Hypothyroidism Treatment

The goal of treating hypothyroidism is multifaceted: to improve your well-being, extend your body’s lifespan, and reduce the risk of complications associated with hypothyroidism, including heart disease and osteoporosis, in addition to increasing thyroid hormone levels.
The good news is that hypothyroidism is usually quite easy to treat (for most people)! The simplest and most effective treatment is to take thyroid hormone tablets once a day. The most commonly used form of thyroid hormone is a medication called levothyroxine.

Levothyroxine
Levothyroxine is a pure synthetic form of the hormone T4, produced in a laboratory and is an exact copy of the T4 normally secreted by the human thyroid gland. It comes in several dosages, which means that it is almost always possible to find an appropriate dosage for each patient.
The dosage should be reviewed and possibly adjusted monthly until the proper level is established. Then the dose should be reassessed at least once a year. If you are taking this medication, make sure your healthcare provider is aware so they can check the levels at least once a year.

Synthetic T4 can be safely taken with most other medications. Patients taking cholestyramine (a compound used to lower blood cholesterol levels) or certain seizure medications should consult their doctor about possible interactions.
Pregnant women taking T4 should be assured that this medication is exactly what their own thyroid gland would otherwise produce. However, they should consult with their doctor, as the dose of T4 may need to be adjusted during pregnancy (usually more hormone is required to meet the increased demands of the mother’s new elevated metabolism).

There are other potential issues with other medications, including iron-containing vitamins. Again, pregnant women (and all women and men in this regard) taking iron supplements should discuss this with their doctor.

How long will it take to feel better?
Some patients notice a slight reduction in symptoms within 1-2 weeks, but the full metabolic response to thyroid hormone therapy often takes a month or two before a person feels completely normal. It is important to use the correct dosage of the thyroid hormone analog.
With insufficient dosage, the patient may experience persistent fatigue or some other symptoms of hypothyroidism.

Too high a dose can cause symptoms such as nervousness, rapid heartbeat, or insomnia, typical of hyperthyroidism (overactivity of the thyroid gland). Recent research has shown that too much thyroid hormone can also lead to increased calcium loss from bones, increasing the risk of osteoporosis.
For people with heart conditions, the optimal dose of thyroid medications is especially important. Even a slight excess can increase the risk of a heart attack or worsen angina. Some doctors believe that more frequent checks of the dose and hormone levels in the blood are appropriate for such patients.

Approximately one month after starting treatment, blood hormone levels are measured to determine if the thyroid hormone dose the patient is taking is adequate. Blood samples are often also checked to see if there are antibodies against the thyroid (which is a sign of autoimmune thyroiditis)

Lack of a Universal Approach For most people with hypothyroidism, taking some form of thyroid hormone replacement (synthetic or natural, tablets or liquid, etc.) will return thyroid function tests to the normal range, accompanied by an overall improvement in condition. Because of this, doctors often rely on test results to determine when a patient is on the appropriate dose and, therefore, feels well.

But this simple approach doesn’t work for everyone. Sometimes it can be difficult to determine the correct dosage, so you may need more frequent check-ups and blood tests. Additionally, some patients feel unwell when taking certain thyroid medications but feel better with others. Therefore, it’s important to find an endocrinologist who is willing to listen to you and take the time needed to explore different dosages and consider other types of medications (or possibly even alternative diagnoses).

Conclusion: when developing a treatment plan for hypothyroidism, many factors must be considered, and it is individualized for each person.

Remember that thyroid tests have a wide normal range. You want to work with a doctor who will help you FEEL better, not just improve your test results, because once you learn about this diagnosis, you will likely live with it for a very long time. There is more than one medication, more than one laboratory test, and a “suitable” doctor for everyone.

Questions to Ask Your Doctor

What is the cause of insufficient thyroid activity (hypothyroidism)?
Do I have Hashimoto’s disease (Hashimoto’s thyroiditis)?
What do the results of my blood test mean?
How long will I need to take medication for hypothyroidism and what are the side effects?
What target TSH level will you use for me?
After I reach the optimal range, how often do you suggest I have blood tests again to ensure my dosage needs haven’t changed?
Do I have a risk of related health problems?
How quickly can I expect relief from hypothyroidism symptoms?
Can I change my lifestyle to alleviate symptoms?

Once you have the answers to these questions, you will be better prepared to discuss (possibly more than once) the best treatment plan for your thyroid with your doctor.

Barsukova (Kuzina) Liliya Albertovna.
Endocrinologist-Dietitian
V.S. Buzaev International Medical Centre