Hypothyroidism Treatment Options

Signs and symptoms of hypothyroidism are caused by low levels of thyroid hormones, T4 and T3, in the blood. These hormones play an important role in regulating metabolic rate and energy levels of the body. Restoring the levels of thyroid hormones is the most commonly used treatment method for hypothyroidism. As hormone levels are restored, the signs and symptoms of the condition improve considerably.

Need for treatment is based on the following factors:

• Low levels of T4
• High levels of thyroid stimulating hormone (TSH)
• Blood cholesterol levels
• Age of the patient
• Presence of other medical conditions

It is important to treat children with hypothyroidism without delay. People who have hypothyroidism due to thyroid removal surgery (thyroidectomy) or radiation therapy also require treatment. Severe forms of hypothyroidism require immediate treatment to prevent some potentially life threatening complications such as myxedema coma.

Synthetic thyroid hormones like levothyroxine is the medication of choice in the control of hypothyroidism. With the use of this medication for a few weeks, fatigue and other symptoms gradually reduce in severity. It also helps in reducing body weight gained due to hypothyroidism. Hormone therapy may have to be exercised for a life time, but the dosage may change over time.

Dosage for medication

Dosage for a particular patient is decided based on the levels of TSH in the blood. Blood tests are done once every 2-3 months to assess the levels of TSH. Increased dosage may result in palpitations, hunger, trembling, and sleeplessness. Dosage for medication may also depend on certain conditions. In the presence of coronary artery disease, the dosage of thyroid hormone is gradually increased so that heart can adjust to increased metabolic rate. Other considerations for dosage include

• TSH levels should be re-evaluated if the patient is planning to start or discontinue the use of other hormones like estrogen or androgen. These hormones may change the requirement for thyroxine hormones.
• Tyrosine kinase inhibitors affect the metabolism of thyroxine hormones and hence levels of TSH should be checked before introducing this medication.
• Some other factors considered during the introduction of synthetic thyroxine include body weight, lean mass, pregnancy, causes, age and severity of hypothyroidism.
• A re-evaluation of TSH is required if the patient is under treatment for other conditions like gastrointestinal disorders.

Once the dosage is established, it may require an annual re-evaluation. In some patients, finding or deciding the most appropriate dosage of medication may be difficult, and may need frequent blood tests. Moreover, the patient may not respond well to one thyroid medication when compared to another. Hence, one should not shy from discussing the status of symptoms with the doctor after the initiation of treatment.

How long will it take to cure the symptoms of hypothyroidism?

In most of the cases, the symptoms start subsiding within the first few weeks of initiating the hormone therapy. The symptoms may completely disappear within few months. Response to thyroxine treatment may be delayed in older adults and those with other medical conditions. Patients with hypothyroidism caused by Hashimoto’s thyroiditis, may get back normal thyroid gland function after a period of time without any specific treatment. If hypothyroidism is triggered by infection or any other medical conditions, thyroid function may be restored when the infection or illness is contained or treated. Symptoms of hypothyroidism may reduce by stopping the medication that cause sluggish thyroid functioning. 

Alternative medications

Synthetic hormone is most commonly used medication for treating hypothyroidism. Natural extracts of thyroid hormone from pigs, containing both thyroxine and triiodothyronine (T3) are sometimes used in the treatment of the condition. But many of these alternative medications are not regulated and hence should be used with caution.

Treatment for sub-clinical hypothyroidism

Mild forms of hypothyroidism, or sub-clinical hypothyroidism, may not need treatment. In this case, the doctor may suggest a ‘wait and watch’ approach. Treatment with synthetic hormone may be initiated only if the signs and symptoms of the condition worsen.