Treating hypothyroidism typically requires that patients take daily thyroid hormone replacement medication. This helps rebalance thyroid function and make up for deficiencies caused by the condition. Usually, the prescription of thyroid hormone therapies is accompanied by several instructions on how to take it properly. Most doctors place significant emphasis on the regularity and method of intake. However, the importance of proper storage is frequently overlooked. This is significant because improper storage may cause seemingly inexplicable symptoms to develop while medication continues to be taken. Therefore, being aware of the dangers of improper storage and knowing how to keep medications safe are crucial for effective treatment.
The Growing Need for Thyroid Medication
Hypothyroidism is an increasingly common condition. Some studies suggest that approximately one in 10 people will develop hypothyroidism at some point in their life.
As diagnosed cases of hypothyroidism continue to increase, so too have prescriptions for levothyroxine, a synthetic form of thyroid hormone T4. In 2014 alone, nearly 120 million prescriptions for levothyroxine were ordered. Unfortunately, awareness regarding the importance of proper storage has not matched the increased proliferation of thyroid medication.
It is relatively common for patients taking thyroid hormone replacement to exhibit consistently abnormal TSH serum levels and hypothyroid symptoms. Doctors often respond to such situations by increasing dosage. However, this is not always the appropriate response. An estimated 15 to 20 percent of patients continue to exhibit elevated levels of TSH, indicative of hypothyroidism, even after dosage is increased. This is known as refractory hypothyroidism, which can contribute to inhibited thyroid function and worsening of symptoms.
Until recently, little research had been done to investigate potential causes of refractory hypothyroidism. A study titled Refractory Hypothyroidism Due to Improper Storage of Levothyroxine Tablets published in 2017 found that improper storage of thyroid medication may be the cause of a notable percentage of refractory hypothyroid cases among those treated with levothyroxine. The study suggests that approximately one percent of thyroid patients taking thyroid medication do not store it correctly. This is disconcerting as improper storage often results in damaged medication and subsequent thyroid disruption. Worse still, the degradation of thyroid function can persist even if the patient continues to take their now damaged medication. This can be exceptionally confusing and difficult to identify unless the importance of proper storage is understood.
The Effects of Improper Storage
Proper storage of medications, particularly those like levothyroxine which contain hormones and proteins, is essential for effective treatment. Exposing medications to unsafe environments can negatively influence medications. For example, significant changes in temperature and humidity can irreparably damage medication making them effectively useless. Thyroid medications exposed to natural or artificial light for extended periods or kept in areas of high temperature can be heated to a point where it is essentially cooked. Keeping pills in wet or humid locations can also damage the medication making them less effective or essentially useless.
One study found that refractory hypothyroidism may be highly associated with poor medication storage habits. The study consisted of eight patients suffering from refractory hypothyroidism. Each patient took notes on their individual storage and dosing practices. In all eight cases it was found that the tablets were stored inappropriately and were likely damaged by humidity, light, and/or high temperature. Specific examples of the participants improper storage habits include:
- Medication stored in a cabinet located above a heating unit and/or in close proximity to shower and Jacuzzi.
- Medication stored in kitchen drawer and/or cabinet located near stove burners, oven, or other heat source.
- Medication stored in closet containing mold or mildew.
- Medication removed from original container and placed in transparent glass or container allowing it to be exposed to natural and artificial light for extended periods.
The patient’s storage issues appeared to be the primary cause of their refractory hypothyroidism. After correcting the improper storage behaviors and acquiring a new supply of medication, the TSH levels of each participant returned to normal. Clearly, proper storage is a pivotal component of effective treatment.
The Do’s and Don’ts of Medication Storage
In addition to regularly taking thyroid medications as instructed, it is important that thyroid patients know what storage practices to avoid as well as how to properly store their medication. The following storage guidelines may be useful in maintaining medication quality and integrity:
- Never remove medicine from the original packaging unless it is being taken immediately or soon after removal. An exception can be made for elderly individuals or those who require the assistance of a pill organizer or other mnemonic tool to prevent missing of doses.
- Check the expiration date and safely dispose of expired medications. Never take expired medications, prescription or otherwise.
- Store medications away from all light sources.
- Store medications in dry locations. Avoid bathrooms, sinks, saunas, etc.
- Keep medications away from areas with the potential for elevated temperature such as in a car, near ovens or stoves, or in proximity of a heater.
- Store medications in areas of consistent temperature, ideally between 68 to 77 degrees.
- Do not use medications that have changed in color or consistency.
- Safely discard pills that stick together, chipped pills, or medications that are harder or softer than usual.
The most common safe storage areas around the home are cool dry places such as linen closets, bedroom closets, or cabinets. Avoid medicine cabinets located in bathrooms. Lockboxes or raised cupboards may also be employed to restrict access from pets or children.
Is Storage Really the Problem?
It is important to point out that improper storage may not be the only reason your levothyroxine is not working. Although it is considered the standard method of treatment, T4-only medications don’t a huge percentage of those with thyroid dysfunction. This treatment method does not consider important thyroidal factors such as thyroid hormone conversion and transport. T4 is the inactive form of thyroid hormone which must be converted into T3, the active form of thyroid hormone, to have an impact on the body. Many practitioners erroneously believe that increasing T4 levels via medications is the best method of resolving thyroid issues because they assume it will be correctly converted into T3. Unfortunately, conversion issues are a frequent cause of thyroid dysfunction and the addition of T4 to a broken system likely does more harm than good.
Get the Best Results by Protecting Your Pills
Most thyroid patients are briefed regarding the specifics on how to take their thyroid medication. However, proper medication storage, an important part of their treatment, is frequently not discussed. As studies have shown, those who do not store their thyroid medication properly are likely to experience decreased thyroid function and refractory hypothyroidism even if they consistently take their medication. Ensure that your medication is providing the best benefit possible by employing proper storage practices.
1. Walecia Konrad. “Mistakes in Storage May Alter Medication.” The New York Times August 15, 2011.
2. Benvenga S, Papi G, Antonelli A. “Refractory Hypothyroidism Due to Improper Storage of Levothyroxine Tablets.” Frontiers in Endocrinology. 2017;8:155. doi:10.3389/fendo.2017.00155.
3. Synthroid. “Storage Conditions.” http://www.rxabbvie.com/pdf/synthroid.pdf
4. Nature-thyroid. “Full Prescribing Information.” http://www.pdr.net/full-prescribing-information/Nature-Throid-thyroid-496