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 for 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.
These liquid formulations include medications like Tirosint-Sol and possibly even Tirosint if the gel capsules are broken.
There are some studies (2) that show that placing liquid thyroid medication in your mouth and letting it sit there WILL result in the 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 areas.
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. The 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 (bypassing 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 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.
The more thyroid hormone that makes it into your body the more likely you are to get rid of those symptoms like weight gain, fatigue, and hair loss that stems from low thyroid function.
One of the problems that plague traditional thyroid medications like levothyroxine and Synthroid is the absorption problem.
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 have had people who don’t respond to progesterone cream and REQUIRE progesterone pills.
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!
55 thoughts on “Taking your Thyroid Medication Sublingually: Does it Work?”
I’d like to know if Armour NDL is a slow release formula? I have leaky gut, as a result of daily prednisone use! If it is a SR formula, then what other suggestions or brands would you suggest. I’m looking for only natural option. Nothing from a regular pharmacy at all.
Hi Holly I too am taking Armour and wondering if you have been taking it under your tounge if so do you have any suggestions on how to do this and how you are feeling?
Holly, I have been taking Armour Thyroid sublingually for years, and my doctor approves of it this way. I don’t have any problems with it.
Just would like to start off by saying how amazed I am by you. I’ve seen some of your videos and started reading your blog. You know your information and you know it WELL (unlike other doctors). So thank you for everything. Is there a way I can contact you further?
I also just have a side, simple question. Is 25 considered a low ferritin level? The doctors claim it isn’t, yet I’ve watched your videos and according to those I think it’s pretty low. Just want to make sure I’m not the crazy one here 😉
Thank you! You’re awesome!
Thanks for the information. Two questions please:
(1) Where are the footnotes referenced in the material?
(2) What is the solubility of levothyroxine and of liothyronine in water (which will serve as a surrogate for saliva)?
Hi Dr. Geek,
The references are at the bottom of the post under the title “References (Click to expand)”.
What is the solubility of levothyroxine and of liothyronine in water (which will serve as a surrogate for saliva)?
I don’t see your response to Dr Geeks question and I take this compounded formula so just wondering if it’s ok to take it sublingually? Thanks in advance for your reply!
Did you ever get a response to your second question on “What is the solubility of levothyroxine and of liothyronine in water (which will serve as a surrogate for saliva)?”
I’m curious if it works to take this compounded formula sublingually.
You could try looking it up on your own, the internet has answers for just about everything…
I am taking , just recently, 75 mcg of Levothyroxine Sodium under my tongue .Been taking Synthroid for years. I’ve had stomach problems and this is why I have chosen to put my med under the tongue. However have noticed in the mornings I am having a ‘ steady ‘ high pitch ringing in my ears! As the days go by, I haven’t noticed it much. I am taking medication for Perindophril Erbumine 4 mg. for hypertension and also Furosemide 20 mg. (Fluid pill). I take my Synthroid very early in the morning with ‘lots of water’ after it has dissolved in my mouth. Then wait at least an hour to take the rest of my pills. Concerned about this recent steady ringing. Could it have anything to do with the heart?
Ringing in your ears shouldn’t have anything to do with your heart 🙂
Per the website RX list, tinnitus and hearing loss are possibly side effects of Lasix. You can also access the Professional Prescribing Information for Lasix through a link at the end of RxList’s side effects entry for Lasix. I’d ask my Dr. for a blood pressure med that is NOT linked to hearing loss. It can seem mild, but is cumulative; one reason so many old people have bad hearing, IMO.
Can I use normal levothyroxine tablets under my tongue if it says to swallow them , will they dissolve ?
Sandoz generic levo dissolves extremely rapidly, within 5 seconds, so it would seem the perfect cadidate for sublingual dosing.
If it dissolves that quickly then it would be for sure.
Does this mean have a shot of vodka with your armour? check this tidbit out….”Another hypothesis is that the presence of alcohol (only in the liquid formulation) could play a key role in thyroxine absorption. Indeed, oral mucosal drug delivery is known as an alternative method for systemic drug delivery that offers several advantages over both injectable and enteral methods . Because the oral mucosa is highly vascularised, drugs that are absorbed through the oral mucosa directly enter the systemic circulation, bypassing the gastrointestinal tract . Consistent with this hypothesis, we would expect to see more rapid pharmacokinetics if oral liquid thyroxine can be absorbed by oral mucosa. Further studies are needed to clarify this intriguing point.?” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726924/
Hi Dr. Childs,
is methimazole a good candidate for sublingual absorption? FYI I take both the methimazole and Tirosint for the block and replace therapy)
Taking methimazole and Tirosint together is like pushing on the gas and the brake at the same time. I’m not sure why you’d need to be on both at the same time.
