Hypothyroidism has a variety of causes, and finding the cause is the first step in choosing the right treatment. Hashimoto's disease, an immune-system disorder that causes antibodies to attack the thyroid gland, is the most common cause of hypothyroidism in the United States. This creates chronic inflammation in the gland that interferes with its ability to make enough thyroid hormone. This condition affects more women than men and can run in families.
A few other conditions can also cause the problem. Inflammations of the thyroid, such as subacute, lymphocytic or postpartum thyroiditis, can lead to hypothyroidism, and so can medications that affect the thyroid. A faulty pituitary gland can be another problem. Some treatments for hyperthyroidism will lead to the condition as well. In some of these cases, treating the underlying cause will stop the hypothyroidism.
Risk factors for the condition increase with age. As many as 15 percent of women over the age of 70 have hypothyroidism — doctors recommend that women be tested every few years after the age of 50.
Treatment for Hypothyroidism
The goal of hypothyroidism treatment is to replace the thyroid hormone. This is done with an oral medication of the thyroid hormone thyroxine (T4 or levothyroxine). The medication works quickly, and most people notice improvement within a couple of weeks after starting treatment for hypothyroidism. However, if the problem is severe, it may take longer for the treatment to work. Also, it may take some time for the doctors to find the right level of medication to keep hormone levels in check.
Certain conditions may require special attention when seeking hypothyroid treatment. For example, if someone is older or has a weak heart, the thyroid hormone can increase stress on the heart, so a lower dose is needed.
Pregnant women may need higher doses to ensure that their hypothyroidism treatment is effective. After the baby is delivered, the dose may need to be adjusted.
Patients who are having surgery need to have enough T4 in the system for anesthesia and recovery to go well. This may require intravenous medication after surgery while the patient is recovering.
This treatment is a lifelong commitment. Patients will usually need to remain on their medication for the remainder of their lives. Regular follow-up with an endocrinologist is also necessary to ensure the proper thyroid hormone levels. The good news is that hypothyroid treatment is quite effective once hormone levels are where they should be. If you are experiencing symptoms of hypothyroidism, talk to your doctor to find the right treatment.
Leonard Wartofsky, MD, MACP
Washington Hospital Center
Georgetown University School of Medicine
Bryan Haugen, MD
University of Colorado Denver School of Medicine>
Last Review: May 2013