Version May 2024
| Drugs causing hypothyroidism |
| Inhibition of thyroid hormone synthesis and/or release – thionamides, lithium, perchlorate, aminoglutethimide, thalidomide, and iodine and iodine-containing drugs including amiodarone, radiographic agents, expectorants (eg, guaifenesin), kelp tablets, potassium iodine solutions (SSKI), Betadine douches, topical antiseptics |
| Decreased absorption of T4 – cholestyramine, colestipol, colesevelam, aluminum hydroxide, calcium carbonate, sucralfate, iron sulfate, raloxifene, omeprazole, lansoprazole, and possibly other medications that impair acid secretion, sevelamer, lanthanum carbonate, and chromium; malabsorption syndromes can also diminish T4 absorption |
| Immune dysregulation – interferon alfa, interleukin-2, ipilimumab, alemtuzumab, pembrolizumab, nivolumab |
| Suppression of TSH – dopamine |
| Destructive thyroiditis – TKIs (eg, sunitinib, sorafenib); checkpoint inhibitors (eg, nivolumab, pembrolizumab, and ipilimumab) |
| Increased type 3 deiodination – TKIs (eg, sorafenib) |
| Increased T4 clearance and suppression of TSH – bexarotene |
| Drugs causing hyperthyroidism |
| Stimulation of thyroid hormone synthesis and/or release – iodine, amiodarone |
| Immune dysregulation – interferon alfa, interleukin-2, ipilimumab, alemtuzumab, pembrolizumab |
| Drugs causing abnormal thyroid function tests without thyroid dysfunction |
| Low serum TBG – androgens, danazol, glucocorticoids, slow-release niacin (nicotinic acid), L-asparaginase |
| High serum TBG – estrogens, tamoxifen, raloxifene, methadone, 5-fluouracil, clofibrate, heroin, mitotane |
| Decreased T4 binding to TBG – salicylates, salsalate, furosemide, heparin (via free fatty acids), certain NSAIDs |
| Increased T4 clearance (hypothyroid patients taking levothyroxine may require an increase in their levothyroxine dose) – phenytoin, carbamazepine, rifampin, phenobarbital, ritonavir combination antiviral medications (eg, nirmatrelvir-ritonavir) |
| Suppression of TSH secretion – dobutamine, glucocorticoids, octreotide |
| Impaired conversion of T4 to T3 – amiodarone, glucocorticoids, contrast agents for oral cholecystography (eg, iopanoic acid), propylthiouracil, propranolol, nadolol |
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