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Do I need to take hypothyroidism drugs for life?

Thursday, 30 April 2009
Answered by: Dr Smita Gupta
Assistant Professor of Clinical Medicine, Division of Endocrinology and Metabolism,
Southern Illinois University,
USA
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Q. I am a 27 years old man having hypothyroidism for the last year. I am taking Eltroxin 100 mg for a year now. After taking this tablet every 3 months I get a thyroid test done. My thyroid levels are: T3 (free) – 1.19 ng/dl, T4 (free) – 0.65 ng/dl, TSH – 10.25 microIU/ml about 18 months back. Then again 15 months back I took the test and result was - T3 (free) – 2.39 ng/ml, T4 (free) – 1.42 ng/dl, TSH – 0.90 microIU/ml. Then again after 3 months it was T3 (free) – 1.59 pg/ml, T4 (free) – 1.01 ng/dl, TSH – 1.2 microIU/ml. Then again after 3 months my T3 (free) was 4.54 ng/ml, T4 (free) – 2.18 ng/dl, TSH – 0.07 microIU/ml. Then again after 3 months - T3 (free) – 1.84 ng/ml, T4 (free) – 1.09 ng/dl, TSH – 0.92 microIU/ml. Now 3 months back T3 (free) was 2.5 pg/ml, T4 (free) – 2.2 ng/dl, TSH – 0.26 microIU/ml and my latest report states T3 (free) – 1.9 pg/ml, T4 (free) – 1.4 ng/dl, TSH – 0.19 microIU/ml. My doctor said that there were some fluctuations in the thyroid level so he asked me to continue the tablets. But I am feeling irritation after taking this tablet daily? Can I stop the tablet? Is there any permanent cure for hypothyroidism? What are the side effects of Eltroxin?

A.  From the laboratory results that you have sent me, you clearly had hypothyroidism (underactive thyroid) before the treatment was started 3 years back. You will need lifelong treatment of hypothyroidism. Untreated hypothyroidism can cause tiredness, weight gain, puffiness, sleep problems, constipation and in severe cases can have adverse effect on the heart. Treatment with thyroid hormone replacement therapy (like Eltroxin in your case) is effective and does not have any long-term side effects as long as the dose is correct. Food and other medications can alter the absorption of thyroid medication causing fluctuation in the doses. We routinely advise the patient to:
  • Take the thyroid hormone regularly at a consistent time.
  • Taking thyroid hormone on an empty stomach, at least 2 hrs before eating, which allows for maximum absorption.
  • Be consistent about a high-fiber diet. If you start or stop eating high-fiber, get your thyroid rechecked, because it may change your absorption.
  • If you take vitamins, calcium tablets or supplements with iron, take at least two to three hours apart from thyroid hormone. These can interfere with thyroid hormone absorption if taken too close together.
  • Don't take antacids within four hours of thyroid hormone, so that absorption is not affected.
  • Use of any estrogens or oral contraceptives( in women) can alter thyroid hormone dose requirements.
  • Do not change the brand of thyroid hormone medication as there may be slight difference in the preparations from different drug companies.
  • Make sure you tell your doctor about other medications that you are taking, so he/she is aware of any drug interactions.
After you have followed above instructions, and your thyroid tests still look the same as the last one, a slight decrease in the dose of your thyroid hormone will be needed.

A.  From the laboratory results that you have sent me, you clearly had hypothyroidism (underactive thyroid) before the treatment was started 3 years back. You will need lifelong treatment of hypothyroidism. Untreated hypothyroidism can cause tiredness, weight gain, puffiness, sleep problems, constipation and in severe cases can have adverse effect on the heart. Treatment with thyroid hormone replacement therapy (like Eltroxin in your case) is effective and does not have any long-term side effects as long as the dose is correct. Food and other medications can alter the absorption of thyroid medication causing fluctuation in the doses. We routinely advise the patient to:
  • Take the thyroid hormone regularly at a consistent time.
  • Taking thyroid hormone on an empty stomach, at least 2 hrs before eating, which allows for maximum absorption.
  • Be consistent about a high-fiber diet. If you start or stop eating high-fiber, get your thyroid rechecked, because it may change your absorption.
  • If you take vitamins, calcium tablets or supplements with iron, take at least two to three hours apart from thyroid hormone. These can interfere with thyroid hormone absorption if taken too close together.
  • Don't take antacids within four hours of thyroid hormone, so that absorption is not affected.
  • Use of any estrogens or oral contraceptives( in women) can alter thyroid hormone dose requirements.
  • Do not change the brand of thyroid hormone medication as there may be slight difference in the preparations from different drug companies.
  • Make sure you tell your doctor about other medications that you are taking, so he/she is aware of any drug interactions.
After you have followed above instructions, and your thyroid tests still look the same as the last one, a slight decrease in the dose of your thyroid hormone will be needed.

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