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Obesity and Weight Management

Hypothyroid

11/01/2004

Question:

Two years ago I was diagnosed with hypothyroid. I take my medication very carefully and have my blood work done every three months. My blood work showes that I am in "normal" range but I do not feel any better. Other changes are happening - hair growth, weight gain, carpal tunnel, and intolerence to any types of birth control. I am going to see a specialist next month. Is there anything else they can do besides the levathroid? I get concerned because it says normal range but I sure do not feel like it. Please help!!!

Answer:

Women, especially older than 40, are more likely to have an underactive thyroid than men are. The thyroid gland produces two main hormones, thyroxine (T4) and triiodothyronine (T3). Their release is controlled by the pituitary gland and the hypothalamus.

The lack of producing the right balance of hormones can be due to a number of different factors. Even taking a medicine to fix the imbalance can be difficult. Therapy aims to replace missing thyroid hormone with a structurally identical T4. However, even replacement therapy needs constant adjustments. This is why it is important to work closely with your doctor.

How old are you? Is there a possibility that you are menopausal? You mentioned changes of hair growth, weight gain, carpal tunnel, and intolerance to birth control. All these could be related to your disease associated with subclinical hypothyroidism. You mentioned you have normal blood work. Your doctor is the only one that can evaluate whether your blood work is normal. Work closely with your primary care physician and an endocrinologist. (You mentioned you are seeing a specialist next month).

Hypothyroidism is best treated with Levothyroxine (T4: Synthroid, Levothroid, Levoxyl, Novothyrox, Unithroid). It is stable and predictable.

Alternatives are Liothyronine (T3: Cytomel, Triostat). It has a higher cost, increase in cardiac side effects, and is more difficult to monitor. Another, Liotrix (T4:T3, in 4:1 ratio; Euthroid, Thyrolar) attempts to mimic our natural hormonal secretion. It has a higher cost and because 35% of T4 is converted to T3 it lacks therapeutic rationale.

Keep in mind that certain medications, supplements and even foods (high fiber, cough and cold remedies, iron supplements, antacids, vitamins, steroids, anticonvulsants, and calcium) may affect the way you absorb your medication Levothyroxine (Levothyroid).

Reaching a standard dose takes time, needs close monitoring, and readjusting; changing drug brands or going to generic equivalent drug will mean readjusting the dose; take your medication the same time everyday (recommend in the morning ½ hour before a meal); on the day of your blood test, do not take your medication until the blood test is drawn (prevents false T4 elevation); if you’re taking oral contraceptives, are pregnant, starting or are on HRT therapy for menopause, you will probably need to increase your dose; when getting your blood test drawn keep a diary of how you feel, what your weight is, what your dose is, and any new symptom. Discuss your diary at your next doctor visit.

There are many products in the market today that interact with medications. Whenever you are considering an over the counter medication, vitamin, or supplement ask your pharmacist for advice. Remember to talk to your doctor about your concerns.

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Response by:

Dennis   Mungall, PharmD Dennis Mungall, PharmD
Associate Professor, Pharmacy Practice
College of Pharmacy
The Ohio State University

Maria Papouras-Volakis, PharmD Student, BS Pharmacy
Staff Pharmacist
Nationwide Children's Hospital
The Ohio State University