Treatment of hypothyroidism gas x while pregnant


Hypothyroidism is treated by prescribing an oral thyroid hormone preparation (usually levothyroxine, a T4 preparation). The dosage should be sufficient enough to restore normal thyroid hormone levels without producing toxicity from too much thyroid hormone.

There are different formulations of T4 made by different manufacturers. While all FDA-approved formulations are judged to be suitable, most experts recommend sticking to the same formulation you start on, since the dosage equivalents may vary somewhat among different preparations.

In young, healthy people, doctors will generally begin with what is estimated to be a “full replacement dose” of T4 (that is, a dose that is supposed to completely restore thyroid function to normal). The full replacement dose is estimated according to body weight and, for most people, is between 50 and 200 micrograms (mcg) per day.

People should take T4 on an empty stomach to prevent the absorption of the medication from being erratic. Moreover, doctors usually recommend taking the medication first thing in the morning, then waiting at least an hour to eat breakfast or drink coffee. Taking the medication at bedtime, several hours after the last meal, also appears to work and may be a more convenient approach for some people.

TSH levels are monitored to help optimize the dose of T4. TSH is produced in the pituitary gland in response to thyroid hormone levels. So when thyroid hormone levels are low (as in hypothyroidism), TSH levels respond by increasing, in an attempt to “whip” more thyroid hormone out of the thyroid gland.

If TSH levels remain above the target range, the dose of T4 is increased by about 12 to 25 mcg per day, and TSH levels are repeated after six more weeks. This process is continued until the TSH level reaches the desired range and symptoms are resolved.

In fact, according to a 2016 study published in the Journal of Clinical Endocrinology and Metabolism, about 15 percent of people in the United States with hypothyroidism continue to feel unwell despite being treated for the disease. Some doctors may then consider liothyronine (T3) as an add-on treatment for select individuals, though this is a matter of debate.

T4 is the major circulating thyroid hormone, but it is not the active hormone. T4 is converted to T3 in the tissues, as needed. And T3 is the thyroid hormone that does all the work. (T4 is merely a prohormone—a repository of potential T3 and a way of making sure enough T3 can be created on a minute-to-minute basis as it is needed.)

However, there is emerging evidence suggesting that, at least in some people with hypothyroidism, that efficient conversion of T4 to T3 is lacking. In other words, despite the fact that their T4 levels may be normal, their T3 levels may be low, especially in the tissues, where T3 actually does its work.

Why T4 to T3 conversion may be abnormal in some people is, at this point, largely speculation—although at least one group of patients has been identified with a genetic variant (in the diodinase 2 gene) that reduces the conversion of T4 to T3. In any case, it appears that doctors should be treating at least some people (albeit, a small group, most likely) who have hypothyroidism with both T4 and T3.

Giving appropriate doses of T3 is trickier than appropriately dosing T4. T4 is inactive, so if you give too much there is no immediate, direct tissue effect. T3 is a different story, though, as it is the active thyroid hormone. So if you give too much T3, you can produce hyperthyroid effects directly—a risk, for instance, to people with cardiac disease.

In people taking combined T4/T3 therapy, doctors usually check a TSH level six weeks after beginning treatment. T3 levels are not generally checked because currently-available T3 formulations lead to wide fluctuations in T3 blood levels throughout the day.

In an infant diagnosed with congenital hypothyroidism, the objective is to restore thyroid levels to normal as quickly and safely as possible. The quicker the thyroid levels are normalized, the more normal the cognitive and motor skills development of the infant.

Often, a liquid form of levothyroxine is given to infants. It’s important to not mix the levothyroxine with soy infant formula or any calcium or iron-fortified preparations. Soy, calcium, and iron can all reduce the infant’s ability to absorb the medication properly.

If permanent hypothyroidism has not been established, levothyroxine treatment may be discontinued for a month at age 3, and the child retested. If levels remain normal, transient hypothyroidism is presumed. If levels become abnormal, permanent hypothyroidism is assumed.

Children with transient congenital hypothyroidism who are taken off medication should, however, still have periodic thyroid evaluation and retesting, as these children face an increased risk of developing a thyroid problem throughout their lives.

For example, some experts suggest that certain yoga poses (specifically, shoulder stands and inverted poses where the feet are elevated) may be beneficial to blood flow to the thyroid gland, or to the reduction of general stress that contributes to worsening symptoms of hypothyroidism.

It’s important to note that self-treating your thyroid problem with supplements and/or making a few dietary changes is not a good idea. Treating an underactive thyroid is a complex process that requires careful symptom and dose monitoring by a physician.

Keep in mind, as well, that supplements are not regulated by the government, meaning there is no scientific consensus that they are safe and effective. In other words, just because a supplement is "natural" or available without a prescription does not necessarily mean it’s actually harmless.

Lastly, while some holistic or CAM practitioners may be able to recommend approaches to support your thyroid, immune and hormonal systems, it’s important to be cautious of any product that’s marketed as a "cure" for your disease, or one that’s said to have no side effects.