The problem with thyroid medication absorption: Enter sublingual thyroid medication
Thyroid medication is both a blessing and a curse to thyroid patients.
A blessing in that it can truly be a life-altering medication or therapy to many thyroid patients.
But a curse in the sense that this blessing only occurs if you take your medication correctly, at the right dose, at the right time of day, and so on.
There are so many factors that negatively influence your thyroid medication that taking it correctly is like defusing a nuclear bomb with a 2 minute timer.
I'm exaggerating a little bit, but you get the point.
Today we are going to talk about something that you may have never heard of before as a thyroid patient and it has to do with taking your thyroid medication via the sublingual route.
The sublingual route is a fancy way of saying that you are taking your medication under the tongue INSTEAD of swallowing it and letting it get absorbed in your stomach/gut.
There are some serious pros to this method but there's a lot you should know before you run out and give it a try.
You are going to learn...
- All about taking your thyroid medication via the sublingual route
- Whether or not it's safe to take your thyroid medication in this way
- Who should consider taking their thyroid medication this way
- The pros and cons of the sublingual route
- And more...
Let's jump in:
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Is it possible to take your thyroid medication sublingually?
First off, we need to have a small discussion on whether or not it's actually possible to take your thyroid medication via the sublingual route.
If you are in the medical field then you probably already know that all medications are not necessarily absorbed if they are taken in this way.
It would be nice if they were, but only a select few ingredients and hormones can be taken effectively via this route.
Not all medications work this way because some are too big to be absorbed under your tongue, others take too long to dissolve so they end up getting swallowed anyway, and others actually need to be activated in your gut to be effective.
But what about thyroid hormones?
It turns out that thyroid hormones CAN be absorbed under your tongue (1), but it's not quite that simple.
Just because they CAN make it through the membrane under your tongue doesn't guarantee that they WILL get absorbed.
Unfortunately, many thyroid medications come bound tightly to inactive ingredients found inside of your thyroid capsules which makes the dissolving of your thyroid medication quite difficult.
So, even though it is theoretically possible to absorb your thyroid medication under your tongue, it's quite possible that if you put your thyroid medication under your tongue that only a fraction is absorbed there while the rest ends up getting swallowed as a dissolved solution.
This leads us to a big problem:
Which thyroid medications work if taken under the tongue?
Not all thyroid medications probably work if taken sublingually
And, unfortunately, we don't have a lot of scientific studies to help guide us here.
It would be nice if someone studied each and every thyroid medication available and then determined which formulated CAN be absorbed sublingually but we just don't have that.
Instead, we have a small number of medical studies and a large number of patient stories and experiences.
Let's work with what we have:
We know for sure that LIQUID formulations of thyroid medications can absolutely be safely absorbed if taken sublingually.
There are some studies (2) that show that placing liquid thyroid medication in your mouth and letting it sit there WILL result in absorption of that medication into your body.
But what about other thyroid medications such as NDT or natural desiccated thyroid?
This is where we get into some grey area.
There are plenty of patient reports (meaning stories shared by other thyroid patients) who have had success taking NDT via the sublingual route.
Unfortunately, NDT is quite hard to break down, even for your stomach, so you have to assist the process if you want it to occur under your tongue.
This usually means doing things like:
- Chewing up or smashing your NDT and letting it sit in your mouth
- Warming your mouth up with warm water BEFORE you put your thyroid medication in your mouth
- Taking your thyroid medication with sugar under the tongue
- Taking your NDT with B12 lozenges
These strategies are all necessary to give your body an edge to absorb the thyroid hormone once it's in your mouth.
Sugar may help dissolve the inactive ingredients, warming up your mouth increases blood flow to under your tongue, and smashing the NDT helps start the salivation process which can help dissolve the thyroid medication.
The problem with this method is that we don't have any standardized controls to let us know if it's actually working or not.
My experience suggests that absorption of nonliquid thyroid formulations is hit or miss (but we will talk more about that later).
Pros of the sublingual route
Even though it may not be possible to take all types of thyroid medications sublingually, there are some serious benefits to taking your thyroid medication this way.
Let's talk about some:
#1. Rapid absorption of thyroid medication into your body
One of the biggest benefits of using the sublingual route is that the medication you put under your tongue is rapidly absorbed into your body.
What do I mean?
Well, when a medication goes through the gastrointestinal tract it is SLOWLY absorbed typically over several hours.
This means that there is a delayed-release into your system so whatever effect you are looking for won't happen right away.
Some thyroid medications, especially those with T3 thyroid hormone, can impact your body almost immediately upon ingestion.
Some thyroid patients who use the sublingual route for taking their thyroid medication do it because they want to feel a quick boost in their energy levels at the start of the day.
This effect is probably due to the rapid absorption that the sublingual route provides.
#2. Absorption directly into the bloodstream (bypass the GI tract)
One of the biggest benefits of taking your thyroid medication sublingually is that you are bypassing the gastrointestinal tract.
If your medication is absorbed under your tongue, the thyroid hormone in your medication goes straight into your venous blood system which then goes to your heart which then pumps that thyroid hormone directly to your cells and the rest of your body.
