Taking Thyroid Medications: Everything You Need to Know

Kinds of Thyroid Drugs

One of the most prescribed drugs in the United States has been Synthroid.  Hypothyroidism can be treated using three types of drugs: T4 drugs such as Synthroid, Levoxyl, Levothyroxine and Tirosint, T3 drugs such as Cytomel, and T4/T3 combination drugs such as Armour, Nature-Throid, and WP Thyroid. Individuals afflicted with Hashimoto’s thyroiditis may have impaired conversion of levothyroxine to liothyronine resulting in a more metabolically active thyroid hormone which can manifest as thyroid symptoms such as weight gain, fatigue, depression, and hair loss, despite being on treatment.

Drug Switching

Switching between different brands or generic thyroid drugs will probably result in variations of actual dosage as compared to your previous drug, which was already adjusted by your healthcare professional.  Your thyroid should be retested 4-8 weeks after switching from one brand of drug, or the dose must be readjusted periodically until the right amount is achieved.

Interactions with other drugs

Thyroid drugs are infamous for their interactions with other drugs, resulting in changes in their effectiveness and toxicity profiles. Consult with your healthcare professional before taking any other drugs to prevent such a scenario from happening.

Treatment Monitoring

Thyroid drugs are dosed in micrograms due to their narrow therapeutic index. Very slight variations in doses can result in unusual symptoms during treatment.  Rapid or irregular heartbeat, chest pain, irritability, nervousness, insomnia, weight loss, diarrhea, excessive sweating, hair loss, or fatigue have been determined as common symptoms of such variations. Consequences of over-or-under treatment can be prevented by careful dosage titration.  TSH, Free T3 and Free T4 should be monitored to track your reaction to the drugs. Your healthcare professional will be the one responsible to interpret your results and adjust your dose accordingly.

Addison's disease

You should always be tested for Addison’s disease before you start treatment with thyroid hormones.  This is in order to prevent a possibly life-threatening situation by having an increased clearance of glucocorticoids when thyroid drugs are given to individuals with untreated Addison’s disease.

Pregnancy

Thyroid drugs have been deemed safe for use during pregnancy.  Being dosed properly can actually aid in the reproductive process of females as well as prevent any problems during pregnancy such as miscarriages.  Consult with your healthcare professional if you get pregnant while taking thyroid drugs.  Your dose will increase due to the increased demands of thyroid hormones during pregnancy.

Drug Absorption

The absorption of thyroid drugs can be affected by food, other medications and supplements. Also, intestinal conditions like untreated celiac disease, lactose intolerance, malabsorption and infections can prevent optimal absorption of thyroid hormones.

Prognosis

Thyroid drugs are like anti-hypertensive drugs which generally must be taken for the rest of your life.  Spontaneous remissions have only been reported in a fifth of the total cases.  Thyroid function examinations should be performed at least every 6-12 months to monitor your thyroid hormone levels.

Other Factors

The most common underlying cause of thyroid disease is due to autoimmune conditions such as Hashimoto’s and Graves’ disease.The immune system attacks the thyroid gland due to false recognition of the thyroid as being a foreign or unnecessary object in the body. Autoimmunity still persists even after treatment with surgery or radiation.  The risk of having new autoimmune disorders such as Lupus, Rheumatoid arthritis and others diseases are increased if the underlying cause of the immune imbalance is left untreated. A combination of adrenal dysfunction, food sensitivities, nutrient deficiencies, impaired gut function, infections and toxins that lead to the development of autoimmune disease, have been reported as the primary causes of autoimmune diseases.

Related:Prevention and Treatment of Thyroid Disorders

Rheumatic Disorder: Get the Right Treatment

If you have a child who has a rheumatic disorder, it is imperative that you do thorough research before choosing a doctor and following through with certain treatments. During a consultation, keep in mind any questions or concerns of specific treatments, and discuss each treatment thoroughly with the doctor to ensure that each treatment is suitable for your child. There are resources, such as the Choosing Wisely campaign, that can help make your decision more clear.

For the Choosing Wisely campaign, 35 medical specialty groups collaborated to help prevent further unnecessary treatments for children who have rheumatic disorders. This campaign helps to educate those who have rheumatic disorders, or those who have loved ones with rheumatic disorders, about specific treatments, and what treatments are necessary. The purpose of this campaign is to emphasize that all rheumatic conditions are extremely complex; therefore, if you have a child with a rheumatic disorder, it is vital to understand what your child has and what your child needs. The journal, Arthritis Care & Research, which has been recently published on the ACR's list, includes tests and treatments recommended by rheumatologists that may be of help to your child.  

The doctor should conduct a thorough medical history to determine whether or not the symptoms warrant specific treatments. Once the history is noted, specific tests will be necessary to determine a potential treatment. It is not wise to settle for one quick diagnosis, as certain diseases, such as Lyme disease, can leave a false positive for blood tests. If the child has inflammatory arthritis, request a standard X-ray and activity assessments, as these are more cost effective. If a doctor recommends an MRI it is not needed, it is unnecessary. 

Many patients respond to standard treatment; therefore, a trial of methotrexate or other conventional non-biologic drugs must be conducted, which will then proceed with any biologic drugs for rheumatoida arthritis. For a condition like osteoporosis, a screening is done, known as the Dual-Energy X-ray Absorptiometry (DEXA). The scans must not perform more often than once every two years. 

  

Tests and Procedures for pediatric patients

Your child's symptoms, medical history, a comprehensive physical examination, and lab test results are the basis of the diagnosis for a rheumatologic or immunologic disorder, such as:

●     Physicians need to examine your child's joint(s) and other parts of his or her body. Imaging techniques, such as X-rays, CTscans, or MRIs allow for the examination, and are the most efficient techniques of all.

●     Biopsies of select body organs.

●     The removal of fluids in certain areas of his or her body.

After the diagnosis is reached, the physician will recommend treatment plans specifically designed for your child. In order to reduce pain and inflammation, in addition to recovering the joint and other organ system functions, children are treated with physical and occupational therapy, certain exercise, and oral and intravenous medications.  

Joint Aspirations and Injections 

Excess and often inflamed fluid from the affected joint is removed by a joint aspiration and injection procedure. After that, an injection of a high potency corticosteroid is given to provide a strong anti-inflammatory effect.

Medications that are given intravenously include Infliximab (Remicade), Cyclophosphamide (Cytoxan) and Intravenous Immunoglobulin (IVIG).

Contact your local rheumatologist to discuss any of these treatments.