Treatment guidelines for patients with hyperthyroidism and hypothyroidism. Consensus statement for good practice and audit measures in the management of hypothyroidism and hyperthyroidism. Timing and magnitude of increases in levothyroxine requirements during pregnancy in women with hypothyroidism. N Engl J Med. The thyroid gland. Greenspan's Basic and Clinical Endocrinology.
Accessed April 30, Wartofsky L. Levothyroxine therapy for hypothyroidism: should we abandon conservative dosage titration? Synthroid levothyroxine sodium tablets, USP [package insert]. North Chicago, Ill. Accessed January 27, American Association of Clinical Endocrinologists.
The starting dose of levothyroxine in primary hypothyroidism treatment: a prospective, randomized, double-blind trial. Effects of evening vs. Treatment of hypothyroidism with once weekly thyroxine. Thyroxine-triiodothyronine combination therapy versus thyroxine monotherapy for clinical hypothyroidism: meta-analysis of randomized controlled trials.
Common variation in the DIO2 gene predicts baseline psychological well-being and response to combination thyroxine plus triiodothyronine therapy in hypothyroid patients. Elevated serum thyrotropin in thyroxine-treated patients with hypothyroidism given sertraline. Spontaneous subclinical hypothyroidism in patients older than 55 years: an analysis of natural course and risk factors for the development of overt thyroid failure. This content is owned by the AAFP.
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Previous: Epidural Analgesia for Labor Pain. Aug 1, Issue. Hypothyroidism: An Update. C 12 Older patients and patients with known or suspected ischemic heart disease should be started on 25 to 50 mcg of levothyroxine daily, rather than the full replacement dosage, because of the potential risk of tachyarrhythmia or acute coronary syndrome. C 19 , 20 Patients with hypothyroidism who become pregnant should have their levothyroxine dosage immediately increased to nine doses weekly.
B 21 Patients who remain symptomatic on appropriate doses of levothyroxine, as determined by a thyroid-stimulating hormone level of less than 2. Enlarge Print Table 1.
Table 1. Enlarge Print Table 2. Clinical Signs of Hypothyroidism Bradycardia Coarse facies Cognitive impairment Delayed relaxation phase of deep tendon reflexes Diastolic hypertension Edema Goiter Hypothermia Laboratory results Elevated C-reactive protein Hyperprolactinemia Hyponatremia Increased creatine kinase Increased low-density lipoprotein cholesterol Increased triglycerides Normocytic anemia Proteinuria Lateral eyebrow thinning Low-voltage electrocardiography Macroglossia Periorbital edema Pleural and pericardial effusion.
Table 2. Evaluation for Suspected Hypothyroidism Figure 1. Treatment of Primary Hypothyroidism Figure 2. Enlarge Print Table 3. Table 3. Enlarge Print Table 4. Table 4. Enlarge Print Table 5.
Common Reasons for Abnormal TSH Levels on a Previously Stable Dosage of Thyroid Hormone Patient nonadherent to thyroid hormone regimen missing doses Decreased absorption of thyroid hormone Patient is now taking thyroid hormone with food Patient takes thyroid hormone within four hours of calcium, iron, soy products, or aluminum-containing antacids Patient is prescribed medication that decreases absorption of thyroid hormone, such as cholestyramine Questran , colestipol Colestid , orlistat Xenical , or sucralfate Carafate Patient is now pregnant or recently started or stopped estrogen-containing oral contraceptive or hormone therapy Generic substitution for brand name or vice versa, or substitution of one generic formulation for another 25 Patient started on sertraline Zoloft , another selective serotonin reuptake inhibitor, or a tricyclic antidepressant 31 Patient started on carbamazepine Tegretol or phenytoin Dilantin note : Reasons are sorted by the clinically most important cause.
Table 5. Enlarge Print Table 6. Reasons for Endocrinology Consultation in Patients with Hypothyroidism Age younger than 18 years Cardiac disease Coexisting endocrine diseases Myxedema coma suspected Pregnancy Presence of goiter, nodule, or other structural thyroid gland abnormality Unresponsive to therapy Information from reference Table 6.
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Delayed relaxation phase of deep tendon reflexes. Diastolic hypertension. Lateral eyebrow thinning. Low-voltage electrocardiography. Pleural and pericardial effusion. Older patients; patients with known or suspected cardiac disease. Patient with subclinical hypothyroidism. Adrenal insufficiency rare. Chronic kidney disease. Obstructive sleep apnea. Patient nonadherent to thyroid hormone regimen missing doses.
Decreased absorption of thyroid hormone. Patient started on carbamazepine Tegretol or phenytoin Dilantin. Age younger than 18 years. Coexisting endocrine diseases. Myxedema coma suspected. Presence of goiter, nodule, or other structural thyroid gland abnormality.
