Treatment of hypothyroidism – Levothyroxine
- Diagnosis of hypothyroidism
- Treatment of hypothyroidism by levothyroxine drug
- How does Levothyroxine work?
- How much strength of levothyroxine you need?
- When should you take levothyroxine? What foods, supplements, and drugs avoid along with levothyroxine?
- Is levothyroxine safe in pregnancy?
- What will happen if you take too much levothyroxine?
- Management of hypothyroidism
Hello friends! Welcome to pharmacistopinions.com/. Today, I am going to tell you important information on the treatment of hypothyroidism.
As we discussed in last post – what are early warning signs of thyroid problems. We learned how thyroid hormones play an important role in regulating your body’s functions.
Usually, hypothyroidism happens, when there is an imbalance in the level of thyroid hormones and you may get a serious adverse reaction.
But today, we will know what are treatment options are available to tackle this problem. Let’s start our topic – treatment of hypothyroidism.
Before going through the treatment, firstly you need to know about the diagnosis of hypothyroidism.
Diagnosis of hypothyroidism
Normally, your thyroid hormones depend on demand and supply relationships. If TSH is your demand then T3/T4 will be supplied.
In hypothyroidism, its imbalances the TSH and T3/4 levels. Your TSH level increase and T3/T4 level decreases. It means TSH kicking your thyroid gland to secrete thyroid hormones. There is an increase in demand for TSH but supply (T3/T4) falls.
Sometimes, if TSH level increased and T3/T4 is normal that represents subclinical hypothyroidism (mild hypothyroidism).
Although there are two kinds of hypothyroidism – primary and secondary hypothyroidism. Primary hypothyroidism is due to a problem in your thyroid gland and it is the most common type of hypothyroidism. In this condition, the TSH level is usually high.
Whereas, secondary hypothyroidism rarely happens. It represents there is something problem in your brain (hypothalamic region) and low TSH level.
As per the American thyroid association 2013, If TSH is lying in between 4 to 10 mU/L and T3/T4 WNL(within normal limit) is called Subclinical hypothyroidism.
Whereas if TSH is more than 10 mU/L or T4 less than 5 ug/dl (5 – 12 ug/dl) and T3 less than 80 ng/dl (80 – 220 ng/dl) is considered hypothyroidism.
Now, the free T4 test is used in place of T4. It means how much amount of T4 in your blood is not bound to thyroid-binding globulin (TBG).
If there is no clarity in these tests. You will have to do an Anti-TPO antibodies test (anti-thyroid peroxidase antibodies test). This test confirms a diagnosis of autoimmune thyroiditis. If it is positive along with your symptoms. Then you must have to take medicine.
Treatment of hypothyroidism by levothyroxine drug
During hypothyroidism, your natural thyroid hormone – thyroxine is unable to produce an adequate amount. So, you need to take artificial thyroid hormone which is available in the form of levothyroxine.
There are a few common brands name available in the market –
It is the only drug used in the treatment of hypothyroidism. So, you need to know everything about Levothyroxine. Let’s know about important information about this drug –
How does Levothyroxine work?
Levothyroxine mimics the action of natural thyroid hormone (thyroxine). Levothyroxine is a prohormone which converted into triiodothyronine (T3) in your body. It introduced into the cell and binds to the thyroid hormone receptor (nuclear receptor).
Eventually, it influences the DNA transcription to enhance the rate of cell metabolism and other functions.
How much strength of levothyroxine you need?
The dose of levothyroxine depends on your symptoms and medical lab report. The strength of your medicine may change from time to time as per your recent medical lab report.
As per studies, the normal adult dose of levothyroxine is 1.6 mcg/kg/day. It is based on your body weight. It means if your body weight is 62 kg then you will have to take (62×1.6) around 100 mcg tablet.
But there are some exceptions. The strength of levothyroxine may vary in different conditions.
- If you are pregnant, the dose will be 2 – 2.4 mcg/kg/day.
- If you are elderly, you need to reduce your dose. It will be 25 – 50 mcg/day.
- If you are a patient of heart disease like ischemic heart disease, angina pectoris, etc., then you need to reduce your strength. You will have to take 12.5 – 25 mcg/day.
- If you are on medication like enzyme-inducing drugs like phenytoin, rifampicin, etc. In these circumstances, you should consult your doctors. They will increase your dose. You will have to take 2 mcg/kg/day.
