Levothyroxine Side Effects

Medically reviewed by Drugs.com. Last updated on Mar 11, 2024.

Applies to levothyroxine: injection powder for solution.

Other dosage forms:

• oral capsule liquid filled, oral solution, oral tablet

Serious side effects of levothyroxine

Along with its needed effects, levothyroxine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur while taking levothyroxine:

Rare side effects

• seizures

Incidence not known

• fast heartbeat
• fever
• hives, itching, skin rash
• hoarseness
• irritation
• joint pain, stiffness, or swelling
• redness of the skin
• swelling of the eyelids, face, lips, hands, or feet
• tightness in the chest
• troubled breathing or swallowing

Get emergency help immediately if any of the following symptoms of overdose occur while taking levothyroxine:

• anxiety
• changes in menstrual periods
• chest pain, discomfort, or heaviness
• decreased urine output
• diarrhea
• dilated neck veins
• excessive sweating
• extreme tiredness or weakness
• fainting
• fast, pounding, or irregular heartbeat or pulse
• feeling of warmth
• hand tremors
• headache
• heat intolerance
• increased appetite
• leg cramps
• mood changes
• muscle weakness or spasm
• nausea
• nervousness
• pain or discomfort in the arms, jaw, back, or neck
• restlessness
• sensitivity to heat
• stomach cramps
• sweating
• trouble sleeping
• trouble sitting still
• vomiting
• weight gain or loss

For healthcare professionals

Applies to levothyroxine: compounding powder, injectable powder for injection, intravenous powder for injection, intravenous solution, oral capsule, oral solution, oral tablet.

General adverse events

The more commonly reported adverse events have included those of hyperthyroidism due to therapeutic overdose including arrhythmias, myocardial infarction, dyspnea, muscle spasm, headache, nervousness, irritability, insomnia, tremors, muscle weakness, increased appetite, weight loss, diarrhea, heat intolerance, menstrual irregularities, and skin rash.

Cardiovascular

• Frequency not reported: Palpitations, tachycardia, hypertension, arrhythmias, increased pulse and blood pressure, heart failure, angina, myocardial infarction, cardiac arrest^[Ref]

Cardiac function was evaluated in 20 patients requiring TSH suppression for either thyroid goiter or following thyroidectomy and radioactive iodine therapy for thyroid cancer and in 20 age and sex-matched controls. TSH suppression was associated with an increased incidence of premature ventricular beats, an increased left ventricular mass index, and enhanced left ventricular systolic function. The clinical significance of these changes remains to be determined.

Overtreatment with this drug may cause an increase in heart rate, cardiac wall thickness, and cardiac contractility and may precipitate angina or arrhythmias, particularly in patients with cardiovascular disease and in elderly patients.^[Ref]

Endocrine

• Frequency not reported: Changes in symptom presentation for diabetes and adrenal cortical insufficiency^[Ref]

Nervous system

• Frequency not reported: Headache, hyperactivity, insomnia, seizures, pseudotumor cerebri (children)^[Ref]

Dermatologic

• Frequency not reported: Hair loss, flushing, urticaria, pruritus, skin rash, angioedema, excessive sweating^[Ref]

Musculoskeletal

• Frequency not reported: Tremors, muscle weakness, muscle cramps, increased risk of osteoporosis, slipped capital femoral epiphysis (children)^[Ref]

A study evaluated the effect of long-term thyroid hormone therapy on bone mineral density in 196 women (mean age, 74.4 years) compared to a control group comprised of 795 women (mean age, 72.1 years). The mean daily thyroxine dose was 1.99 mcg/kg (range, 0.3 to 6.6 mcg/kg) with a mean duration of therapy of 20.4 years (range, less than 1 to 68 years). Women taking daily doses of 1.6 mcg/kg or more had significantly lower bone mineral density levels at the ultradistal radius, midshaft radius, hip, and lumbar spine compared to controls. However, estrogen use appeared to negate the adverse effects of thyroid hormone on bone mineral density.

Higher rates of femur fractures have been found in males (p=0.008) prescribed long-term thyroid hormone therapy as compared to controls in a case-control analysis of 23,183 patients, from the United Kingdom General Practice Research Database, prescribed thyroid hormone.

Overtreatment may result in craniosynostosis in infants and premature closure of the epiphyses in children with resultant compromised adult height.^[Ref]

Gastrointestinal

• Frequency not reported: Diarrhea, vomiting, abdominal cramps^[Ref]

Genitourinary

• Frequency not reported: Menstrual irregularities, impaired fertility^[Ref]

Hypersensitivity

• Frequency not reported: Serum sickness, hypersensitivity to inactive ingredients^[Ref]

Hypersensitivity reactions have occurred; however, it has been attributed to the inactive ingredients. These reactions have included urticaria, pruritus, skin rash, flushing, angioedema, various GI symptoms (abdominal pain, nausea, vomiting and diarrhea), fever, arthralgia, serum sickness and wheezing. Hypersensitivity to levothyroxine itself is not known to occur.^[Ref]

Metabolic

• Frequency not reported: Increased appetite, weight loss^[Ref]

Immunologic

• Frequency not reported: Autoimmune disorders (e.g., chronic autoimmune thyroiditis)^[Ref]

Other

• Frequency not reported: Fatigue, heat intolerance, fever^[Ref]

Psychiatric

• Frequency not reported: Nervousness, anxiety, irritability, emotional lability^[Ref]

Frequently asked questions

• Does levothyroxine cause weight gain or loss?
• What can I eat for breakfast after taking levothyroxine?
• Can I take other medications with levothyroxine?
• Does levothyroxine cause hair loss?
• How long after taking levothyroxine can you drink milk?
• How long does levothyroxine stay in your system?
• How soon after taking levothyroxine can I take omeprazole?
• What is the difference between Levoxyl and Synthroid?
• What is the difference between Unithroid and Synthroid?

Further information

Levothyroxine side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

Medical Disclaimer