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Thyroid Hormone Treatment

Compiled By; Dr. Hafiz Shahid Amin (MBBS, DCA, DLO) ENT Surgeon, Gujranwala- Pakistan-

This brochure has been written for you if you are being treated with thyroid hormone.
You may be taking thyroid therapy because your own thyroid gland is underactive
(hypothyroid) and your physician wants to raise the amount of thyroid hormone in your
system to normal. Many patients also take thyroid hormone to control the growth of their
thyroid gland, which may be enlarged (a goiter) or contain nodules (lumps).

This brochure has also been written for patients who are taking thyroid hormone because
of a history of thyroid cancer. If that is your situation, your doctor is giving you thyroid
hormone treatment to reduce the risk of developing a recurrence of your tumor, as well
as treating your underactive thyroid resulting from surgery.

No matter which of these therapeutic situations fits you best, you should speak with your
doctor to be sure that you know why you are being treated and how long the treatment
will last. We hope that you will find this brochure helpful as a resource for general
information about thyroid hormone therapy. Just like your doctor, we want you to know
why you are being treated, the importance of taking your medication regularly and
reliably, and what this medication is expected to do for you.

How Does Your Doctor Choose the Proper Dosage of Thyroid Hormone?

In past years there were no truly precise laboratory tests for your doctor to use in
choosing a proper dose of thyroid hormone. Rather, physicians relied on their patients to
tell them whether they felt well or normal. They might have been guided by
improvement in a patients hair, skin, pulse, and reflexes, or a goiter or thyroid nodules
may have disappeared. Unfortunately, such guidelines for therapy were not always
accurate enough to assure proper thyroid hormone dosage.

Today the uncertainty of thyroid therapy has largely been eliminated by the development
of accurate and sensitive laboratory tests which measure blood levels of important
hormones.

How Does Your Doctor Evaluate Your Treatment?

When you visit your physician for a check-up about your thyroid hormone treatment,
expect to be asked about changes in the way you feel. He or she will examine your
thyroid and assess the effectiveness of your therapy. Your physician may also
recommend a blood test to measure the concentrations of thyroid hormones as well as
your serum TSH level.

Thyroid-stimulating hormone, or TSH, is a hormone made by your pituitary gland that


controls thyroid function. The pituitary regulates your thyroid in much the same way that
the thermostat on your living room wall regulates your furnace.

If your pituitary gland senses that there is not enough thyroid hormone in your blood, it
will release TSH; TSH stimulates the thyroid, in turn, to increase production and release
of thyroid hormone into the blood. When there is enough thyroid hormone in the
bloodstream, the pituitary decreases production of TSH. If there is too much thyroid
hormone in your system, such as might happen from an overactive thyroid
(hyperthyroidism) or from your taking too much thyroid hormone medication, the
pituitary stops production of TSH entirely and TSH disappears from your bloodstream.
Thyroid hormone is usually prescribed as pure synthetic thyroxine (T4). Desiccated (dried
and powdered) animal thyroid, once the most common form of thyroid therapy, is rarely
prescribed today because it also contains triiodothyronine (T3), a rapidly acting thyroid
hormone which produces more variable blood levels than pure thyroxine preparations. It
also may vary in potency from batch to batch, because it comes from animal thyroid
glands, which can vary in their thyroid hormone content. Most endocrinologists switch
patients who are taking desiccated thyroid to synthetic thyroxine, which is purer and has
a constant level of potency. There is no evidence that desiccated thyroid, a biological
preparation, has any advantage over synthetic thyroxine.

Gradually increasing doses of thyroxine are given until the blood levels of T4 and TSH are
both in the normal range. In instances where the patient is elderly or has an underlying
heart condition, it is extremely important to start with a very low dose of thyroid
hormone until the body gets used to the more normal thyroid hormone levels. Since the
potency of generic thyroxine has in the past varied considerably, your physician will
likely specify a brand name of thyroxine to treat hypothyroidism.

If your doctor is treating you for hypothyroidism, it is likely that you will be treated with
gradually increasing doses of thyroid hormone until you feel well and your thyroid
hormone and TSH levels are in the normal range. Most physicians want a follow-up
examination once a year, during which he or she will make sure that these levels are still
normal. For some patients, thyroid failure is a progressive disease, and the thyroid
dosage may have to be increased little by little as the thyroid continues to slow down.

Certain patients, especially those with thyroid cancer, will be given as much thyroid
hormone as necessary to virtually eliminate TSH from the blood. TSH may stimulate the
growth and spread of thyroid cancers. Here, too, periodic blood tests will be needed to
assure that this goal of therapy has been achieved.