When should you take levothyroxine? What foods, supplements, and drugs avoid along with levothyroxine?
The best time to take levothyroxine is early morning on empty stomach. You should take half an hour before breakfast. You need to know some foods, supplements, and drugs which interfere in the absorption or metabolism of your levothyroxine medicine.
You should avoid soya products and caffeine because it decreases the absorption of levothyroxine.
You should reduce the frequent use of goitrogenic foods like cabbage, cauliflower, red meat. These foods decrease the synthesis of thyroid hormones.
In several recent studies, some supplements may impair the absorption of levothyroxine. These are iron tablets, calcium tablets, and antacids. You should not take these things along with levothyroxine and make the difference of at least four hours.
There are some drugs that increase levothyroxine clearance. They are enzyme-inducing drugs like phenytoin, phenobarbitone, carbamazepine, and rifampicin which affect your levothyroxine metabolism.
Enzyme inducer drugs mean they increase the metabolism of other drugs (levothyroxine). You need to increase the dose of levothyroxine if you are on enzyme-inducing drugs. So, you need to take 2 mcg/kg/day.
Levothyroxine may also affect other drugs.
- It increases the effect of anticoagulant drugs (like warfarin) and antidepressant drugs (like amitriptyline). You need to reduce the dose of warfarin and amitriptyline.
- It decreases the effect of beta-blockers (propranolol, atenolol, and sotalol) because it enhances the metabolism of beta-blockers.
Is levothyroxine safe in pregnancy?
If you have a pregnancy and you already a patient of hypothyroidism or sometimes pregnancy may induce hypothyroidism. Then you should immediately consult your gynecologist during this circumstance. They will adjust your dose of the levothyroxine drug.
The untreated hypothyroidism may affect your baby during pregnancy if you are not taking levothyroxine adequate dose.
Hypothyroidism in pregnancy may lead to –
- preterm birth delivery (before date delivery)
- low birth weight
- impaired psychomotor development (low IQ)
- stillbirth (fetal death)
Although, levothyroxine is safe in pregnancy. But you need to require more strength (2 – 2.4 mcg/kg/day) of levothyroxine because in pregnancy demand for medicine may increase and it also needs to your baby.
What will happen if you take too much levothyroxine?
Although there are not many life-threatening side effects of levothyroxine in the recommended dose. But if you take levothyroxine in a high dose, definitely it will be a problem for you.
The overdose of levothyroxine may produce a reverse reaction of hypothyroidism symptoms like increase blood pressure, diarrhea, sweating, increase heart rate, flushing, etc.
It will be more dangerous for those who are having heart diseases. It may exacerbate your angina, myocardial infarction, ischemic heart disease, etc.
You need to reduce your dose especially if you are a heart disease patient. The recommended dose is 12.5 – 25 mcg/day in a heart disease condition.
Management of hypothyroidism
Hypothyroidism is a lifestyle disease. Usually, you need to take the medicine lifelong. Diet, weight loss, and exercise may control the hypothyroidism condition but it does not work alone. It works better with your hypothyroidism medication.
There are some foods which help to control subclinical hypothyroidism condition –
- Iodine-rich foods – dairy products (milk, yogurt, etc.), all berries (cranberries, strawberries, etc.), iodized salt.
- Iron-rich foods – seafood, meat, beans, dried fruits, etc.
- Selenium-rich foods – garlic, mushroom, beef, lean pork, lean chicken breast, etc.
- Antioxidants – citrus fruits, grapes, blueberries, green tea, green leafy vegetables, etc.
If your condition is not treated by hypothyroidism diet and exercise then you will have to add medicine. Levothyroxine is the recommended drug used to manage your hypothyroidism.
As per the recent hypothyroidism treatment guidelines or algorithm –
For primary hypothyroidism
High TSH (>10 mU/L) + low fT4 → lifelong treatment with levothyroxine
For subclinical hypothyroidism
TSH (5-10 mU/L) + normal fT4 + positive symptoms → lifelong treatment with levothyroxine.
TSH (5-10 mU/L) + normal fT4 + no positive symptoms → Anti-TPO test. If it is positive, need levothyroxine.
So, we have finally discussed our topic – the treatment of hypothyroidism. This is the information which you need to know. I hope you get a clear understanding of everything in this post.
If you have a query regarding this post-treatment of hypothyroidism. Please mention this in the below comment box.