Hi Dr. Childs,
“Add Back” or “Block and Replace” therapy using both methimazole and T4, is a treatment used for people with graves to bring about full remission. In my case, I have both graves and hashimotos. This research group on facebook is a remarkable source of information
Gotcha! Add back therapy is something you can definitely do, I just wouldn’t recommend it for most people. By taking both methimazole and thyroid medication you are adding in an extra variable that must be controlled to try and balance a system of two antagonizing things. My preferred approach is to use only methimazole (if necessary) and focus on treating the underlying causes so you can get off of methimazole as quickly as possible. I had an hour-long interview with Dr. Osansky on methods to do just that here: https://www.restartmed.com/how-to-prevent-thyroid-surgery-and-radioactive-iodine-ablation-therapy-dr-osansky-and-dr-childs/
Hi Dr. Child’s. I’m on NP thyroid. I have half a thyroid. I would like to try this as I’m on a high dose. I take bio identical hormones in a troche. It has testosterone in it along with the E2 and progesterone. Is that a problem? Thank you.
It may work for you, the only way to know is to try 🙂
Is Nature Throid back on the market? I had to switch to NP Thyroid because of Nature Throid’s recall.
However NP doesn’t seem to be working for me. I’ve been on it since October. I’m going to try the subliminal delivery. I have Celiac disease and can’t handle dairy or gluten. This has been a problem since some thyroid meds have dairy or gluten as fillers.
Is it true that taking vitamin C when you take your thyroid meds helps it work better?
Some people are able to get it, you can call local pharmacies to see if they have it available.
I would like to try the under the tongue method. I am currently taking levothyroxin manufacturer is Sandose, but all the pharmacies say they are no longer making this. Big problem because that has been the only manufacturer brand that has agreed with me. I have some left, but soon running out. Do you have any recommendations, I have trouble with absorption. I can get Lannett manufacturer, but I’ve taken Sandose brand for 4 years since my thyroidoctomy. Any help would greatly be appreciated..
I take synthroid and generic cytomel (because I haven’t been able to get cytomel in years!). Depending on the brand of cytomel (if it is chewable) I chew it. I always chew my synthroid. Is this as effective as sublingual? If not, what about grinding the pills up with a mortar and pestle and then taking the powder sublingually? Since taking multiple doses is better with thyroid hormone anyway, this seems like an even better way to take multiple doses/day.
It is provided you allow it to stay in your mouth a sufficient amount of time. If you chew it up and ultimately swallow it relatively quickly then you are basically just doing what the stomach would do in your mouth.
I just decided to take my Levothyroxin small blue pill under my tongue and am shocked how much better l feel in doing so.
No one told me about this method and l have not been experiencing any benefits swallowing the pill, so just on a reasoning thought, one a.m., l tried the sublingual method, and l am amazed of the results. I have more energy and less depression. Everything in daily living has improved. I don’t know why l decided to do this but am glad l did. Unreal, unreal ??
I’m glad it’s working for you! And believe me, it’s real 🙂 It’s worked for many people in the past.
I have been taking Levothyroxine (blue tab) under my tongue for over a month now. It dissolves quickly and I feel much better than I have in a long time. I am worried about what the lab tests will show and what my doctor will say about me self medicating.
If you are worried that the doctor would decrease your dose (as most doctors use TSH test as the only indicator and dont like to see it fall), My adise – NEVER take the pill in the morning the day of your test. If you are worried that the doc would decrease your dose – skip the pill couple of days before testing, and your labs would show that you need more hormones, not less. We play this game many years with the doctors, otherwise they tend to underdose you
Wise words 🙂 But you didn’t hear it from me!
Given an example where a person takes say 1 grain of Armour thyroid but FEELS fatigue and rundown. Their blood work shows decent numbers in the normal ranges. They start taking the same dosage as an sublingual and feel better yet the blood works stays relativity the same. Has there been a change? Is the blood work going to be different? If absorbed differently what would you expect to see different in the blood work if anything?
If you feel better you feel better. You shouldn’t worry about blood tests when you don’t have to 🙂 I see people feel better at basically all levels so blood tests are only helpful to some degree.
I have been putting my 137 mg synthroid under my tongue but then my tongue and teeth are blue from the dye. That can’t be good. I’m thinking it would be better to do 50mg. Any thoughts on that?
I would mention though, that from the experience of thousands of patients on Stopthethyroidmadness forum on FB, 1 grain of armour is too little. At the beginning of the dose increase you feel good, but as soon as fatique returns in several weeks, people usually increase armour. Average dose used by most patients is 3 grain of armour total (180mg), divided in 2 doses. Any medication that has T3 in it should be taken twice a day (due to the short life of T3). So most people take 1 or 1.5 gain in the morning and 1 or 1.5 grain at noon or afternoon. Never take pill before your test in the morning. It would artificially increase your T3 and freak out the doctor. Stopthethyroidmadness has great recommendations on how to take meds, when to do blood tests, how to interpret them, what is the optimal lab ranges, which brand of thyroid meds work better at the moment etc..
