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Hypothyroidism, including secondary hypothyroidism, can be treated
simply, safely, and effectively by replacing the thyroid hormone
T4. The preferred drug used for this purpose is synthetic T4,
a man-made thyroid hormone that is identical to the body's; it's
chemical name is levothyroxine. Fortunately, almost everyone can
take levothyroxine. Hypothyroid patients are usually advised to
take one tablet daily. The amount prescribed is based upon your
physical examination and the levels of TSH and
thyroid hormone in yout blood. Because most cases of hypothyroidism
are permanent, lifelong thyroid hormone replacement will be necessary.
The majority of patients can be started with the anticipated full
thyroid hormone replacement dose. However, older patients and
those with a history of heart disease are sometimes given smaller
doses that are gradually increased every few weeks. It may take
eight weeks or more before the full effect of levothyroxine is
noticed. Sometimes, adjustments in the strength of the tablets
are necessary. You should never take more thyroid hormone
than prescribed in an attempt to speed up your treatment or to
lose weight. Adverse reactions are mainly caused by levothyroxine
overdose. An overdose of thyroid hormone can cause symptoms of
hyperthyroidism (an overactive thyroid): feeling hot, trembling
hands, and/or palpitations.
Since hypothyroidism can influence the effects of antidiabetic
drugs or anticoagulants, patients on these medications may be
monitored more frequently as they begin treatment with levothyroxine.
In addition, patients who become pregnant or begin taking estrogens
may require higher doses of levothyroxine. Finally, certain drugs
can interfere with the body's absorption of thyroid medication
and should, therefore, be taken at least four hours after levothyroxine.
Antacids, the cholesterol-lowering drug cholestyramine, and drugs containing
iron are examples of such preparations. It is important
that your physician is aware of all the medications, including over-the-counter
preparations, you are taking.
Consult a physician in cases of chest pain, increased pulse
rate, palpitations, excessive sweating, heat intolerance, and
nervousness after beginning levothyroxine treatment.
Myxedema coma is a rare, life-threatening form of hypothyroidism.
It can occur either in patients with undiagnosed, untreated hypothyroidism
or in diagnosed hypothyroid patients who do not take their prescribed
thyroid hormone replacement for months. The signs and symptoms
of myxedema coma consist of a progressive worsening of the signs
and symptoms of hypothyroidism, eventually leading to respiratory
failure and a loss of consciousness. Treatment includes hospitalization
in an Intensive Care Unit, intravenous thyroid hormone, and, frequently,
life support with a respirator.
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