 100% reliant upon thyroid medication to sustain your body.
There are some situations in which this isn’t true, such as those who have only had their thyroid partially removed and those who have only had half or a portion of their thyroid destroyed from radioactive iodine.
But for the purpose of this article, I am going to operate under the assumption that you have MOST (90+%) of your thyroid removed or destroyed.
And if you fit into either of these categories you are absolutely hypothyroid now.
The only difference between you and someone who has a condition like Hashimoto’s thyroiditis is that they have a non-functioning thyroid gland in their body, while you simply don’t have one at all.
In fact, end-stage Hashimoto’s thyroiditis is very much akin to those who have undergone radioactive iodine ablation because both conditions result in an atrophic and completely damaged thyroid (1) which no longer produces thyroid hormone.
Because of this, both parties MUST take thyroid medication to survive and, hopefully, thrive.
But, there’s a catch.
Not everyone without a thyroid does well on thyroid medication (2).
The Problem with Thyroid Medication
And the reason for this is multi-factorial but it has to do with the type of thyroid medication you are using, the dose you are taking, the time of day that you take it, your nutrient status, your genetics, and more.
Each of these factors plays together to influence just how effective your thyroid medication will be and how it will make you feel.
I won’t go into these factors in detail but you can read more about how they influence your body and your symptoms in the links listed above.
Most people who take thyroid medication after RAI or thyroidectomy notice that they still continue to experience some minor symptoms of hypothyroidism.
It’s not uncommon for these people (perhaps even you) to experience such symptoms as weight gain (3), fatigue (4), cold intolerance, hair loss, and so on.
All of these symptoms point to the fact that your thyroid levels are not optimized in your body.
And this is what drives so many people with these symptoms to seek out supplements as a way to augment their thyroid medication.
And these supplements may actually be beneficial and help your thyroid function.
One of the main questions that people have once they get this far in their thought process is whether or not these supplements will work for them.
After all, they DON’T have a thyroid.
The good news is that the vast majority of information that you see me write on my blog about hypothyroidism is relevant for those with a thyroid and even for those WITHOUT a thyroid and I’m going to explain why below.
Nutrients That Help Your Thyroid (Even if you Don’t Have one)
Supplements work by providing your body with specific and certain nutrients which are required for your cells to function.
These nutrients help your body produce proteins, enzymes, DNA, RNA, hormones, and so on.
If you don’t have a sufficient amount of these nutrients then your thyroid function may start to suffer or even be reduced.
This is especially true even if you are taking thyroid medication!
And this information still applies whether your thyroid is there or not, whether it has been removed surgically, or whether it has been fried with radioactive iodine.
Your body NEEDS these nutrients.
It’s important for you to realize that these nutrients work in almost EVERY cell in your body.
So even if you don’t have a thyroid there is still a need for ALL of these nutrients!
Let’s take a minute to explain how these nutrients work, why they are still important for your body, and what can happen if you supplement with them.
#1. You STILL Need Iodine
Iodine is one nutrient that almost everyone is familiar with, whether you have a thyroid issue or not.
Iodine is probably the most important nutrient in your body as it relates to thyroid hormone because it is necessary for thyroid hormone production.
If you don’t have iodine then you won’t be able to produce thyroid hormone and you will become deficient (5).
You may be tempted to think that because you don’t have a thyroid gland, and your body can’t produce thyroid hormone on its own that you don’t need iodine.
And that’s where you would be very wrong.
While it is true that iodine is no longer necessary for thyroid hormone production if you don’t have a thyroid gland (and if you are taking thyroid hormone), it is still important for other cells in your body!
Tissues such as the skin, breast, and brain tissue still require iodine for cellular function and a reduction in iodine may cause symptoms such as cystic acne, fibrocystic breast disease (6), and developmental issues.
Iodine is also important because the only way that humans can obtain iodine is through their diet.
So if you aren’t consuming foods that are naturally high in iodine (or taking supplements) then there is a chance your levels may be sub-optimal.
Does that mean you need to run out and start taking iodine?
Not necessarily, but I am using this as an example to illustrate a larger point and that is that nutrients are still helpful for the body if you don’t have a thyroid gland.
You can ensure you are getting enough iodine by consuming at least 150mcg per day (this isn’t a hard and fast rule, but you can learn more about the nuances of supplementation here).
If you are pregnant or lactating then the amount that you need will be higher.
#2. You STILL Have to Convert T4 to T3
One of the most important factors to consider when you look at supplementing for your thyroid is how well your body is converting T4 into the active T3 thyroid hormone.
How well you convert T4 into T3 is MORE important for people without a thyroid than it is for those with a thyroid.
Because those people with a thyroid gland can still produce some amount of T3 thyroid hormone whereas those without a thyroid gland cannot produce any.
And this is a big problem because most doctors (endocrinologists and primary care physicians) will NOT prescribe T3 medications.
We won’t get into why that is for this article, but just realize that they typically do not prescribe this type of medication for those people who don’t have a thyroid.
