NA: The most common cause of hypothyroidism is autoimmunity, where the immune system makes antibodies that can attack the thyroid gland. It can run in the family but can happen suddenly as well. In other cases, surgical removal, iodine deficiency, radiation exposure or medications can affect the function of the thyroid. NA: As we age, normally our thyroid function tends to slow down and the normal reference ranges increase.
However, thyroid disorders have no age limits. Hypothyroidism is more common in elderly than in young adults and is often underdiagnosed. Unlike younger people, older people may not have all the symptoms on the thyroid spectrum but can have significant change in their quality of life with just one or two symptoms.
Regardless, we as physicians have to be very vigilant in making a diagnosis, as once diagnosed most patients require long-term follow-up. NA: Medication is the most common treatment for hypothyroidism.
It does not cure the condition but only controls it. Usually we first try thyroxine T4 therapy, since it has a good response, minimal side effects and the dose is easy to adjust. The treatment for high thyroid depends on the cause, but our options include medications, surgery and the use of radioactive iodine I to destroy the thyroid gland. Endocrinologists diagnose and treat hormonal imbalances, usually due to various gland conditions, such as:.
This can be for a number of reasons—perhaps you have multiple other medical problems making your case a complex one , or perhaps your doctor does not have a lot of experience treating patients with such a disorder. Alternatively, your endocrinologist may work alongside your primary care doctor to manage your condition. Once your endocrinologist stabilizes your thyroid hormone replacement dose, your primary care doctor may then follow your TSH levels.
You may then only see your endocrinologist if a problem arises, or once a year for a check-in. Naturopaths and chiropractors are two professionals who are sometimes consulted.
If you consult with these or other practitioners, be sure that you only do so as an adjunct to your care by a primary care doctor or endocrinologist. He or she should also be aware of any treatments recommended by other clinicians. A licensed naturopathic doctor ND graduates from a four-year graduate level holistic medical school. Their approach to healthcare tends to be more integrative perhaps than traditional doctors in that NDs believe no part of your body operates in complete isolation from the rest of the system.
So, for example, an ND may discuss the aspects of how nutrition affects thyroid disorders and make sure that you have a diet plan that works to support your thyroid health. For instance, for the treatment of hypothyroidism, many NDs prescribe desiccated thyroid hormone , which is derived from the dried thyroid glands of pigs or cows and provides both T4 thyroxine and triiodothyronine T3.
Alternative names include natural thyroid, thyroid extract, porcine thyroid, pig thyroid; brand names include Nature-throid and Armour Thyroid.
Dosage levels are increased or decreased depending on symptoms and results of blood tests. Medication will compensate for the weakened thyroid, eventually taking over when the thyroid ceases to function altogether. For some, increasing their medication to compensate for reduced thyroid function happens over many years. Others go from no medicine to a full dose within six months. I reassure my patients that we will work together to find a dose of medication that will hold things steady at some point.
Mandagere: Some of my patients ask if mineral, vitamins or herbal supplements can be helpful. As an endocrinologist, I answer these questions based on my knowledge and experience with evidence-based studies and data. We also know that healthy living benefits our immune system, which in turn can lead to better thyroid function. I talk with my patients about general recommendations that include good quality sleep, regular exercise, and a lean and green diet that avoids process foods.
Mandagere: For my patients who are already being treated for hypothyroidism, I emphasize the importance of taking their medication in a consistent manner. This is where, with my passion for, and background in biochemistry and nutrition, things really get interesting in terms of problem-solving with my patients. We may find that their body is not absorbing the thyroid medication efficiently or that the metabolism of the medication has changed for one reason or another.
We talk about a proper dosing routine that includes taking their medication the same time every day on an empty stomach. We also discuss other prescriptions or supplements that might be impacting their thyroid medication.
For instance, switching to Synthroid, the brand drug from the generic levothyroxine or levothroid has helped some patients. This is because every time you purchase Synthroid at the pharmacy you get the exact same product. You know that the absorption and metabolism is very predictable. When you purchase the generic brand, however, the pharmacy may give you one generic batch one time and a different batch the next. The active drug is the same but the formulation — perhaps the coating on the pill — may be different and can affect absorption.
I prefer prescribing Synthroid for my patients but, of course, the brand is more expensive so a lot people do opt for the generic and sometimes that means more monitoring and adjusting. Kelly Mandagere joined Boulder Medical Center in after practicing for over 10 years as an endocrinologist in Louisville, Colo.
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