Are There Problems with Taking Too Much or Too Little Hormone?

If you are being treated for an underactive thyroid and are not taking enough thyroid
hormone, some of the symptoms of hypothyroidism such as sluggishness, mental
dullness, feeling cold, or muscle cramps may persist. In addition, you may have
problems with elevation of cholesterol which could increase your risk for hardening of the
arteries (arteriosclerosis). If you take too much thyroid hormone, you may have
symptoms mimicking an overactive thyroid, including nervousness, palpitations,
insomnia, and tremor. It is also possible that mild thyroid hormone excess over many
years may increase your risk for a serious heart rhythm problem or heart attack if you
have underlying heart disease. It may also cause excessive calcium loss from your bones
and thus increase your risk for fractures in later years.

What You Can Do

1. See your doctor regularly and understand the purpose of your therapy.

2. Take your thyroid pills every day. You are more likely to remember them if you take
them at the same time every day. If you are having trouble remembering the medication,
try putting your thyroid tablets near your toothbrush and take your tablet right after
brushing your teeth every morning. If you remember that you missed a tablet, you may
safely take two tablets the next day.

3. If a physician starts you on new treatments for non-thyroid disease, ask your doctor if
this will make any difference to your dose of thyroxine. Also notify your doctor if you
become pregnant, since your thyroid hormone dose may have to be changed.

4. Call your doctor if you have questions about new symptoms or if it has been more
than one year since your last check-up. If you change doctors, be sure that the new
physician knows about your thyroid problem.
hyperthyroidism means the thyroid increases the metabloism = weight
loss

hypothyroid means thyroid decreases the metabolism = weight gain


Understanding the difference between Hypothyroidism and Hyperthyroidism

Jan 13, 2012, 8:40 a.m.

Both hypothyroidism and hyperthyroidism occur as a result of a thyroid hormone imbalance. Simply put,
hypothyroidism means that your thyroid gland isn't producing enough hormone, while hyperthyroidism
means your thyroid is producing too much of the hormone. Either way, the condition affects the
metabolism of the body.

According to the U.S. Department of Health and Human Services, approximately five percent and one
percent of the U.S. population has hypothyroidism and hyperthyroidism, respectively. Women are more
likely than men to develop either one of the conditions. The risk of developing either hypothyroidism or
hyperthyroidism increases with age and family history.

The Thyroid Gland. The thyroid gland is a small butterfly-shaped organ, which lies near the front of the
neck below the voice box. Because the thyroid is one of the glands of the endocrine system, it releases
hormones into the bloodstream. Thyroid hormones help regulate your metabolism, and affect practically
every organ in the body.

Hypothyroidism

When you have an underactive thyroid, the condition is called hypothyroidism. With this condition, you'll
have a marked decrease in circulating thyroid hormones, and your metabolism will slow.

Although symptoms vary from person-to-person, common hypothyroidism symptoms include weight gain,
cold intolerance, fatigue, puffy face, dry hair, thinning hair, constipation, slowed heart rate, decreased
sweating, irregular or heavy menstrual periods, impaired fertility, or depression.

Hyperthyroidism

When you have an overactive thyroid, the condition is called hyperthyroidism. Instead of having a
deficiency of thyroid hormones as is the case with hypothyroidism, with hyperthyroidism, you'll have
excess thyroid hormones circulating through your body. Your metabolism will be revved up.

Common hyperthyroidism symptoms include heat intolerance, weight loss, trouble sleeping, fatigue,
muscle weakness, nervousness, irritability, hand tremors, rapid or irregular heartbeat, mood swings, or
frequent diarrhea and bowel movements. In addition, you may have an enlarged thyroid, called a goiter,
which may make your neck look swollen. Some symptoms, like fatigue, overlap between hypothyroidism
and hyperthyroidism.
Diagnosis

Your doctor will perform blood work to diagnose thyroid disease. The TSH test is typically the first test
performed by your doctor due to its accuracy and sensitivity. A TSH test reading below normal indicates
that a person has hyperthyroidism, while a TSH reading above normal is an indication of hypothyroidism.

To determine the cause or confirm a hypothyroidism diagnosis, your doctor may conduct additional tests,
such as the T4 test. The T4 test is used to measure the actual level of thyroid hormone circulating in the
blood stream. A T4 level of lower than normal may be an additional indication of hypothyroidism.

