Treatment Using Synthetic Thyroxine (T4)
Hypothyroidism (defined as insufficient hormone secretion by the thyroid GLAND) is usually quite easy to treat (for most people)!
The easiest and most effective treatment is simply taking a thyroid hormone pill (Levothyroxine) once a day, preferably in the morning. This medication is a pure synthetic form of T4, which is made in a laboratory to be an exact replacement for the T4 that the human thyroid gland normally secretes. It comes in multiple strengths, which means that an appropriate dosage can almost always be found for each patient. The dosage should be reevaluated and possibly adjusted monthly until the proper level is established. The dose should then be reevaluated at least annually. If you are on this medication, make sure your physician knows it so he/she can check the levels at least yearly.
Note: Just like we discussed above, however, this simple approach does not hold true for everybody. Occasionally the correct dosage is a bit difficult to pinpoint and therefore you may need an exam and blood tests more frequently. Also, some patients just dont do well on some thyroid medications and will be quite happy on another. For these reasons you should not be shy in discussing with your doctor your blood hormone tests, symptoms, how you feel, and the type of medicine you are taking. The goal is to make you feel better, make your body last longer, slow the risk of heart disease and osteoporosisin addition to making your blood levels normal! Sometimes thats easy, when its not, you need a physician who is willing to spend the time with you that you deserve while you explore different dosages other types of medications (or alternative diagnoses).
Some patients will notice a slight reduction in symptoms within 1 to 2 weeks, but the full metabolic response to thyroid hormone therapy is often delayed for a month or two before the patient feels completely normal. It is important that the correct amount of thyroid hormone is used. Not enough and the patient may have continued fatigue or some of the other symptoms of hypothyroidism. Too high a dose could cause symptoms of nervousness, palpitations or insomnia typical of hyperthyroidism. Some recent studies have suggested that too much thyroid hormone may cause increased calcium loss from bone increasing the patients risk for osteoporosis. For patients with heart conditions or diseases, an optimal thyroid dose is particularly important.
Even slight excess may increase the patients risk for heart attack or worsen angina. Some physicians feel that more frequent dose checks and blood hormone levels are appropriate in these patients.
After about one month of treatment, hormone levels are measured in the blood to establish whether the dose of thyroid hormone, which the patient is taking, is appropriate. We dont want too much given or subtle symptoms of hyperthyroidism could ensue, and too little would not alleviate the symptoms completely. Often blood samples are also checked to see if there are antibodies against the thyroid, a sign of autoimmune thyroiditis. Remember, this is the most common cause of hypothyroidism.
Once treatment for hypothyroidism has been started, it typically will continue for the patients life. Therefore, it is of great importance that the diagnosis be firmly established and you have a good relationship with a physician you like and trust Synthetic T4 can be safely taken with most other medications. Patients taking cholestyramine (a compound used to lower blood cholesterol) or certain medications for seizures should check with their physician about potential interactions.
Women taking T4 who become pregnant should feel confident that the medication is exactly what their own thyroid gland would otherwise make. However, they should check with their physician since the T4 dose may have to be adjusted during pregnancy (usually more hormone is needed to meet the increased demands of the mothers new increased metabolism). There are other potential problems with other drugs including iron-containing vitamins. Once again, pregnant women (and all women and men for that matter) taking iron supplements should discuss this with your physician. You may want to discuss with your doctor or pharmacist the most cost effective brand since recent studies suggest that none is better than the other.