This is a problem because T3 is the most active thyroid hormone in the body. In fact, T3 does all of the work of thyroid hormone in the body.
Most of you reading this, especially if you don’t have a thyroid, are probably taking a medication such as levothyroxine or Synthroid.
These medications contain ONLY the thyroid prohormone T4 or thyroxine.
This means that your body MUST convert that T4 into T3 or else it won’t work. And in this case, you are at a disadvantage compared to those people with a thyroid gland (even if it doesn’t work that well) because they can produce some T3.
Because of this, it’s even more important to ensure that your body has all of the nutrients it needs to convert T4 into T3.
And there are several nutrients involved in this process including Zinc and Selenium.
Low levels of Zinc and Selenium may predispose you to lower levels of free T3 (which can be tested for) and the symptoms I described above.
It’s important to know that other factors can also influence how well your body converts T4 into T3 including things like inflammation, stress, infections, the food that you eat, and so on.
My purpose for talking about conversion in this setting is to let you know that certain nutrients can enhance this process and help your thyroid function.
#3. You STILL Need Your Cells to be Sensitive to Thyroid Hormone
Lastly, we need to talk about how receptive your cells are to the thyroid hormone that is floating around in your bloodstream.
It may be tempting to think that the thyroid hormone you take by mouth has no problem getting absorbed into your body, getting activated by the right enzymes, and turning on the right cellular processes, but this isn’t the case for many of you.
Problems can arise at any level and that is also true at the cellular level.
The last step that must occur before your body is ready to use thyroid hormone is cellular activation through cellular receptors.
Even if all of the other steps occur normally if the last step doesn’t occur then you may not see as much improvement as you’d like.
When it comes to the cellular level, there is competition for thyroid binding from 2 different sources.
The first is from the anti-thyroid metabolite reverse T3 and the second is from thyroid sensitivity due to nutrient deficiencies.
If your body doesn’t produce enough T3 then it may produce too much reverse T3 (referred to as rT3).
In addition, your cells can become resistant to thyroid hormone (7) under certain conditions.
This problem is similar to what occurs in other hormone-resistance syndromes.
Insulin resistance, leptin resistance, and cortisol resistance all occur when your cells are less responsive to normal healthy levels of hormones.
It may be possible to “sensitize” your cells to thyroid hormone by treating your conversion issue (by reducing rT3 conversion) and by taking certain nutrients including Vitamin E and Vitamin A.
Supplementing Without a Thyroid
I’ve spoken generally about supplementing without a thyroid (or if your thyroid gland has been damaged from radioactive iodine), but I want to leave you with some specifics as well.
Here are some tips to consider if you want to supplement and you don’t have a thyroid:
- Taking thyroid support supplements can potentially help the thyroid hormone in your body.
- All supplements from my website are safe to use whether you have a thyroid or not. This includes Thyroid Adrenal Reset Complex, T3 Conversion Booster, Thyroid Hair Regrowth Complex, and Thyroid Chill. All probiotics and protein powders are obviously safe as well.
- If you choose not to use my supplements then look for supplements that have similar ingredients from reputable suppliers.
- You can safely avoid “Thyroid Supplements” which primarily help your thyroid gland produce more thyroid hormone (these aren’t helpful if you don’t have a thyroid gland).
- You can safely supplement with nutrients that SUPPORT thyroid function at the cellular level and those supplements which support T4 to T3 conversion.
- Probiotics are a safe and effective way to improve gut function and should be considered for all patients without a thyroid.
- You do not need to take excessive doses of iodine if you don’t have a thyroid gland but a small dose may be helpful to supplement whatever iodine you are getting from your diet.
- Taking adrenal supplements, while they won’t help your thyroid gland directly, can still help improve your stress response and improve thyroid conversion. This includes adrenal adaptogens and adrenal glandulars.
- Taking supplements is a great way to improve your thyroid but you may also need to adjust your thyroid medication. Remember: supplements are NOT a substitute for thyroid medication (though they can help you feel better).
- Get as many vitamins and nutrients from your diet as possible. But do note that even if you are eating a healthy diet you will still probably not be able to get 100% of the nutrients you need from your thyroid on a daily basis. For this reason, I find that most hypothyroid patients do better on thyroid supplements.
I hope this information was helpful to you!
The world of thyroid management is already confusing enough, but let me recap some of the most important points here.
People who have had their thyroid removed or destroyed are now considered to be hypothyroid, this is true even if their original diagnosis was hyperthyroidism.
These same patients can still benefit from the use of thyroid-specific supplements and nutrients.
These nutrients work because they focus on helping thyroid function do its job at the cellular level, by helping the enzymes in your body, and by promoting T4 to T3 conversion.
All of these processes still occur in the body whether you have a thyroid gland or not and whether you are taking thyroid medication.
But, because you don’t have a thyroid gland, you can stay away from taking supplements designed to help promote thyroid hormone production in the thyroid gland (these don’t do you any good).
