Do You Need Treatment For Hypothyroidism?If you have hypothyroidism you need to talk to your doctor to find out if you need treatment. Your doctor will decide whether to treat you based on factors including:
- Your T4 level and TSH levels - if tests show you have low T4 and high TSH (higher than 10 mU/L) then this usually means you need hypothyroidism treatment
- Cholestorol level
- Your age
- Whether you have other medical problems and if they will worsen or improve from thyroid replacement treatment
See Hypothyroidism Diagnosing and Testing for more information about diagnosing hypothyroidism.
Levothyroxine/Synthetic T4 For Treatment Of HypothyroidismUsually the best treatment for hypothyroidism is synthetic thyroid hormone. Levothyroxine is a synthetic form of the T4 hormone which you can take orally once a day. It is also cheap and produces no side effects as long as you are taking the right dosage.
In the past people had to use dessicated thyroid tablets made from animal thyroids to treat hypothyroidism. However this medication was not as good as levothyroxine since its potency varied from tablet to tablet.
In rare cases synthetic T4 won't improve a person's symptoms and they might need to talk to a doctor about other methods of treating hypothyroidism.
T3 vs T4 For Treating HypothyroidismSince T3 is more active than the T4 thyroid hormone, you may wonder why synthetic T3 isn't used as well, or instead of T4. The answer is because T4 is longer lasting. Synthetic T3 needs to be taken multiple times a day because it doesn't last as long, whereas you only need to take T4 once a day.
Studies have also found that taking both synthetic T3 and T4 thyroid hormones to treat hypothyroidism is not more effective than just taking synthetic T4. The body can usually convert T4 to T3 as it needs as well.
Brands of LevothyroxineBrand names of levothyroxine include:
- Thyrax Duotab
There are also generic versions of levothyroxine. If you change your brand of levothyroxine make sure to tell your doctor.
Dosage Level For Hypothyroidism TreatmentOn average, adults need 1.6 micrograms of T4 replacement per kilogram of their body weight each day. This usually works out to between 100-150 micograms each day. Children actually require higher doses.
Young healthy adults are usually started on the full dosage of synthetic T4 immediately. However older people, people with worse hypothyroidism, or people at risk of heart disease or with a heart disease history are started on a smaller dose of 25 micrograms or less of replacement T4. Their dosage is then slowly increased at intervals of six weeks. This gradual increase is so their heart can adjust to the increasing metabolism rate. Sometimes hypothyroidism can get worse with age and so the dosage might need to be increased as time goes on.
It's important to find the right dosage level for you to keep your TSH (thyroid stimulating hormones) within the healthy range. Too high a dosage of synthetic T4 can lead to side effects and health problems. Levothyroxine comes in different strengths, so your doctor should be able to find the right dosage needed for you.
Effects Of Hypothyroidism OvertreatmentTaking too much levothyroxine can lead to your TSH levels becoming too high. This can cause hyperthyroidism and other side effects, including:
- Appetite increase
- Insomnia, sleeplessness
Effects Of Hypothyroidism UndertreatmentIf your dosage of levothyroxine is too low then your hypothyroidism and its symptoms will continue to affect you.
When to Take Hypothyroidism TreatmentIt's best to take levothyroxine in the morning, 30 minutes before you eat.
Length of Hypothyroidism TreatmentUsually hypothyroidism requires lifelong treatment. There are some types of hypothyroidism where your thyroid function might eventually return to normal though.
- If you have sublinical or mild hypothyroidism then you might not need any treatment. However you should talk to your doctor about this.
- If your hypothyroidism was caused by an illness or infection then once you recover your thyroid will probably return to normal.
- Hashimoto's thyroiditis often needs treatment for the rest of your life. However sometimes normal thyroid function can resume so that you no longer need treatment.
- Sometimes medications can cause hypothyroidism. If so, then once you stop taking the medication your thyroid will probably go back to normal.
If you are taking treatment you should not stop once you feel better. If you do then your hypothyroidism symptoms will soon return. You should only stop treatment if your doctor advises you to.
Stopping Hypothyroidism TreatmentUsually if you stop hypothyroidism treatment your symptoms will come back and you'll need to restart treatment again. However if your hypothyroidism was caused by an infection or serious illness then once you recover your hypothyroidism will probably stop too. Your doctor may recommend stopping thyroid medication for a brief time to see if your thyroid has returned to normal. Once treatment stops you may feel hypothyroidism for a short period, but then your thyroid may start to produce normal amounts of hormone on its own. However if the thyroid is not able to produce enough hormone then the hypothyroidism will continue and you'll need to restart your treatment.
How Long Until You See Results Of Hypothyroidism TreatmentYou should usually begin to see results around a week after starting treatment. You should start to feel less tired and other hypothyroidism symptoms should reduce also. After a few months of treatment, all hypothyroidism symptoms should be gone. Older people or people who are quite sick may take longer to see results.
Monitoring And Adjustment Of Hypothyroidism TreatmentYour doctor will need to monitor your TSH levels and perhaps adjust your levothyroxine dosage to keep TSH within the healthy range. After you begin treatment your doctor will usually recheck your TSH levels every six weeks with a blood test. Once TSH levels become stable you will only need a check up and blood test once per year.
If you change your brand of levothyroxine you should talk to your doctor since he will probably need to adjust your dosage. Also if you become pregnant while you use levothyroxine you should also tell your doctor because he will probably need to adjust your dosage, usually to increase it.
Using Levothyroxine With Other MedicationsSome medications, such as those with iron or antacid, can reduce the absorption of levothyroxine. It's best to avoid these things if you are on levothyroxine:
- Aluminum hydroxide
- Calcium supplements
- Iron supplements
- Soy foods
- High fibre diet
Side Effects Of Hypothyroidism TreatmentIf taken in the right amounts, levothyroxine should not cause side effects. However if your dosage is too high you may suffer the symptoms of hyperthyroidism. If your dosage is too low then you will continue to suffer hypothyroidism symptoms.
Treatment Of Subclinical Or Mild HypothyroidismSubclinical hypothyroidism is where your thyroxine levels are normal, your TSH levels are only slightly higher than normal and you show no clear symptoms. If you have subclinical or mild hypothyroidism you might not need treatment. However you should talk to your doctor to find out. Some doctors believe that treating subclinical hypothyroidism can be overtreatment and lead to hyperthyroidism. Others believe that treating subclinical hypothyroidism can prevent it progressing to worse hypothyroidism and more severe symptoms.
There is consensus that you should get treatment in some cases though. Treatment is recommended if you have subclinical hypothyrodism as well as any of these:
- Autoantibodies in your blood showing you're at risk of autoimmune hypothyroidism such as Hashimoto's thyroiditis
- High cholestorol
- Infertility in females caused by hypothyroidism
- TSH levels above 10 mU/L