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The Diagnosis and Treatment of Hypothyroidism

 
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Blood TSH, free T4, free T3 and anti-TPO antibodies should be tested. Patients with an enlarged thyroid and/or a positive anti-TPO antibody test AND a TSH greater than 4.0 mU/mL should be considered to have primary hypothyroidism. Patients without an enlarged thyroid and without a positive anti-TPO antibody test but WITH a TSH greater than 7.5 mU/mL should also be considered to have primary hypothyroidism. Patients with a free T4 of less than 0.9 mg/dL and a TSH less than 1.0 mU/mL are likely to have central hypothyroidism. Patients with symptoms of hypothyroidism but who do not meet these criterion should be watched and retested in six months.

Hypothyroidism Treatment

Once hypothyroidism is diagnosed, there are many treatment options, including synthetic L-thyroxine
(T4) preparations (Synthroid, Levoxyl and Unithroid), synthetic L-triiodothyronine (T3) preparations (Cytomel), synthetic T4/T3 combinations (Thyrolar) and dessicated thyroid preparations (Armour, Naturethroid, Bio-Throid, and Westhroid).

All of the L-thyroxine preparations contain the same active ingredient, but contain different fillers and have different quality control. Until recently, Synthroid did not have FDA approval, but now all L-thyroxine preparations have FDA approval. Thyrolar and the dessicated thyroid preparations probably have a higher T3/T4 ratio than desirable and thus, I often give a lower amounts of these preparations supplemented with T4.

Most endocrinologists use L-thyroxine preparations for the initial treatment of all forms of hypothyroidism. Although the use of L-thyroxine (T4) compared to L-triiodothyronine (T3) may be surprising, as T3 is the more bioactive thyroid hormone, T4 is most frequently used. This is because tissues convert T4 to T3 to maintain physiologic levels of the T3. Thus, administration of T4 results in bioavailable T3 and T4. As T4 is more stable than T3, T4 therapy gives even blood levels, while T3 therapy leads to high levels after taking the medicine and low levels before the next dose. Armour thyroid is the least expensive preparation.

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EmpowHER Guest
Anonymous

Thank you for this informative post. I was diagnosed with hypothyroidism following the birth of my first son in 2006 and experienced many of the symptoms you have listed. I trusted my doctors completely assuming they knew everything there was to know about this disease, especially when I became pregnant again in late 2008. How wrong I was! Under their care my TSH, the gold standard for measuring thyroid function, rose high above the safe range for pregnancy and I miscarried. I vowed to myself that I would research everything there was to know about hypothyroidism and warn other women. I fulfilled my vow and launched my blog Hypothyroidmom.com in memory of the baby I lost to hypothyroidism.

October 21, 2012 - 5:48am
EmpowHER Guest
Anonymous

Thank you for this useful post. However, hypothyroidism isn't the only condition that may cause the loss of hair in an individual but if the thyroid gland is under controlled and still there is a loss of hair, one must think of some other reasons. Hair loss, if not hereditary caused, may be signal of something ‘unfair’ with the body and one should pay an awareness of it.

December 20, 2010 - 2:53am
EmpowHER Guest
Anonymous

Thank you for the informative post. I am an RN who was just diagnosed with hypothyroidism as well (TSH 122, T4 0.4, positive antibodies and multiple nodules on thyroid ultrasound). I just started levothyroxine 50mcg last week. I am waiting to feel better, and also to see ENT regarding possible biopsies of nodules.

Any words of advice about nodules?

Heather
http://3underthree.blogspot.com/2009/07/coming-clean.html

July 24, 2009 - 8:25am
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.

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