Charlotte, NC
Dipesh Rohita, MD
Mose July, MD
Mary is a 45-year-old woman recently diagnosed with hypothyroidism. She was prescribed Levothyroxine by her primary care provider. What advice do you have for her?
The thyroid gland is a small butterfly-shaped organ in the lower front of the neck. The thyroid gland produces thyroid hormones. Thyroid hormones aid the body’s energy usage and keep our brain and other vital organs warm. Individuals who have a lesser amount of thyroid hormones in their blood are hypothyroid. Hypothyroidism occurs when the thyroid organ cannot produce enough thyroid hormones to maintain the body’s functioning.
Your thyroid can be underactive and not make enough thyroid hormones for multiple reasons.
The most common reasons include:
When thyroid hormone levels are low, the body’s cells cannot get enough fuel, and different processes in the body start slowing down. As a result, you may experience fatigue, cold intolerance, constipation, or weight gain. Some people may also have dry hair and skin, muscle cramps, and depression. Others might not have any symptoms at all. However, if your thyroid gland is underactive, your doctor may be able to find out about it during a routine screening that your thyroid gland is underactive.
Your doctor will take a detailed history of your health and look for changes in your body, such as dry skin, swelling of the body, slower reflexes, and a slower heart rate during your physical examination.
Thyroid-stimulating hormone (TSH) test is the first and most important test to check for hypothyroidism. Other blood tests include measuring the amount of thyroid hormone thyroxine (T4) made by the thyroid gland. Your doctor might also test for antibodies in the blood that attack the thyroid gland (antithyroid antibodies) to help diagnose the cause of hypothyroidism.
Your doctor will do periodic TSH screening tests if you have risk factors for hypothyroidism that commonly include your biological sex being female, if you are getting older if you are white or have type 1 diabetes, Down syndrome, a family history of thyroid disease, goiter, previous hyperthyroidism, and a history of radiation in the head and neck area.
Treating hypothyroidism involves taking a pill daily to replace the thyroid hormone in your body. Levothyroxine, commonly known as Synthroid, is the most commonly prescribed thyroid hormone replacement drug.
Your doctor may start with a small dose based on your need and comorbidities. It is essential to take this medicine with a lot of water and space it between meals (1 hour before or 4 hours after a meal). It is best to avoid taking Synthroid with vitamin supplements that have iron, calcium, or soy as they decrease the drug’s optimal absorption in your body.
Your doctor will also order blood tests, which might require several doctor visits to determine your correct dosage. Do note that the benefits of the treatment may not be visible for a month or longer, but this does not mean the treatment is not working.
Hypothyroidism cannot be cured completely. Most people supplement their thyroid hormone with pills for the remainder of their lives; however, hypothyroidism can be controlled in almost every patient.
It is best to talk to your doctor to ascertain which options work best for you. Some patients do not feel better after taking Levothyroxine. In this case, your doctor could add T3 (Cytomel) along with Levothyroxine which may be more beneficial.
Diet plays an essential role in managing thyroid disease. Goitrogens are substances that interfere with thyroid hormone production. Goitrogens are present in everyday food items we eat. They are found in broccoli, cabbage, cauliflower, spinach, kale, and Brussel sprouts. Other fruits and vegetables like sweet potatoes, cassava, peaches, and strawberries also have goitrogens. Since these foods are also very nutritious, the benefits of eating them outweigh the risks. Instead of avoiding them, we recommend incorporating high-fiber foods, fruits and vegetables, coconut oil, and probiotics into your dietary plan. Moderation is key in eating food items with goitrogens to maintain your diet and thyroid health.
Most thyroid problems are lifelong, so supplementary hormones are essential to managing your thyroid health. You will feel well when your thyroid hormone is at the right level. However, this does not mean you stop taking the extra hormones since your gland cannot make enough. You may be able to stop after recovering from thyroid inflammation after pregnancy or thyroiditis after a viral infection, however, you will need to consult your doctor to ensure the underlying condition has been resolved. It is also imperative to follow up with your doctor and monitor your TSH levels regularly.