Treatment

Hypothyroidism can usually be easily treated with thyroid hormone replacement therapy. Most patients
notice improvement within a week, with all symptoms disappearing within a few months. Treatment may
consist of visiting your doctor frequently initially to adjust the dosage.

Depending on your age, the cause of your condition, other health conditions, and the level of thyroid
hormone your body is producing, your doctor will choose one of three main treatment methods when
treating hyperthyroidism. Radioactive iodine and antithyroid medicine are the two most commonly used
treatment methods. Less common, surgery may need to be done to correct the hyperthyroidism symptoms.

Read more: http://www.spot55.com/news/2012/jan/13/understanding-difference-between-hypothyroidism-


an/#ixzz1wnni2KUK
Hyperthyroidism

Basics

Hyperthyroidism is a condition in which the thyroid gland over-produces the hormones that regulate the
body's metabolism. The excess thyroid hormones cause many symptoms. While hyperthyroidism
responds well to treatment, there may be complications, and recurrence is common Figure 01. The thyroid
is a hormone-secreting gland located in the neck that produces two important hormones: thyroxine and
triiodothyronine. These hormones promote normal growth and development, and help to control the body's
metabolism.

Normally, the production of thyroxine and triiodothyronine is regulated by the pituitary gland. When blood
levels of thyroid hormones are low, the pituitary increases production of thyrotropin, which is also known
as thyroid-stimulating hormone (TSH). TSH in turn stimulates the thyroid to secrete thyroxine and
triiodothyronine. Conversely, high blood levels of thyroid hormones signal the pituitary to turn off
production of TSH, which in turn stops production of the thyroid hormones. This feedback loop controls
the levels of thyroid hormones in the blood.

Figure 01. Glands of the endocrine system

Graves' disease, in which the whole gland becomes overactive, is the most common type of
hyperthyroidism. Approximately 70% to 90% of people with hyperthyroidism have Graves' disease. In the
disorder, the entire thyroid gland becomes enlarged and overactive. The enlarged gland appears as a
bulge in the neck (goiter). The generalized overactivity of the thyroid in Graves' disease distinguishes it
from another type of hyperthyroidism in which one or more lumps (nodules) in the thyroid become
overactive, a condition called toxic nodule, or multinodular goiter. Graves' disease is approximately four
times more common in women than men; the reason for this difference is not well understood.

Hyperthyroidism occurs in about 0.5% of the population, and is more common in women than in men. The
incidence of hypothyroidism increases with age. Only 5% of hyperthyroid patients are diagnosed before
age 15, and the condition is most frequently identified in people between the ages of 30 and 40.

Causes

Hyperthyroidism is a condition that occurs when the body produces too much thyroid hormone Table 01.
Overstimulation of the thyroid may be caused by several different factors, acting at the thyroid itself (as is
the case with Graves' disease and multinodular goiter), or less commonly, at the pituitary gland (as is the
case in one type of pituitary tumor). The pituitary produces excess TSH, which in turn causes the thyroid
to produce excess amounts of thyroid hormones.

Table 1. Causes of Hyperthyroidism


Graves' disease (autoimmune stimulation of the thyroid gland)
Hyperactivity of solitary or multiple thyroid nodules
Inflammation of the thyroid gland (e.g., associated with infection or pregnancy)
Intake of excessive amounts of thyroid hormones
Excessive production of thyroid-stimulating hormone (TSH) by the pituitary gland

Adapted from Hershman JM, Thyroid Dysfunction, Current Practice of Medicine 1999; 2(10).

Graves' disease is a disorder in which antibodies stimulate the thyroid gland. A specific type of antibody is
found in the blood of people with Graves' disease. This antibody stimulates the entire thyroid gland to
grow and produce excess amounts of thyroid hormone. This type of hyperthyroidism tends to run in
families, but little is known about the way it is inherited, or about other specific causes of the disease.
Although the direct cause of Graves' disease is specific antibodies circulating in the blood, physicians
have long thought that the condition may be triggered by severe emotional stress, such as the loss of a
loved one. Studies have shown that stress can affect the ability of the immune system to function, so such
a link is certainly possible. However, many patients develop Graves' disease without having identifiable
stress in their lives.

Hyperthyroidism may be caused by overactivity of solitary or multiple benign nodules within the thyroid.
Individual or multiple nodules within the thyroid may enlarge and begin producing excess amounts of
thyroid hormone. These nodules produce hormones, even in the absence of TSH, and as such are not
affected by the normal mechanisms that control thyroid hormone levels.

