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Treatment Options (Part I)

© Keri

You can choose how treat thyroid disease. You make the choice depending on the type and severity of the disease and the input from your healthcare providers. But, the choice is an individual one; only you can choose the best option to make you feel better.

Let's start with hypothyroidism, underactive thyroid, since it is the most common form of thyroid disease. As many as one woman in ten, over the age of 65, may have some symptoms of underactive thyroid. Hypothyroidism may be the initial problem or it can be the end result of thyroiditis or treatments for hyperthyroidism or thyroid cancer.

The thyroid gland produces two types of hormone: thyroxine (T4) and triiodothyronine (T3). T4 is produced only by the thyroid gland while 80-90% of T3 is produced when other organs in the body break down T4. When you take T4, the blood level rises and falls slowly. T3 is more potent and causes the levels to change rapidly. When taking T3, you can even become hyperthyroid during part of the day.

When beginning thyroid replacement, the doctor will closely monitor the blood levels and your symptoms to determine the appropriate dose. Keep track of how you feel and realize that there is no quick fix. It may take weeks or months to determine which dose is right for you.

The most common replacement is synthetic thyroxine (T4) as recommended by The American Academy of Clinical Endocrinologists (AACE) in the Clinical Practice Guidelines. This is also the choice advocated by The Thyroid Society and The American Thyroid Association. The most common brand names in the US are Synthroid, Levothyroid, and Levoxyl. The synthetic hormones can have variations between manufacturers. It is strongly recommended that you maintain the same brand throughout the treatment. Changing brands will require monitoring to establish the appropriate dosage.

Your doctor determines the initial dose based on the severity of the deficiency and your physical condition. It does not take much to replace T4. Thyroxine is measured in micrograms and the average dose is around 112 micrograms (mcg) or 0.112 milligrams (mg). The dosage recommendation is 1.6 mcg per kilogram of body weight. That's 1.6mcg for every 2.2 pounds that you weigh. Remember this is the average dosage and has to be regulated to control your symptoms and blood levels.

Synthetic T4 if effected by temperature and moisture content and can react with packaging materials. Therefore, it is most important to follow the handling recommendations. Keep it in the original container, away from heat and light and out of moist environments. Certain dosages contain a dye that can cause an allergic reaction in some individuals. This problem can usually be avoided by switching to a different pill without the dye and adjusting the number taken accordingly.

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