How To Take Your Medications
- Space ALL thyroid medications at least 2 hours from ALL food, drinks (including coffee), medications, and supplements. The only exceptions are that you can consume water, non-buffered ascorbic acid, and Betaine HCl. This helps maximize and normalize the absorption of your medicine. If your prescription is extended release, then you need to space it 3-4 hours.
- The time of day is not as important. Some people take their thyroid medicines in the morning, some take it before bed, and some set an alarm in the middle of the night. You may have to be creative or alter meal times to make sure that your thyroid medicine is spaced properly.
- Some medicines require taking it twice a day or cutting the pills in half. Some pharmacies will do this for you, or you can buy a good pill cutter online. It doesn’t have to be cut perfectly, but try to take the larger half as your morning dose.
Pharmacy & Prescription Info
After your appointment, your prescription(s) will be electronically sent to your pharmacy. It usually takes a couple hours for the pharmacy to receive it, so be patient!
REGULAR PRESCRIPTIONS (Synthroid, levothyroxine, Armour, liothyronine, etc.) can be sent to any pharmacy you want. If you have health insurance, the pharmacy will process it through your insurance. If it needs a prior authorization, we unfortunately do not have the staff to do this. It is your responsibility to understand your insurance plan and know which medications are covered and which are not, and if desired, to call your insurance company to appeal their decision. Alternatives include using GoodRx to get a cheaper cash rate (see below) or asking the pharmacy if they have a discount card. If you still cannot afford your prescription, send a message to your Provider via the Patient Portal and request a cheaper alternative. If your pharmacy faxes us a request for a cheaper or generic medication, we will ignore it unless you have personally messaged us.
COMPOUNDED PRESCRIPTIONS must be sent to a specialty pharmacy and will likely not be covered by insurance. Our Providers usually use Tidewater Pharmacy in Mount Pleasant, South Carolina, who can mail prescriptions to you. One of the most important parts of your thyroid treatment regimen is receiving quality medications which are hypoallergenic, free of unnecessary chemicals, and provide a constant dose each time. If you prefer a compounding pharmacy closer to your house, please inform your Provider during your appointment and we will be happy to send your prescription to them instead.
For medications that we know are frequently rejected by insurance, we suggest a few specialized pharmacies (see below) which have better cash prices. Once they receive your prescription, they will contact you, verify your mailing address, and mail the medicine directly to you for a small fee. If you haven’t heard from them 2-3 days, you will need to call them.
If your prescription is sent to a pharmacy and you want to change it to another pharmacy, ask the pharmacist to transfer the prescription.
Refills
Click here if you need a prescription refill.
Vitamins & Supplements
To order vitamins & supplements, click here.
Medication Side Effects
Although we hope you won’t, some people do experience side effects from their thyroid prescriptions. The most common side effects are listed below with general suggestions. For serious side effects, you should go to the ER or an urgent care. If minor, you can also contact your Provider through the Portal for their recommendations.
Remember that it takes a few weeks for your thyroid prescriptions to normalize in your bloodstream. If you’re having mild side effects right after your start a new medicine or a new dose, you should try to give it a few weeks prior to making any other changes.
This is usually due to a dye or filler in your medicine. Hold your medicine for a few days and see if it resolves. If so, consider changing to a new medicine. If it’s only around your period, it’s likely not related to your thyroid.
This usually occurs when your T3 dose was recently increased, but can also be from T4 or antibodies. If tolerable, wait for about a week to see if it goes away. If not, temporarily stop your medicine for 2-3 days and then restart it. If still having symptoms after that, you should contact your Provider. If your heart racing is severe or you have having chest pain, go to the ER.
Make sure you’re spacing your medicine properly as discussed above. You can also take your medicine with (non-buffered) ascorbic acid 500mg. Other causes are stress, iron deficiency, vitamin B12 deficiency, or poor sleep. Use a smart watch to track your sleep. If it persists, schedule another appointment with your Provider and get updated labs to make sure that your dose is correct.
Anxiety is generally not related to your thyroid dose. You can hold your medicine for 2-3 days to see if it improves. If not, then consider supplements such as GABA, passion flower, or talking to your PCP about it.
Hold your medicine for 2-3 days to see if your sleep improves. If it does, you may need a lower dose. If it doesn’t, it’s likely not related to your thyroid and you can consider supplements such as magnesium or melatonin.
This can be due to your antibodies, an unrelated condition, or from your thyroid medicine being too strong. If it’s related to starting a new medicine or new dose, hold the medicine for a few days to see if it resolves. If not, contact your PCP. If you are having moderate to severe shortness of breath, go to the nearest ER.
Although other symptoms (heavy periods, difficulty swallowing, rash, constipation, diarrhea, etc.) may be related to your thyroid, we ask that you first talk to your primary care doctor or other appropriate specialist. Since we are a telehealth-only practice and do not have the ability to see you in person, all other problems not specifically related to your thyroid must go through another physician. If they are unable to help, tell your Provider at your next scheduled appointment or make a follow up appointment so we can discuss it further.
Specialty Pharmacies
- Tidewater Pharmacy (Mount Pleasant, South Carolina): Used for most compounded medications and/or if USP is used.
- Carolina Compounding Pharmacy (Cary, North Carolina): Another reliable compounding pharmacy
- Millers Pharmacy (Wyckoff, New Jersey): Used for compounded medications when USP is used.
- Highland Specialty Pharmacy (Hattiesburg, Mississippi): Used for Tirosint and Tirosint-SOL prescriptions. They will also do your prior-authorization.
- Eagle Pharmacy (Lakeland, Florida): Used for Synthroid brand. Their current pricing is here.
- Blue Sky Specialty Pharmacy (Mount Pleasant, South Carolina): Used for all Xifaxan prescriptions. They will also do your prior-authorization.
GoodRx
According to GoodRx.com, their cash prices for 1 month of the following medications are approximately the following:
- Generic levothyroxine ($10)
- Synthroid ($50)
- Levoxyl ($20)
- Tirosint or Tirosint-SOL ($130) — however it is $50 through Highland Specialty Pharmacy
- Nature-Throid ($30)
- Armour Thyroid ($100)
- Generic liothyronine ($15)
- Cytomel ($70)
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