Some women experience hyperthyroidism after giving birth. For reasons not well understood, some
women experience postpartum inflammation of the thyroid (thyroiditis). This inflammation appears to be
caused by antibodies that attack the thyroid and cause a leakage of thyroid hormone into the blood.
Although an estimated 5% to 7% of women will develop the condition after giving birth, it frequently goes
undiagnosed, perhaps because the symptoms are attributed to the normal recovery process after
childbirth.

Hyperthyroidism Treatment

Treatment

Thyroid storm, a sudden, extreme, life-threatening overactivity of the thyroid gland, requires emergency
treatment. Thyroid storm may cause a rapid heartbeat, fever, agitation, psychosis, nausea, vomiting,
diarrhea, and shock. It usually occurs in people with untreated or undertreated hyperthyroidism, and is
triggered by a factor such as infection, trauma, surgery, uncontrolled diabetes, pregnancy, or labor.
Supportive therapy and rapid treatment of the underlying cause are essential.

Your doctor is the best source of information on the drug treatment choices available to you.

Radioactive iodine is commonly used to destroy part of the thyroid gland in treating hyperthyroidism.
Radioactive iodine is currently the treatment of choice for hyperthyroidism in the US; especially for patients
with Graves' disease. Radioactive iodine taken orally accumulates in the thyroid gland where it destroys
the cells that produce thyroid hormones. When using radioactive iodine, physicians attempt to adjust the
dosage to destroy only enough of the thyroid to bring hormone production back to normal levels. In
practice, however, treatment with radioactive iodine most often results in excessive loss of thyroid function
and thyroid hormone deficiency (hypothyroidism). As a result, most patients treated with radioactive iodine
ultimately end up having to take thyroid hormone tablets for the rest of their lives; otherwise, patients will
experience the symptoms of hypothyroidism (e.g., obesity, depression, muscle and joint diseases).

Radioactive iodine is also very effective treatment for hyperthyroidism due to solitary or multiple thyroid
nodules. In these patients, hypothyroidism seldom results from this therapy.

Surgery for hyperthyroidism is generally reserved for special circumstances. Although surgical removal of
part of the thyroid gland was once a popular approach to reduce thyroid hormone levels, it is now
uncommon in the US. Exceptions include cases in which the patient is allergic to--or will not use--
radioactive iodine or antithyroid drugs. In addition, surgery may be performed when the thyroid has grown
so large as to obstruct the windpipe or esophagus. Complications of thyroid surgery include excessive loss
of thyroid function (hypothyroidism) and a small risk of damaging the vocal cords or other structures in the
throat.

Pregnant women with hyperthyroidism should not receive radioactive iodine treatment. Because iodine
can cross the placenta, treating pregnant women with radioactive iodine risks destroying the fetal thyroid
gland. Treatment with antithyroid medication is usually substituted, but because these drugs also cross the
placenta, the lowest effective dose is recommended.
Hyperthyroidism can be controlled effectively, but most people treated for the condition will ultimately
develop a deficiency in thyroid hormone production. Hyperthyroidism can have serious complications, but
once diagnosed, it can be treated and effectively controlled. Regardless of whether hyperthyroidism is
treated with medications, radioactive iodine, or surgery, thyroid hormone deficiency (hypothyroidism) often
develops at some point. The natural course of the condition is for the thyroid to produce lower levels of
thyroid hormones over time. When that occurs, the deficiency can be controlled by taking a thyroid
hormone tablet each day.

Patients taking antithyroid drugs will be seen initially at 4-12 week intervals until their thyroid hormone
levels stabilize, and then every 3-4 months thereafter while continuing the medication. If the
hyperthyroidism goes into remission and drug therapy is stopped, the American Thyroid Association
recommends annual follow-up examinations to monitor weight, pulse, and blood pressure, as well as an
annual thyroid and eye examination. Blood levels of thyroid hormones and TSH will be determined as well.

Patients using radioactive iodine will be seen at 4- to 6-week intervals for the first 3 months after therapy,
and then at regular intervals as the clinical situation requires. Hypothyroidism generally occurs within 6-12
months after treatment with radioactive iodine, but it may occur at any time, so follow-up should continue
indefinitely. When hypothyroidism does occur, thyroid hormone replacement therapy will be prescribed.
The American Thyroid Association recommends continuing follow-up on an at least annual basis after
radioactive iodine therapy.

For patients who undergo thyroid surgery, follow-up will occur after approximately 2 months to assess
thyroid status, and on an annual basis thereafter.

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