I have been on Synthroid, Armour, NP, WP and now back on Armour due to the changes in formulation so I have heard. I am having knee problems and wondering if this is due to the changes in formulation? I have never had this happen to me before, and the ringing in my ears is awful I have had one ear ring for many years and just last month the other ear started to ring any connection to the thyroid?
Hi Lillian, did you maybe get a reply from Dr Childs as I seem to be having the same problem.
Hi, I know it’s been awhile. Was there an answer to the ringing in the ear and knee problems? Thank you
I have been using .75 mg of Levothyroxine for 5 yrs. with my family practice right. Starting October 2020 in less than 45 days time I gained 10 lbs. I immediately started strict diet changes, no sugar, only fish & poultry, lots of fruits, vegetables, tennis everyday for two hours, walking 3 miles a day, etc. This has always brought me down to 10 to 15 lbs. within 2 months. Not so this year. I’m now up 14 lbs. My Dr. released me stating she really doesn’t know much about thyroid stuff! She made an appt. for me with an Endo which is not for 2 more months and will be at least 2 more months till I can actually get some kind of treatment. Based on my minimal lab tests, my T4 is not converting to T3. And I have insulin & Lipton resistance. So today I am trying to take my levo under my tongue. Wish me luck,
Good luck! 🙂
I am going to give this a try. I am currently taking 60mg of NP but I don’t think it working as effectively as the Armour or NaturThroid.
I made my first attempt this morning – the NP took some time to dissolve but it happened. I will try some of the other tricks – maybe crushing – or a combination like hot water and crushing.
I have an appointment with my doctor in 2 weeks – see how it goes – I would like a change in prescription as well. With these NDTs being more expensive and not approved by insurance – reducing dosage would help.
It doesn’t work for everyone but it’s certainly worth a try for most people.
I have done this for 3 days – interestingly I noted that about 2 to 3 hours after dissolving the NP, I get a warm rush in my body. First time I took my temp since I recently had a covid vac but temp was normal. Seems there’s a connection and I take it as a positive sign.
I spoke with my pharmacist and he said to give it whirl but make sure I was being monitored. I am continuing.
I take 25 mg of Cytomel 1/2 in am and 1/2 in afternoon.
I also take a combination of Progesterone, Estrogen and Testosterone cream before Bedtime. Do I understand it correctly that taking my Thyroid Meds sublingual wouldn’t work?
I would like to try this. Maybe I missed it but, how long do you hold the medication under your tongue? I plan to crush it first (NP THYROID).
I’m taking 30 mg of Armour 3x/week and 6omg of armour 4x/week. I’ve been taking this armor now for about 15 years. I would like to take it sublingually. What might be the positive and negative effects of taking it this way?
BTW About a year ago I went to an endocrinologist and he changed my med to Levo. It was terrible. I became jittery and felt as if I was having heart problems. I went back to my armour and Not to that doctor! That’s when I found your website and have been happy for all your input. Thank you for all your help
Thank you so much for posting this article online! I have Hashimoto’s and have been on thyroid for 34 years. Doctors never seem to be interested in telling us any of this information. Most of the time they just say here’s a prescription, take the pill and that’s it. So many of us end up doing all of the research ourselves.
This was really helpful, thank you!
Glad it was helpful!
Has anyone had good experiences taking liothyronine (T3) sublingually? If so, do you still have to wait 2hr before or 30m after for food?
I take mine in the afternoon so it would be really nice to not have to try to plan around my meals/snacks during the day.
It’s still a good idea to wait before eating because some of the medication will make it down into your intestinal tract for absorption.
Hi Dr Child’s,
I am on a compounded t3 and t4. Could I take this sublingually. Also, would you suggest taking T3 twice a day vs only once a day? I have flairs and facial swelling and thinking maybe taking it twice a day would help.
You could theoretically take any thyroid medication sublingually but some will work better than others. In terms of T3 dosing, both once a day and multi dosing throughout the day have the potential to work, it depends on your body which one will work best 🙂
I have just started on thyroid medication levothyroxine 50 mg. In my first week my stomach reacted and I had bad pains so I changed my dose to 25 mg. I have had silent reflux for years. The 25 mg was better but then I watched your video on taking the medication sublingually. I’m also on transdermal estrogen and prometrium for menopause. I’ve just read above that you mentioned there is some problems with HRT and the medication. Do you have any links to this or am I misinterpreting your comments.
Thankyou for your wonderful videos and information and the education your providing, when all my doctor did was say here take a pill you’ll be on it forever.
You are correct in that estrogen and progesterone can impact your thyroid. Please see this post: https://www.restartmed.com/prescription-medications-that-block-thyroid-function/