Thyroid Hormone Deficiency (Hypothyroidism): Treatment and Monitoring
What types of thyroid hormone deficiency are caused by autoimmune disease?
Each year, approximately four out of every 1,000 women develop autoimmune hypothyroidism. One type of autoimmune hypothyroidism, Hashimoto’s thyroiditis, results when your body produces antibodies to an enzyme called thyroid peroxidase, or TPO. Another type, called atrophic thyroiditis, results when the thyroid gland simply atrophies over time. Sometimes this results from Hashimoto’s thyroiditis. In other cases, this is a side effect of treatment for a form of autoimmune thyroid hormone excess, called Graves’ disease.
What are the medical treatments for my conditions?
Thyroid hormone replacement represents the cornerstone of treatment for thyroid hormone deficiency, regardless of the cause. Your doctor will prescribe levothyroxine, a synthetic form of T4, that is taken once daily by mouth with a full glass of water, 30 to 60 minutes before breakfast. Adults under 60 without evidence of heart disease generally start on doses between 50 and 100 μg. If you have evidence of heart disease; longstanding or severe, untreated hypothyroidism; a previous history of Graves’ disease or other types of hyperthyroidism; or subclinical hypothyroidism, you may start on a lower dose. Pharmaceutical companies market levothyroxine under several brand names, including Synthroid and Levothyroid. However, it is also available as a generic. Always read the inserts that come with your medications, especially if you have allergies. Some levothyroxine preparations contain povidone, tartrazine, cornstarch, or lactose, ingredients that can cause problems for sensitive individuals.
Although most doctors prescribe levothyroxine, thyroid hormone extracts derived from pigs are also available. Unlike levothyroxine, these extracts include both T3 and T4 and, for some patients, may offer superior symptom control. These extracts, marketed under the brand names Armour and Nature-Throid, are available by prescription only and should not be confused with supplements sold as over-the-counter dietary supplements.
How will my doctor monitor my condition, and how frequently at first and over time?
The symptoms of autoimmune hypothyroidism usually develop gradually and correcting them is also a slow process. For patients, this is often the most frustrating aspect of the disease! Your doctor will typically schedule follow-up TSH, T4 and T3 blood tests about two months after you start thyroid hormone replacement. If your TSH remains above the reference range, your doctor may increase your dose by 12.5 or 25 μg per day. If your TSH drops below the reference range, she may decrease your dose by similar increments. Patients often do not experience complete relief from symptoms for 3 to 6 months after TSH levels become normal and it often takes several adjustments to reach normal levels.
Once your TSH, T4 and T3 levels are stable within normal limits, your doctor may recheck them at annual intervals. After several years with no change, your doctor may extend this interval to every 2 to 3 years. The key word here is stable. The autoimmune process gradually reduces thyroid function. For the first few years after diagnosis, your condition usually isn’t stable. This means you and your doctor are essentially treating a moving target! Other changes, such as pregnancy also impact your thyroid hormone status. If you are pregnant or thinking about becoming pregnant, talk to your doctor right away.
Questions for your doctor:
- How can I best monitor my condition, especially if my symptoms don’t seem stable?
- What if I become pregnant on levothyroxine or another thyroid hormone replacement?
- Can I breastfeed on levothyroxine or another thyroid hormone replacement?
- Will levothyroxine or another thyroid hormone replacement interact with my other medications or health conditions?
About the Author
Heather Breen is a physician and registered dietitian living in Charlotte, North Carolina.
This blog post was originally published by AutoimmuneMom.com, written by Heather Breen and first published on Apr 3, 2012.
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