Thyroid Hormone Treatment

This brochure has been written for you if you are being treated with thyroid hormone. You may be taking thyroid therapy because your own thyroid gland is underactive (hypothyroid) and your physician wants to raise the amount of thyroid hormone in your system to normal. Many patients also take thyroid hormone to control the growth of their thyroid gland, which may be enlarged (a goiter) or contain nodules (lumps).

This brochure has also been written for patients who are taking thyroid hormone because of a history of thyroid cancer. If that is your situation, your doctor is giving you thyroid hormone treatment to reduce the risk of developing a recurrence of your tumor, as well as treating your underactive thyroid resulting from surgery.

No matter which of these therapeutic situations fits you best, you should speak with your doctor to be sure that you know why you are being treated and how long the treatment will last. We hope that you will find this brochure helpful as a resource for general information about thyroid hormone therapy. Just like your doctor, we want you to know why you are being treated, the importance of taking your medication regularly and reliably, and what this medication is expected to do for you.

How Does Your Doctor Choose the Proper Dosage of Thyroid Hormone?

In past years there were no truly precise laboratory tests for your doctor to use in choosing a proper dose of thyroid hormone. Rather, physicians relied on their patients to tell them whether they felt well or normal. They might have been guided by improvement in a patientís hair, skin, pulse, and reflexes, or a goiter or thyroid nodules may have disappeared. Unfortunately, such guidelines for therapy were not always accurate enough to assure proper thyroid hormone dosage.

Today the uncertainty of thyroid therapy has largely been eliminated by the development of accurate and sensitive laboratory tests which measure blood levels of important hormones.

How Does Your Doctor Evaluate Your Treatment?

When you visit your physician for a check-up about your thyroid hormone treatment, expect to be asked about changes in the way you feel. He or she will examine your thyroid and assess the effectiveness of your therapy. Your physician may also recommend a blood test to measure the concentrations of thyroid hormones as well as your serum TSH level.

Thyroid-stimulating hormone, or TSH, is a hormone made by your pituitary gland that controls thyroid function. The pituitary regulates your thyroid in much the same way that the thermostat on your living room wall regulates your furnace.

If your pituitary gland senses that there is not enough thyroid hormone in your blood, it will release TSH; TSH stimulates the thyroid, in turn, to increase production and release of thyroid hormone into the blood. When there is enough thyroid hormone in the bloodstream, the pituitary decreases production of TSH. If there is too much thyroid hormone in your system, such as might happen from an overactive thyroid (hyperthyroidism) or from your taking too much thyroid hormone medication, the pituitary stops production of TSH entirely and TSH disappears from your bloodstream.

Thyroid hormone is usually prescribed as pure synthetic thyroxine (T4). Desiccated (dried and powdered) animal thyroid, once the most common form of thyroid therapy, is rarely prescribed today because it also contains triiodothyronine (T3), a rapidly acting thyroid hormone which produces more variable blood levels than pure thyroxine preparations. It also may vary in potency from batch to batch, because it comes from animal thyroid glands, which can vary in their thyroid hormone content. Most endocrinologists switch patients who are taking desiccated thyroid to synthetic thyroxine, which is purer and has a constant level of potency. There is no evidence that desiccated thyroid, a biological preparation, has any advantage over synthetic thyroxine.

Gradually increasing doses of thyroxine are given until the blood levels of T4 and TSH are both in the normal range. In instances where the patient is elderly or has an underlying heart condition, it is extremely important to start with a very low dose of thyroid hormone until the body gets used to the more normal thyroid hormone levels. Since the potency of generic thyroxine has in the past varied considerably, your physician will likely specify a brand name of thyroxine to treat hypothyroidism.

If your doctor is treating you for hypothyroidism, it is likely that you will be treated with gradually increasing doses of thyroid hormone until you feel well and your thyroid hormone and TSH levels are in the normal range. Most physicians want a follow-up examination once a year, during which he or she will make sure that these levels are still normal. For some patients, thyroid failure is a progressive disease, and the thyroid dosage may have to be increased little by little as the thyroid continues to slow down.

Certain patients, especially those with thyroid cancer, will be given as much thyroid hormone as necessary to virtually eliminate TSH from the blood. TSH may stimulate the growth and spread of thyroid cancers. Here, too, periodic blood tests will be needed to assure that this goal of therapy has been achieved.

Are There Problems with Taking Too Much or Too Little Hormone?

If you are being treated for an underactive thyroid and are not taking enough thyroid hormone, some of the symptoms of hypothyroidism such as sluggishness, mental dullness, feeling cold, or muscle cramps may persist. In addition, you may have problems with elevation of cholesterol which could increase your risk for hardening of the arteries (arteriosclerosis). If you take too much thyroid hormone, you may have symptoms mimicking an overactive thyroid, including nervousness, palpitations, insomnia, and tremor. It is also possible that mild thyroid hormone excess over many years may increase your risk for a serious heart rhythm problem or heart attack if you have underlying heart disease. It may also cause excessive calcium loss from your bones and thus increase your risk for fractures in later years.

What You Can Do

1. See your doctor regularly and understand the purpose of your therapy.

2. Take your thyroid pills every day. You are more likely to remember them if you take them at the same time every day. If you are having trouble remembering the medication, try putting your thyroid tablets near your toothbrush and take your tablet right after brushing your teeth every morning. If you remember that you missed a tablet, you may safely take two tablets the next day.

3. If a physician starts you on new treatments for non-thyroid disease, ask your doctor if this will make any difference to your dose of thyroxine. Also notify your doctor if you become pregnant, since your thyroid hormone dose may have to be changed.

4. Call your doctor if you have questions about new symptoms or if it has been more than one year since your last check-up. If you change doctors, be sure that the new physician knows about your thyroid problem.

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