Unresponsive to therapy. Log in Best Value! Methods A search of the literature was conducted using PubMed and general search terms such as primary hypothyroidism, levothyroxine, aetiology, economic impact, quality of life and treatment guidelines. Hypothyroidism in Context Causes of Hypothyroidism As described earlier, hypothyroidism is characterised by deficiency in the T4 and T3 hormones [ 1 , 2 ].
Prevalence and Incidence The reported prevalence of hypothyroidism varies geographically, in part due to differences in disease definitions, poorly defined and diverse populations studied, variability in the sensitivity of measures of thyroid function used in the past, and iodine intake [ 27 ]. Impact of Iodine Worldwide, environmental iodine deficiency is the most common cause of thyroid disorders, including hypothyroidism [ 6 ].
Diagnosis of Hypothyroidism Hypothyroidism has a varied clinical presentation and non-specific symptoms, including weight gain, fatigue, poor concentration, depression, diffuse muscle pain, menstrual irregularities, and constipation [ 4 ], with no particular symptom definitively predicting the presence of hypothyroidism [ 52 ].
Table 1 Available formulations of levothyroxine. Open in a separate window. The Use of Levothyroxine to Treat Hypothyroidism Upon diagnosis of hypothyroidism, lifelong treatment with levothyroxine is often initiated [ 4 , 53 , 67 , 68 , 71 — 73 ], except in cases where hypothyroidism is caused by transient forms of thyroiditis or by drugs which can be discontinued [ 50 ].
Acknowledgements This supplement has been sponsored by Merck. Authorship All named authors meet the International Committee of Medical Journal Editors ICMJE criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
Compliance with Ethics Guidelines This article is based on previously conducted studies and does not contain any studies with animals performed by any of the authors. Footnotes Enhanced Digital Features To view enhanced digital features for this article go to References 1. Shift from levothyroxine tablets to liquid formulation at breakfast improves quality of life of hypothyroid patients.
Malaty W. Primary hypothyroidism. Accessed 4 Jan Hypothyroidism: an update. Am Fam Physician. Intraepidermal nerve fiber density reduction as a marker of preclinical asymptomatic small-fiber sensory neuropathy in hypothyroid patients. Eur J Endocrinol. Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull. Epidemiology of subtypes of hypothyroidism in Denmark.
The incidence and prevalence of thyroid dysfunction in Europe: a meta-analysis. J Clin Endocrinol Metab. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol Oxf ; 7 — Comparative study of thyroid function and types of thyroid dysfunction in two areas in Denmark with slightly different iodine status.
Clinical, behavioural and pharmacogenomic factors influencing the response to levothyroxine therapy in patients with primary hypothyroidism-protocol for a systematic review.
Syst Rev. Kraut E, Farahani P. Clin Invest Med. Is delayed diagnosis of hypothyroidism still a problem in Faisalabad, Pakistan. J Pak Med Assoc. Hypothyroidism in pregnancy: consequences to neonatal health.
Raval AD, Sambamoorthi U. Incremental healthcare expenditures associated with thyroid disorders among individuals with diabetes.
J Thyroid Res. Diminished quality of life and increased brain functional connectivity in patients with hypothyroidism after total thyroidectomy. Inadequate levothyroxine replacement for primary hypothyroidism is associated with poor health-related quality of life-a Brazilian multicentre study. Hypothyroidism is a predictor of disability pension and loss of labor market income: a Danish register-based study.
J Clin Endocrinol Metabol. Excess mortality in patients diagnosed with hypothyroidism: a nationwide cohort study of singletons and twins. World Health Organization. WHO model list of essential medicines. Defending plasma T3 is a biological priority. Clin Endocrinol.
Relationships between circulating and intracellular thyroid hormones: physiological and clinical implications. Endocr Rev. Principles of endocrinology. Williams textbook of endocrinology. Philadelphia: Saunders Elsevier; Persani L. Clinical review: Central hypothyroidism: pathogenic, diagnostic, and therapeutic challenges.
The Colorado thyroid disease prevalence study. Arch Intern Med. The prevalence of thyroid dysfunction in a population with borderline iodine deficiency. Low prevalence of hypothyroidism among Black and Mulatto people in a population-based study of Brazilian women. Clin Endocrinol Oxf ; 66 — Iodine and mental development of children 5 years old and under: a systematic review and meta-analysis.
Assessment of iodine deficiency disorders and monitoring their elimination. A guide for programme managers. Poverty and immigration as a barrier to iodine intake and maternal adherence to iodine supplementation. J Endocrinol Invest. Tomer Y. Mechanisms of autoimmune thyroid diseases: from genetics to epigenetics. Annu Rev Pathol. Thyroid peroxidase and thyroglobulin auto-antibodies in patients with newly diagnosed overt hypothyroidism.
