How Do I Treat Hypothyroidism?

Published: December 15, 2022
By Eric Pham, 2023 PharmD Candidate

Thyroid hormone is produced by your thyroid gland, which is located in your neck. Thyroid hormone is responsible for your body’s metabolism (how your body turns food into fuel).

What happens when my thyroid hormone level gets low?
Hypothyroidism (low thyroid) occurs over time, so symptoms may be gradual and subtle. Symptoms may include any of the following:

  • fatigue (feeling tired)
  • forgetfulness
  • depression (low mood)
  • numbness and tingling in hands
  • Increased sensitivity to cold
  • muscle soreness and weakness
  • weight gain and/or fluid retention

In a lot of cases, the symptoms can be mild and may not need treatment. In some cases, levels can get so low that patients may be at risk for serious or life-threatening consequences, including difficulty regulating body temperature, trouble breathing, heart problems, development of a goiter (enlarged thyroid gland), and myxedema coma (when hypothyroidism gets so severe, the body starts to shut down).

What causes hypothyroidism?
Most cases of hypothyroidism are caused by an autoimmune condition where the body attacks the thyroid gland, which keeps it from producing enough thyroid hormone to regulate the body. Other causes of hypothyroidism include the destruction of the thyroid from radiation or cancer, too little or too much iodine (the body uses iodine to make thyroid hormone), or some medications.

How will my doctor diagnose me with hypothyroidism?
Your doctor will ask you about your symptoms and family history. They will also perform a physical exam to look at your skin and extremities for swelling as well as check your thyroid to see if it is enlarged. They will also order blood tests where they will look at your levels of TSH (thyroid-stimulating hormone), a hormone responsible for telling your body how much thyroid hormone (T4) to make. They will also look at the levels of T4 but it is not as useful as the TSH. In some cases, they may also order an ultrasound of your thyroid.

How do you treat hypothyroidism?
Mild cases may not need treatment and you may just monitor your symptoms and labs over time. Other cases may require daily medication to replace the thyroid.

Levothyroxine (T4) (Synthroid) is the most commonly prescribed medication for the treatment of hypothyroidism and provides a synthetic form of thyroid hormone. There are other synthetic and natural thyroid replacement products that are less commonly used.

You should have your TSH levels and clinical symptoms checked every 4-6 weeks until levels are normal. Then, it should be checked 4-6 months later, then annually.

Pharmacist’s tips for taking thyroid medicine

  • It is important to consume a consistent preparation (ex. the same formulation and manufacturer) to keep thyroid levels within the goal range.
  • You should take this medication as prescribed by your doctor, typically, once daily at the same time each day for consistent absorption.
  • This medication should be taken with water and on an empty stomach, 30 minutes to 1 hour before breakfast.
  • Antacids, iron, calcium, aluminum, magnesium, cholestyramine, orlistat, sevelamer, and sucralfate should be separated from levothyroxine by at least 4 hours.
  • This medication should not be suddenly discontinued, and you should discuss with your doctor a plan to gradually reduce your dose, if necessary.

Hypothyroidism is a common disorder that is typically treated with a thyroid replacement medication like levothyroxine. Appropriately consuming your levothyroxine dose and checking your serum TSH and thyroid hormone level is useful to ensure your hypothyroidism is well-controlled.

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