Hypothyroidism - Treatment

Daily Regimen. Because thyroid replacement is usually lifelong, setting up a regular daily routine is helpful. Here are some tips to remember:

Establish a habit of taking the medication at the same time each day. This may help prevent missed doses.
Levothyroxine is very forgiving. The hormone remains in the body for several days, so one missed dose should not cause a noticeable decline in well-being. The patient can safely take two doses the next day.
Fiber and common daily supplements, such as calcium, may interfere with thyroxine absorption. Although levothyroxine can be taken at any time of day either with or without food, some experts recommend taking thyroid hormone upon awakening and at least 30 minutes before consuming anything, including breakfast or supplements.

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Annual Evaluation. Thyroid failure is an ongoing process and so is its treatment. Many factors can cause changes that require modifying the thyroxine dosages.

A dose that is appropriate for one year may be too low the next. To maintain normal thyroid levels, some patients may need to take gradually increasing doses of thyroid hormone every year or two. Experts recommend that patients be reevaluated six months after normal TSH levels have been reached and then once a year thereafter.

Specific factors, such as changes in health or diet, new medications for other conditions, or simply switching brands, can also cause changes in thyroid hormone levels that require different doses. If the patient changes dose levels or thyroxine brands then he or she should be checked again at least six weeks following such changes.

Problems Encountered with Levothyroxine Treatment

Because levothyroxine is identical to the thyroxine the body manufactures, side effects are nearly unheard of. Over- or under-dosing, however, is fairly common, although rarely serious in the short term.

Symptoms of Under- and Over-Dosing of Levothyroxine
Under-Dosing	Over-Dosing
Sluggishness	Heart symptoms (rapid heart beat, palpitations, and wide variations in pulse; possible angina or congestive heart failure).
Mental dullness	Agitation (tremor, nervousness, insomnia, excessive sweating).
Feeling cold	Pain (headache and muscle pain).
Muscle cramps	Intestinal and metabolic symptoms (change in appetite, diarrhea, weight loss).
	Fever and intolerance to heat.

No Symptom Improvement When Normal Thyroid Levels Are Reached. Some patients fail to feel significantly better even when their thyroid levels become normal after taking thyroid replacement.

Some experts argue that many patients become symptom-free only if their thyroid replacement achieves high-normal T4 and low-normal TSH levels (rather than just normal levels). They believe that slightly higher thyroxine levels will not be harmful. Research is needed to confirm these claims.