Lupus and Thyroid Medications

posted in Thyroid disease and lupus on May 10, 2023 by

Gavin Abson

Updated December 29, 2023

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Lupus is an autoimmune disease where the immune system can attack the thyroid gland as well as the skin, joints, and other organs. One of the lesser-known complications of lupus is its impact on thyroid function. This article will explore the relationship between lupus and thyroid medications and how they can affect each other.

This blog on “Lupus and Thyroid Medications” was edited and contributed to by Donald Thomas, MD; author of “The Lupus Encyclopedia.” Parts of this blog post come from “The Lupus Encyclopedia: A Comprehensive Guide for Patients and Health Care Providers, edition 2“

Hypothyroidism and Lupus

Hypothyroidism, or an underactive thyroid, is a common condition affecting millions worldwide. Lupus patients have a higher risk of developing hypothyroidism than the general population. Some studies have shown that up to 19% of lupus patients also have hypothyroidism. Hashimoto’s thyroiditis, where the immune system attacks the thyroid gland, is the most common cause of hypothyroidism in lupus patients. Initially, Hashimoto’s can cause thyroid gland inflammation and an overactive thyroid (hyperthyroidism). Hashimoto’s thyroiditis damages the gland over time, causing the thyroid gland to secrete less thyroid hormones (hypothyroidism). People with Hashimoto’s usually have high levels of thyroid peroxidase antibodies. Hashimoto’s is one of the most common autoimmune diseases worldwide and is the most common cause of hypothyroidism.

Grave’s disease is another autoimmune thyroid disease that occurs more commonly in lupus patients than in the general population. It causes an overactive thyroid gland (hyperthyroidism). It is much less common than Hashimoto’s. After treatment (medications, surgical removal, or iodine radiation treatments), hypothyroidism can occur, requiring thyroid supplements.

Thyroid Medications and Lupus

Healthcare providers prescribe thyroid medications, such as levothyroxine (a thyroid hormone supplement or replacement therapy), to treat hypothyroidism. Lupus patients with hypothyroidism need to work closely with their healthcare provider to find the right thyroid medication and dosage that works for them. Regular monitoring of thyroid function is also crucial to ensure that the medication is working as intended. If too high a dose is taken, side effects such as heart palpitations, anxiety, weight loss, osteoporosis (fragile bones), and heart attacks can occur.

For hyperthyroidism due to Grave’s disease, healthcare providers may prescribe medication (such as methimazole) to reduce thyroid hormone production.

Monitoring thyroid function blood tests (TFTs) can be challenging in lupus patients. Prednisone can cause a lower-than-normal thyroid stimulating hormone (TSH) level, which does not require treatment. Patients taking biotin (often taken to help with hair growth) should stop it a few days before their lab tests to ensure it does not interfere with their TFT results.

Thyroid Medications and Lupus Flares

If you have lupus and are taking thyroid medication, it is important to know the signs and symptoms of a lupus flare. These may include joint pain, fatigue, rash, and fever. If you experience any of these symptoms, it is important to contact your healthcare provider immediately. While thyroid medications are an important tool in managing hypothyroidism, lupus patients must work closely with their healthcare provider to ensure they receive the appropriate medication and dosage.

Rarely the thyroid medication methimazole can cause drug-induced lupus. Lupus resolves after the drug is stopped. Fortunately, it is safe for lupus patients with Grave’s disease to take methimazole. It does not appear to worsen lupus or cause lupus flares in patients.

If you are taking thyroid medication, it is important to stay in close communication with your healthcare provider. You should report any changes in symptoms or medication side effects promptly. With proper management, lupus and thyroid disorders can be effectively managed, and patients can enjoy a good quality of life.

For more in-depth information on lupus and thyroid medications in greater detail:

Read chapter 17 of The Lupus Encyclopedia, edition 2

It includes much more about how the thyroid gland can be affected in lupus patients.  

Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia.

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Reviewed and edited by Donald Thomas, MD