Management of Hypothyroidism

Thyroid gland sample

Hypothyroidism is a common endocrine disorder that affects women more than men. Being a lifelong condition and an endocrine disorder that can lead to numerous complications, hypothyroidism needs proper care.

Hypothyroidism is caused due to a primary insufficiency of the thyroid glands (primary hypothyroidism) or as a consequence of a disorder in the pituitary glands or hypothalamus. In the second case, people have hypothyroidism since there is insufficient stimulation of the thyroid glands leading to the thyroid problem hypothyroidism.

Hypothyroidism can also be caused due to autoimmune diseases and so the treatment of hypothyroidism depends upon the underlying causes and managing or preventing the complications of hypothyroidism.

What happens in untreated hypothyroidism?

Undiagnosed, and untreated hypothyroidism leads to numerous serious complications.

  • Hypertension
  • High cholesterol levels
  • High triglyceride levels
  • Heart diseases like atherosclerosis, heart attack
  • Cognitive impairment
  • Infertility
  • Neuromuscular dysfunction

In pregnant women, it can lead to birth defects to the fetus. These birth defects can be physical and mental.

In extreme cases, it can lead to a condition called myxedema. Though rare, myxedema is a life-threatening condition that causes the metabolism of a person to slow down eventually leading to coma. Myxedema symptoms include extreme fatigue and cold intolerance. It needs immediate medical attention.

Hypothyroidism can also lead to mental health issues like mood disorders, and depression.

Hypothyroidism Diagnosis & Treatment

Once a person exhibits hypothyroidism symptoms, he/she is advised by the general practitioner to consult an endocrinologist. The endocrinologist further suggests diagnostic tests including a thyroid profile test, and blood works like lipid profile, and blood sugar test among others. The thyroid profile test includes a test of TSH level. A high TSH level and is an indicator of hypothyroidism.

Hypothyroidism Diagnosis Criteria

  • Subclinical Hypothyroidism: High TSH level, normal T4 level
  • Primary Hypothyroidism: High TSH level, low T4 level
  • Secondary Hypothyroidism: Normal TSH level, low T4

Hypothyroidism treatment depends upon the causes of the condition and the management /prevention of complications. Coexisting diseases are also taken into consideration while treating hypothyroidism.

Hypothyroidism treatment is provided by endocrinologists in conjunction with the general practitioners in order to manage/prevent cardiac and other complications.

Hypothyroidism treatment goals

The goals of hypothyroidism treatment are generally set specific to the individual’s health condition. These are set by the endocrinologist. However, the general goals of hypothyroidism treatment include normalizing thyroid hormone levels along with:

  • Stabilizing resting heart rate
  • Normalizing cholesterol levels
  • Normalizing menstrual cycles
  • Reducing anxiety levels
  • Normalizing sleep patterns

Hypothyroidism Treatment and Management

Hypothyroidism treatment

After hypothyroidism diagnosis is confirmed by an endocrinologist, the patient is initiated on L-thyroxine replacement therapy. L-thyroxine is the first-line therapy for hypothyroidism. This is done after an assessment of Free T4 in the blood in order to determine the dosing of L-thyroxine. However, some patients are also treated with a combination of L-thyroxine and L-Triiodothyronine.

The dosage of L-thyroxine is dependent upon age, lean body mass, possible pregnancy, and weight of the patient. Having said that, people with subclinical hypothyroidism need lesser dosages when compared to those who have hypothyroidism. People who have had a thyroid surgery with thyroidectomy or radioiodine therapy might need the highest dosage. Dosages are determined by endocrinologists.

Hypothyroidism management

L-thyroxine therapy with levothyroxine tablets is the first-line therapy for hypothyroidism. Most endocrinologists prescribe taking these tablets an hour before breakfast in the morning. This is because absorption of the medication is maximum at this time.

After initiating a patient on L-thyroxine therapy for around four to eight weeks, TSH levels are measured in order to adjust dosages. In the case of central hypothyroidism, the levels of Free T4 are measured after 4-8 weeks in order to adjust dosages.

In order to attain normal TSH levels it might take one to two months. To get relief from hypothyroidism disease symptoms like skin changes, it might take around three to six months. Ultimately, a patient with hypothyroidism is treated for reaching normal thyroid hormone values in order to avoid serious complications.

Though the dosage of L-thyroxine might reduce with progressing age and significant weight loss, there is still need for frequent checkups for cardiovascular diseases and angina disorders.

Side effects of L-thyroxine therapy

L-thyroxine therapy is highly effective for people with hypothyroidism; however, this therapy does have some side effects including:

  • Nervousness
  • Fatigue
  • Headache
  • Sleeplessness
  • Tremors
  • Tachycardia (faster heartbeat)
  • Palpitations
  • Atrial fibrillation

Most of these side effects are reduced with a dose adjustment. In some cases, these side effects need further evaluation by an endocrinologist.

If you experience any of these side effects with hypothyroid medication, consult an endocrinologist.

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Along with medication, hypothyroidism treatment and management involves a change in the lifestyle with modification in the diet, and physical exercise in order to reduce cholesterol levels and to reduce weight. Lifestyle modifications go a long way in managing hypothyroidism as they are known to reduce the risk of heart diseases.