Lupus and Thyroid Medications
posted in Thyroid disease and lupus on May 10, 2023 by
Updated February 8, 2025
Lupus and thyroid disease go hand in hand. The thyroid gland, which is situated at the front of the neck, just below the Adam’s apple, and plays a vital role in metabolism. This results in autoimmune thyroid diseases like Hashimoto’s thyroiditis and Grave disease. This article will explore the relationship between lupus and thyroid medications and how they can affect each other.
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NOTE: Johns Hopkins University Press, publisher of The Lupus Encyclopedia, is a nonprofit publisher. By purchasing JHUP books such as The Lupus Encyclopedia, you contribute to valuable projects like Project MUSE.
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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 is the term for an underactive thyroid where ‘hypo-‘ refers to a decrease or insufficiency. Lupus patients have a higher risk of hypothyroidism than the general population. Up to one out of five lupus patients have hypothyroidism. Hashimoto’s thyroiditis, where the immune system attacks the thyroid gland, is the most common cause of hypothyroidism in lupus patients and the general population.
Hashimoto’s causes thyroid gland inflammation (known as thyroiditis). Early in the disease, this can lead to a mildly overactive thyroid. This is uncommon. However, when it occurs, the affected person may notice tremors, fast heart rate, weight loss, trouble sleeping, hair loss and other hyperthyroid symptoms.
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 hyperthyroidism and an enlarged thyroid gland (called a goiter). It is much less common than Hashimoto’s. It is treated with medications, surgical removal, or iodine radiation treatments. After treatment, the person develops hypothyroidism, requiring thyroid supplements for the rest of their life.
Thyroid Medications and Lupus
Healthcare providers prescribe thyroid medications, such as levothyroxine (a thyroid hormone supplement), to treat hypothyroidism. Healthcare providers follow a blood test called TSH (thyroid stimulating hormone) and adjust the dose of levothyroxine until TSH is in the normal range. If too high a dose is taken, resulting in low TSH levels, 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
It is essential to be careful about interpreting thyroid function tests (TFTs) in sick SLE patients. Steroids, like prednisone, can cause the TSH to be low. A low TSH usually indicates an overactive thyroid (hyperthyroidism). However, this is not always the case if someone is on prednisone, especially someone taking over 20 mg daily.
Patients with high lupus disease activity can often have low TSH levels along with low T3 and T4 thyroid hormone levels. We suspect that systemic lupus inflammation may cause the brain to make less TSH, resulting in low T3 and T4 levels. This may be a way for the body to protect itself during periods of illness. Finding low TSH, T3, and T4 levels in someone with active lupus is probably not helpful. It is best to wait until they are doing better (and are not on very high doses of steroids).
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.
Portions of the above were taken from “The Lupus Encyclopedia, chapter 17.”
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
For more in-depth information on Lupus and Thyroid Medications:
Read more in The Lupus Encyclopedia, edition 2
Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia
If you enjoy the information from The Lupus Encyclopedia, please click the “SUPPORT” button at the top of the page to learn how you can help.
What are your comments and opinions?
If you have lupus, what has your experience been? What do you recommend for other patients?
Do you have any questions to ask Dr. Thomas?
Please click on “Leave a Comment” above to comment.
Please support “The Lupus Encyclopedia” blog post page
Click on “SUPPORT” at the top of the page to learn how you can support “The Lupus Encyclopedia“
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