Hypothyroidism - Treatment Overview

Treatment Overview

Hypothyroidism can be easily treated using thyroid hormone medicine. The most effective and reliable thyroid replacement hormone is man-made (synthetic). After starting treatment, you will have regular visits with your doctor to make sure you have the right dose of medicine.

In most cases, symptoms of hypothyroidism start to improve within the first week after you start treatment. All symptoms usually disappear within a few months. Infants and children with hypothyroidism should always be treated. Older adults and people who are in poor health may take longer to respond to the medicine.

• If you have had radiation therapy and have hypothyroidism, or if your thyroid gland has been removed, you will most likely need treatment for the rest of your life. If your hypothyroidism is caused by Hashimoto's thyroiditis, you might also need treatment for the rest of your life. Occasionally, thyroid gland function returns on its own in Hashimoto's thyroiditis.
• If a serious illness or infection triggered your hypothyroidism, your thyroid function most likely will return to normal when you recover.
• Some medicines may cause hypothyroidism. Your thyroid function will return to normal when you stop the medicines.
• If you have mild (subclinical) hypothyroidism, you may not need treatment but should be watched for signs of hypothyroidism getting worse. Current research does not provide clear evidence to support treatment, and many health professionals disagree about whether mild hypothyroidism should be treated. When making the decision to treat mild hypothyroidism, you and your doctor will talk about the possible benefits of improved symptoms compared to potential risks and the costs of medicine and monitoring symptoms. The dose of thyroid medicine must be monitored carefully in people with heart disease because too much medicine increases the risk of chest pain (angina) and irregular heartbeats (atrial fibrillation).

Initial treatment

Your doctor will treat your hypothyroidism with the thyroid medicine levothyroxine sodium (for example, Synthroid, Levoxyl, or Levothroid). Take your medicine as directed. Your doctor will want to see you 6 to 8 weeks later to make sure the dose is right for you.

If you take too little medicine, you may have symptoms of hypothyroidism, such as constipation, feeling cold or sluggish, and gaining weight. Too much medicine can cause nervousness, difficulty sleeping, and shaking (tremors). If you have heart disease, too much medicine can cause irregular heartbeats and chest pain. People with heart disease often start on a low dose of levothyroxine, which is increased gradually.

If you have severe hypothyroidism by the time you are diagnosed, you will need immediate treatment. Severe, untreated hypothyroidism can cause myxedema coma, a rare, life-threatening condition. Treatment for myxedema coma involves care in an intensive care unit (ICU). Thyroid hormone is given intravenously (IV). If you have trouble breathing, a ventilator may be used. You will also be monitored for heart problems, including heart attack, and treated if necessary.

Treatment during pregnancy is especially important because hypothyroidism can harm the developing fetus.

• If you develop hypothyroidism during pregnancy, treatment should be started immediately. If you have hypothyroidism before you become pregnant, your thyroid hormone levels need to be monitored to determine whether the dosage of thyroid medicine is correct. During pregnancy, your dose of medicine may need to be increased by 25% to 50%.³
• You also may need treatment if you develop hypothyroidism after pregnancy (postpartum hypothyroidism). You will be retested for hypothyroidism if you become pregnant again. In some cases, hypothyroidism will go away on its own; in other cases, it is permanent and requires lifelong treatment.

Ongoing treatment

You are likely to need treatment for hypothyroidism for the rest of your life. As a result, you need to take your medicine as directed. For some people, hypothyroidism is a progressive disease and the dosage of thyroid medicine may have to be increased gradually as the thyroid continues to slow down.

Most people treated with thyroid hormone develop symptoms again if their medicine is stopped. If this occurs, medicine needs to be restarted.

If a serious illness or infection triggers your hypothyroidism, your thyroid function most likely will return to normal when you recover. To determine whether thyroid function has returned to normal, thyroid hormone medicine may be stopped for a short time. In most people, a brief period of hypothyroidism occurs after thyroid medicine is stopped; there is often a delay in the body's signals that tell the thyroid to start working again. If the thyroid can produce enough hormone on its own, treatment is no longer needed. But if hormone levels remain too low, you need to restart thyroid medicine.

While taking thyroid hormone medicine, you need to see your doctor once a year for checkups. You will have a blood test (thyroid-stimulating hormone [TSH] assay) to make sure you have a normal hormone level.

Treatment if the condition gets worse

Sometimes symptoms of hypothyroidism continue, such as sluggishness, constipation, confusion, and feeling cold. This may occur if you are not taking enough thyroid hormone or if your medicine is not absorbed from your gastrointestinal tract. Having a bowel disease or taking certain other medicines may block thyroid hormone. Your doctor may increase your dose of thyroid medicine if you are taking estrogen or phenytoin (Dilantin).³ Take calcium supplements at least 4 hours before or after taking thyroid hormone.⁹

Your doctor may suggest you try the combination therapy of T3/T4 medicine if T4 medicine is not controlling your symptoms.

If your dose of thyroid hormone is too high, you may develop complications such as irregular heartbeats and, over time, osteoporosis. If you have heart disease, too much medicine can cause pain (angina) and irregular heartbeats. Your doctor will monitor your thyroid levels using a thyroid-stimulating hormone (TSH) assay. If necessary, your doctor will lower your dose.