If you have any questions, especially those that I didn’t cover here, please leave your questions or comments below!
I will be continuing to update this page with information to help those without a thyroid.
Now I want to hear from you:
Are you confused about your thyroid?
Are you still feeling poorly after your thyroid removal?
Have you tried taking supplements before?
Did they work for you? Why or why not?
16 thoughts on “Should Thyroidectomy & RAI Patients Take Thyroid Supplements?”
Dr. Childs, are you aware of any studies/research on the effects of regular physical exercise and lower TSH levels following complete thyroidectomy? I did some research and found only a couple small studies on men, relatively young. Since the occurrence of thyroid problems are much more prevalent among older women, I would think someone would have some studies on this.
My personal experience, complete thyroidectomy at age 63 on 12/22/2010 due to malignant neoplasm of thyroid cartilage in which parathyroids were damaged/removed resulting in hypocalcemia. Following a few months of adjustments, I stabilized on 137mcg of Synthroid and additional calcium supplements. I was very active, working fulltime, playing regular rec league softball 2 or 3 nights a week, spring, summer and fall for several years and felt great! In December, 2017, a (uncharacteristically sedentary) month after the end of softball season, I began experiencing short episodes of atrial fibrillation. My Synthroid dosage was decreased in stages to 112 and by March I was given a clean bill of health by cardiology specialists.
In hindsight, I have discovered that my TSH had been consistently VERY LOW for years (from 0.18 to as low as 0.01) with NO symptoms and NO ISSUES, while I was physically very active and felt great, hence my question – can extremely low TSH be tolerated with no negative effects in active, older women? Are you aware if this has ever been looked at?
There are risks associated with a low/suppressed TSH, but even though there are risks it doesn’t mean that they will be realized in all people. It’s possible that exercise can stave off some of the more negative aspects of TSH suppression such as osteoporosis. You can learn more about this idea here: https://www.restartmed.com/suppressed-tsh/
I’ve been eyeing your supplements for a while now but I have some questions. I had my sodium levels done recently and my results were 143 (145 is the highest range) I’ve always had high sodium levels along with my Mother and sister.
I’m curious if your supplements have iodine added would this increase my sodium blood levels?
No, iodine won’t impact your sodium level. Sodium is more a measure of the amount of water in your blood than it is a measure of actual sodium levels. This is a complicated topic that confuses interns and residents alike for quite a while.
Dr. Childs, is there a way to achieve weight loss through the keto diet and/or intermittent fasting without a thyroid. Im currently taking Nature Throid.
Yes, it’s possible that those strategies may help but if you overuse them they can also cause thyroid damage so you must be careful if you opt for that route.
What is the best diet for someone that is hypothyroid, had a complete hysterectomy and gastric bypass 15 years ago. Keto did not work for me.
You can find more information about diet here: https://www.restartmed.com/hypothyroidism-diet/
Hi, in one of your articles you referenced “normal” and “optimal” ranges of fT3, fT4, etc… are these ranges valid also for a person on T4 medication?
I’m post TTD (2013), currently taking 137mg Euthyrox (a T4 replacement here in Europe).
Inspired by your blog, I had my test done: TSH uIU/L, fT4 1.82 ng/dL, fT3 2.75 pg/mL. Shall I interpret these results using the same ref. ranges?
No, those optimal ranges break down once you start taking thyroid medications and become more complex. They are best if used only initially to determine if your thyroid is functioning optimally or not. From there, you will need to look at your lab ranges differently to find out what you need.
I am currently taking NP with Synthroid, would I need to supplement with your T3 Conversion Booster since NP has T3?
If had part of my thyroid removed, then required RAI a few years later. I am on synthroid & cytomel. What are the optimum levels for my T3 & T4 since I am on replacement?
Hello, I had RAI in high school (1978) it was normal for many years and around age 35 started to go hyper again so they removed, have had high BP issues since on Synthroid and tried all the natural options (Nature Throid/Armour/NP) Felt terrible and super high BP even on BP meds with Nature Throid. Went back to Synthroid, do I need to also take T3? What is that called for RX? Or do your supplements help with this? I need to do something very soon…seems like I am battling with BP Meds and thyroid meds and all affect each other, really affecting my life for many years 🙁 I would appreciate any advice.
The Rx for T3 is known as liothyronine or Cytomel. And yes, several of the supplements in this article help improve T3 levels.
I have removed my Thyroid gland total thyroidectomy last November due to PTC (papillary Thyroid Cancer), currently I am on 100mcg Levothyroxine. can I take thyroid supplements? currently I am taking a thyroid manage supplement which has Zinc , Iodine and selenium , it also says it assists and promotes hormones for the healthy functioning of the thyroid gland. should I stop taking this and look for supplements zinc and selenium? is iodine ok to take ? please reply
Of course, you can find a list of thyroidectomy approved supplements here: https://www.restartmed.com/product-category/thyroidectomy-supplements/
If you are looking just at zinc, selenium, and iodine then you are missing the bigger picture.