Thyroid antibody status, subclinical hypothyroidism, and the risk of coronary heart disease: an individual participant data analysis.
Thyroid peroxidase and thyroglobulin autoantibodies in a large survey of populations with mild and moderate iodine deficiency. Hashimoto H. Thyroid volume in hypothyroidism due to autoimmune disease follows a unimodal distribution: evidence against primary thyroid atrophy and autoimmune thyroiditis being distinct diseases. Iodine intake as a determinant of thyroid disorders in populations.
Effect of iodine intake on thyroid diseases in China. N Engl J Med. Kim D. The role of vitamin D in thyroid diseases. Int J Mol Sci. Low population selenium status is associated with increased prevalence of thyroid disease.
Moderate alcohol consumption may protect against overt autoimmune hypothyroidism: a population-based case-control study. Hypothyroidism incidence in and around pregnancy: a Danish nationwide study.
Thyroiditis: an integrated approach. Which domains of thyroid-related quality of life are most relevant? Patients and clinicians provide complementary perspectives. Thyroid disease awareness is associated with high rates of identifying subjects with previously undiagnosed thyroid dysfunction. BMC Public Health. Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee.
Clin Endocrinol Oxf ; 84 — Gender differences in symptoms of hypothyroidism: a population-based DanThyr study. Clin Endocrinol Oxf ; 83 — This disease attacks your thyroid gland and causes chronic thyroid inflammation.
The inflammation can reduce thyroid function. It affects middle-aged women most commonly, but it can occur in men and children. This condition also runs in families.
If a family member has been diagnosed with the disease, then your risk for having it is higher. If your thyroid gland produces too much thyroid hormone, you have a condition known as hyperthyroidism. Treatment for this condition aims to reduce and normalize thyroid hormone production.
Sometimes, treatment can cause the levels of your thyroid hormone to remain low permanently. This often occurs after treatment with radioactive iodine. Using thyroid medication for the rest of your life is the primary treatment. If only a portion of the gland is removed, your thyroid may still be able to produce enough hormones on its own.
Radiation used for the treatment of these conditions may slow or halt the production of thyroid hormone. This will almost always lead to hypothyroidism.
Several medicines may lower thyroid hormone production, leading to hypothyroidism. These include ones used to treat psychological conditions, cancer, or heart disease, such as:. Two primary tools are used to determine if you have hypothyroidism, a medical evaluation and blood tests.
Your doctor will complete a thorough physical exam and medical history. A thyroxine T4 level test is also useful in diagnosing hypothyroidism. T4 is one of the hormones directly produced by your thyroid. Used together, T4 and TSH tests help evaluate thyroid function. Typically, if you have a low level of T4 along with a high level of TSH, you have hypothyroidism. Other thyroid function tests may be necessary to properly diagnose your condition.
Hypothyroidism is a lifelong condition. For many people, medication reduces or alleviates symptoms. Hypothyroidism is best treated by using levothyroxine Levoxyl, Synthroid. This synthetic version of the T4 hormone copies the action of the thyroid hormone your body would normally produce. The medication is designed to return adequate levels of thyroid hormone to your blood. Once hormone levels are restored, symptoms of the condition are likely to disappear or at least become much more manageable.
Once you start treatment, it takes several weeks before you begin feeling relief. You and your doctor will work together to find a dose and a treatment plan that best addresses your symptoms.
This can take some time. In most cases, people with hypothyroidism must remain on this medication their entire lives. To make sure your medication is still working properly, your doctor should test your TSH levels yearly. Discover other treatment options for hypothyroidism. Animal extracts that contain thyroid hormone are available. These extracts come from the thyroid glands of pigs.
They contain both T4 and triiodothyronine T3. You can also purchase glandular extracts in some health food stores. Use either of these products at your own risk. However, do tell your doctor if you decide to try these products so they can adjust your treatment accordingly. Discover other alternative treatments , such as selenium and vitamin B. Hypothyroidism can also result in infertility or pregnancy-related complications such as preeclampsia.
Find out more about the complications of hypothyroidism. However, here are some recommendations to keep in mind. A balanced diet of whole grains , beans , lean proteins , and colorful fruits and vegetables should provide enough iodine.
Discover other iodine-rich foods. Soy may hinder the absorption of thyroid hormones. If you drink or eat too many soy products, you may not be able to properly absorb your medication. You need steady doses of the medication to achieve even levels of thyroid hormone in your blood. Avoid eating or drinking soy-based foods for at least 4 hours before and after you take your medication. Like soy, fiber may interfere with hormone absorption. Too much dietary fiber may prevent your body from getting the hormones it needs.
Instead, avoid taking your medicine within several hours of eating high fiber foods. If you take supplements or medications in addition to thyroid medications, try to take them at different times.
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