Save money on hypothyroid treatment

Ever wonder why your salt is iodized? 

A woman with goiter; the Chinese treated goite...
Image via Wikipedia


This woman has a humongous goiter, probably due to lack of dietary iodine.  I’ve never actually seen a goiter caused by iodine deficiency, and I’ve certainly never seen one this large.  Any doctor would have treated her long before things got this bad.  Iodine deficiency is not the only cause of goiter, however.  A symmetric swelling like hers could be due to primary hypothyroidism as well. 

Unlike the first image, the lady below has an asymmetric goiter, off to her right side, but still fairly huge.  This raises a concern for tumor or cyst in addition to the question of iodine deficiency or simple hypothyroidism.

A large goiter
Image via Wikipedia


In America doctors rarely see patients with extremely large goiters or advanced hypothyroidism.  These two ladies probably have additional findings, such as swelling of the hands or legs (myxedema) and feeling cold. 


Pretibial myxedema and thyroid acropachy accom...
Myxedema – Image via Wikipedia

Interestingly, neither woman is overweight. Americans suffering from low thyroid usually gain weight due to slowed metabolism (and too much food). Additionally, since goiter can also be caused by overactive thyroid, and since I don’t have the medical history on these women, they could have either low or high thyroid.   Both are thin enough to suspect overactive thyroid, but neither demonstrates the typical bulging eyes.  My guess is they both have low thyroid and don’t live in conditions leading to weight gain. 

In America underactive thyroid is much more common than overactive, and most patients do not demonstrate goiters, or have only mild swelling over the hollow at the base of the neck.
For purposes of this blog I will focus only on treatment of typical hypothyroidism.  Most people do not have tumors, or cancer, or iodine deficiency.  Most do not require surgical procedures or unusual testing.
The typical patient is diagnosed either on routine bloodwork, or on testing done due to complaints of fatigue (but who isn’t tired?), or in someone with a small goiter.  If a small goiter is present, your doctor may order an ultrasound of the thyroid.  If you lack insurance, be sure to ask if this test is absolutely necessary.  Depending on your age and symptoms, and the size, shape, and texture of the goiter, your doctor may or may not insist on the test.  If you do need an ultrasound, be sure to ask whether they offer a discount to uninsured patients.
For most patients the cost of treating hypothyroidism consists of three things:  office visits, bloodwork, and medication. 
If you have been newly diagnosed with underactive thyroid, your doctor will want to see you more frequently than after the condition has stabilized.  I typically see a patient about 1-3 months after diagnosis, depending on symptoms and severity of the disease.  Usually patients aren’t having many symptoms, in which case I see them after 3 months.  It takes about this long at a given dose of medication for the situation to stabilize at a new plateau.  Once we’ve found the appropriate dose of medication, I see them again in 3-6 months.  If a patient has no problems other than hypothyroidism (such as diabetes or hypertension) I sometimes see them only once a year.  I have had patients complain to me of doctors who insist on monthly visits to check their thyroid and bloodwork.  Except in unusual circumstances, this is unnecessary and certainly expensive. 
Besides assessing for symptoms, your doctor will perform periodic blood testing, usually a TSH (thyroid stimulating hormone) level.  The cost for this test varies, from $65 to $300.  Some doctors also order a T3 or T4, but these add very little to effective treatment.  I rarely order them.  Self-pay patients especially should ask whether anything more than a TSH is truly needed.  If your doctor is charging you more than about $80, ask for a prescription to get your bloodwork done elsewhere, and then shop around at outpatient medical labs.

Most patients who take medication for thyroid disease are taking Synthroid or generic equivalent.  In the case of thyroid medication, although generic is cheaper, it’s not always advisable.  Here’s why:  whereas brand name medication must contain +/- 5% of the specified dose, generic equivalents need only be as accurate as +/- 20%.  So if your doctor orders 100 micrograms of levothyroxine, you would be assured of getting between 95-105 mcg. of medication if you receive brand-name Synthroid, but anywhere from 80-125 mcg. if your receive a generic drug.  In many instances, a partially-functioning thyroid will compensate for a slightly fluctuating dosage.  However, a patient with no functioning thyroid tissue may notice a difference.  Since name brand medicine is only about $25 a month (versus $4 to $15 for generic), it may not be worth it to get generic.  If you require additional blood tests, you’ve eaten up your savings. 

Depending on the patient, my approach is often to try a generic.  If the TSH (thyroid stimulating hormone) level is stable, I continue the generic.  If not, we go with brand-name Synthroid.  Even then, TSH levels sometimes vary, due to varying disease activity in the case of auto-immune thyroid conditions.  More common than this, I believe, is that levels vary because patients become lax about skipping the medication occasionally.  When skipping a day doesn’t change how you feel, patients sometimes wonder if they really need daily medication.  But if you forget your medicine 10% of the time, blood tests may indicate you need more medicine, and then your doctor will want to repeat the blood tests.  All in all, it’s cheaper to just take the medicine every day, especially for the month before your bloodwork is due. 

And one last thought, if your TSH is only a few points higher than the normal range, ask your doctor whether medication is definitely indicated.  If  you were diagnosed with low thyroid because you are tired, treating hypothyroidism may not relieve your symptoms.  Generally speaking, although your brain is producing more thyroid stimulating hormone to rev up your thyroid, the circulating amount of thyroid hormone may well be normal, and therefore not the cause of your fatigue. 

The decision whether to treat is not carved in stone. For a scientific discussion of the factors influencing this decision, read

© Cynthia J Koelker, MD – All rights reserved


Image by Andrea Costa Photography via Flickr


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This entry was posted in $4 list, 101 Ways to Save Money on Health Care, Are generics as good?, Blood tests, Generic medication, Goiter, Hypothyroidism, Synthroid, Thyroid disease, Thyroid stimulating hormone (TSH) and tagged , , , , , , , . Bookmark the permalink.

2 Responses to Save money on hypothyroid treatment

  1. Addie J. says:

    Do you know of any herbal or other non-prescription remedies in the event that levoxyl is not available? Can animal thyroid be processed by laypersons?

    • admin says:

      Hi Addie,

      For a partial answer, see:

      Yes, animal thyroid can be used, but dosing would require careful titrating. I’m working on a longer answer, and still have plans to visit a butcher. There have been cases of accidental hyperthyroidism (high thyroid) from patients who inadvertently ingested cow thyroid tissue. Keep tuned for a more complete answer.

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