How is hypothyroidism treated?

The treatment is to take levothyroxine (thyroxine) tablets each day. This replaces the thyroxine which your thyroid gland is not making. Most people feel much better soon after starting treatment. Ideally, take the tablet on an empty stomach (before breakfast). This is because some foods rich in calcium or iron may interfere with the absorption of levothyroxine from the gut. (For the same reason, don’t take levothyroxine tablets at the same time of day as calcium or iron tablets.)

What is the dose of levothyroxine?

Most adults need between 50 and 150 micrograms daily. A low dose is sometimes prescribed at first, especially in those aged over 60 or with heart problems, and is then gradually increased over a period of time. Blood tests are usually taken every 2-3 months, and the dose may be adjusted accordingly. The blood test measures TSH. Once the blood TSH level is normal it means you are taking the correct amount of levothyroxine. It is then common practice to check the TSH blood level once a year. The dose may need adjustment in the early stages of pregnancy. Also, as you get into late middle age and older, you may need a reduced dose of levothyroxine.

Missed a tablet?

Everyone forgets to take their tablets from time to time. Don’t worry as it is not dangerous to miss the odd forgotten levothyroxine tablet. You can take any missed doses as soon as you remember. However, you should try to take levothyroxine regularly each morning for maximum benefit.

How long is the treatment for?

For most people, treatment is for life. Occasionally, the disease process reverses. This is uncommon, apart from the following:

  • Children. Sometimes hypothyroidism is a temporary condition in older children. (This is not so for children who are born with an underactive thyroid.)
  • Pregnancy. Some women develop thyroid imbalance after having a baby. If it occurs, it typically happens about three to six months after the birth. Often this lasts just a few months and corrects itself. Treatment is needed only in a small number of cases. However, afterwards it is wise to have a yearly blood test as there is an increased risk of developing autoimmune thyroiditis and long-term hypothyroidism in the future.

Are there any side-effects or problems from treatment?

Usually not. Levothyroxine tablets replace the body’s natural hormone, so side-effects are uncommon. However, if you have angina, you may find that your angina pains become worse when you first start levothyroxine. Tell a doctor if this happens. If you take too much levothyroxine it can lead to symptoms and problems of an overactive thyroid for example, palpitations, diarrhoea, irritability, and sweating and increase the risk of developing osteoporosis. This is why you need blood tests to check that you are taking the correct dose. Other medicines may interfere with the action of levothyroxine. For example, carbamazepine, iron tablets, phenytoin, and rifampicin. If you start any of these medicines, or change the dose, then you may need to alter the dose of the levothyroxine. Your doctor will advise. Also, if you take warfarin, the dose may need to be altered if you have a change in your dose of levothyroxine.

In summary

  • Hypothyroidism is common.
  • Symptoms develop gradually. They may be confused with other conditions.
  • Treatment with levothyroxine tablets is usually easy and effective.
  • Treatment is usually for life.

Have a blood test once a year if you take levothyroxine tablets once your dose has become stabilised.

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