This is NOT the same path that thyroid hormone takes if you take your medication by mouth.
Instead of going straight to your heart and your cells, thyroid medication absorbed by the gut is taken straight to the liver to be processed.
Once in the liver, your body starts breaking down the thyroid hormone immediately!
After processing it is then taken to your heart and then pumped to the rest of your body.
This means that only a fraction of the original dose that you swallowed ends up making it to your cells and tissues!
As you can imagine, this can be a problem for many people.
Taking your thyroid medication sublingually bypasses this effect (3) and makes whatever dose you are taking more effective because less is broken down.
#3. You have more freedom when and what you take your thyroid medication with
Another huge benefit is that you are able to more freely eat and drink after you take your thyroid medication.
Doctors often recommend that thyroid patients avoid eating or drinking for sometimes hours after they take their thyroid medication.
They say this because food and drinks, especially coffee, can interfere with the absorption of your thyroid medication in your gut (4).
But if your thyroid medication is absorbed under your tongue then it doesn't really matter when you eat or drink after you take your thyroid medication.
You are also free to take any supplements including calcium and iron at any time of the day.
You are also free to take your thyroid hormone at any time of the day (though I would still recommend taking it in the morning even if using the sublingual method).
#4. You are much more likely to feel better.
I should also point out that any therapy or mechanism which puts MORE thyroid hormone into your body is going to have a profound effect on how you are feeling.
You may be taking a total dose of 100mcg but what happens if only 60mcg of that 100mcg gets absorbed?
Well, you are certainly going to feel it and it's not going to feel great.
Cons of the sublingual route
If you are thinking that this sublingual route sounds pretty good, don't jump into the pool with both feet just yet.
There are some potential downsides to using this route that you should be aware of:
#1. The amount of thyroid hormone that you need changes when you switch to the sublingual route
Due to the changes in absorption that occur when you take your thyroid medication via a different route, you are most likely going to need to change your total dose of thyroid medication.
Imagine the scenario I mentioned above:
If you are only absorbing 60mcg of your 100mcg dose of thyroid medication, what is going to happen when you suddenly start absorbing 80 or 90mcg of that 100mcg?
It's like you got a brand new dose of thyroid medication and, in this case, a more powerful dose.
You should be aware that you may need to alter or change your dose of thyroid medication if you opt to go this route.
It's not a guarantee but you should keep an eye out for it.
#2. There is a risk you could accidentally take too much medication
Another potential downside is that it's much easier to take more thyroid hormone than your body needs.
If you were getting 60mcg of thyroid medication each day and suddenly you start getting 100mcg even though your dose hasn't changed, you may now be getting more than you need.
This sort of problem is often scarier to the patient than it is harmful to your body, though.
Taking a one-time high dose of thyroid medication will not cause long term problems but it may scare you by causing some heart palpitations or anxiety.
No worries, though, as your body will eventually metabolize the thyroid hormone and you will go back to normal.
Problem #2 is really an extension of problem #1.
#3. Not all of your thyroid medication may be absorbed sublingually
Another downside is that the thyroid medication you are taking sublingually may not be absorbed.
You can do everything right but, for whatever reason, your body just isn't able to absorb thyroid hormone sublingually.
This happens all of the time when using other hormones such as estrogen, testosterone, and progesterone.
I've had people who don't respond to testosterone cream but do respond to testosterone shots, and so on.
You may just be one of the unlucky thyroid patients who simply doesn't respond to sublingual doses of thyroid medication and that's okay.
Should you switch to the sublingual route?
I think there is definitely a time and place to try the sublingual route if you are a thyroid patient but I wouldn't make any broad recommendations like "all thyroid patients should do this".
But which types of thyroid patients WOULD benefit from using this approach?
Here is a list of people that I think should consider it:
- YOU, if you've tried taking many different types of thyroid medications without any success
- YOU, if you have known gut problems or malabsorption issues from chronic gut issues (SIBO, bad yeast overgrowth, inflammatory bowel disease, and so on)
- YOU, if you've had surgery or changes to the anatomy of your gut (things like gastric bypass or surgical removal or parts of your intestines)
- YOU, if you are sensitive to the inactive fillers and binders found in many thyroid medications
- YOU, if you have a physician who can help monitor you while you make the change (if you have a doctor willing to help you then you can give it a try)
This is just a list that I've created based on my own experience.
You are welcome to give the sublingual route a shot if you feel that it will help you but I do strongly suggest that you do not make any changes to your thyroid medication without letting your doctor know.
Hopefully, your doctor is willing to work with you because he/she should be very familiar with drugs being taken this route.
The bottom line?
Some thyroid medications can safely be taken via the sublingual route and this route has some serious benefits for many thyroid medications.
But, before you jump in and give it a try, make sure you pay close attention to both the pros and cons.
While the cons are not likely to cause any serious long-term harm, you should be aware of them.
Now I want to hear from you:
Have you tried taking your thyroid medication sublingually?
If so, share your experience!
Did you find that the sublingual route worked for you?
Are you thinking about giving the sublingual route a try?
If so, what convinced you to give it a try?
Leave your questions or comments below!
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