TREATING A THYROID DEFICIENCY HYPOTHYROIDISM : is the state of deficiency of thyroid hormone ETH RMON JENCY : Tmoming joint stiffness joint and muscle pains nightly muscle cramps swollen eyes, face, esp. in the moming dry skin and hair diffuse hair loss = abnommal sensitivity to cold, cold hands and feet - ~ tiredness esp. when waking up and resting : better in the evening. - slowness (or sometimes compensatory - hyperactivity - because tired if slows down) |- - headaches : - memory loss, poor concentration = overweight, difficulty to loose weight - hoarseness in the morning, = slow digestion = constipation WHICH MEDICATION TO TAKE 7 A low thyroid function is best compensated following the experience of several physicians by the intake of a preparation containing both thyroid hormones, the active T, and the precursor hormone T, (3 to 5 x less active than T,), as eg. Armour Thyroid® (dessicated thyroid of animal origin) or Novothyral® (synthetic). The advantage of dessicated thyroid is following the experience of patients that it acts in 1a more stable 24 hour way and is better tolerated. Products which contains only one of the two hormones (e.g. only Ty: Synthroid®, L-Thyroxine®, Elthyrone®, Euthyrox®, ete.) or only T; (Cytomel@) don't seem to improve low ‘thyroid patients as satisfying. ‘HOW 10 START THE TREATMENT ? ‘Always in small doses, which you progressively increase (on average, expect 3 to 6 months before reaching the adequate dose). Don't be surprised, as a patient, that you feel the first improvement only 5 to 8 weeks after starting treatment ‘ARMOUR THYROIDG = start on a low dose . during 10 days the next 10 days «the next 10 days the next 10 days 15 mg (1/4 grain) every day .. then 30 mg (1/2 grain) every day ‘then 45 mg (3/4 grain) every day then 60 mg (1 grain) every day then 75 mg (1 grain 1/4) every day ... the next 10 days then 90 mg (1 grain 1/2) every day .. until next consult. and increase in the same slow way every 10 days with 15 mga day until reaching the optimal dose (average dose : 75 ~ 180 NOVOTHYRAL® = start on a low dose with 1/4 tablet every day ...during 14 days then 1/2 tablet every day ... during 14 days then 3/4 tablet every day ... during 14 days then 1 tablet every day ...... until the next consult and increase in the same way a 1/4 of a tablet every 14 days until reaching the optimal dose (often between 1 and 2 tablets a day following the patient). mg following the patient) Chew the tablets preferentially before breakfast stomach, The optimal dose is quite different from one patient to another. Certain patients feel good with e.g. 30 mg of Armour Thyroid® or 1/2 tablet of Novothyral®, others need sometimes 360 mg of Armour Thyroid® or 3 to 4 tablets of Novothyral® daily. PRECAUTIONS = Reduce severely the dose of coffeine (real coffee or tea, cola, important quantities of brown or black chocolate, ...) - Avoid or moderate the dose of tricyclic antidepressants and amphetamines (appetite moderators). ‘They may cause intolerance symptoms of the thyroid medication. For patients with increased volume of their thyroid sland, preparations which contains iodine (certain multivitamin preparations, Visceralgine®, Isobetadine®, Vesalium®, radiographic contrast products, etc.) should be avoided when possible. ~ If the patient forgets to take his thyroid hormone supplement in the morning, it can be taken later in the day (although later in the day its intestinal absorption may not be as good as in the morningl), but avoid taking thyroid hormones in the evening = In case of disease, the patient may take other medications (antibiotics, aspirin, ete.), but when possible at a separate moment, preferably half an hour or more later, to avoid impaired absorption of thyroid hormones in the intestines. 5HOW TO FIND 1) EQUATE DOSE? By being regularly checked by an experimented physician. He will control the improvement at physical ‘examination examination (through the disappearance of signs of hypothyroidism as e.g. quicker Ackillous’ tendon reflexes, warmer hands and fect, less dryness of skin and hair, disappearance of lower eyelid swelling, etc.) and with new laboratory tests (blood, urines of 24 hours). But also, and this is essential, by the disappearance of the typical Patient's complaints of hypothyroidism (as e.g. disappearance of the abdormal coldness, the (morning) tiredness, the depressive tendency, the nightly muscle cramps, the headaches, etc.). As the dose varies much from one individual to the other, knowledge by the patient of the symptoms of excess thyroid hormones (overdosing) is important to keep the treatment on the right tracks. sYMPT\ \F EXCES 'YROID. These signs and symptoms are there 24 hours on 24 hours and not briefly (if so, think of another cause : stress, etc.). With an excessive dose of thyroid hormones, the patient becomes nervous and has a tendency to do evervthing too quickly = wakes up too early in the morning = excessive hunger, thirst = moves, reacts too quickly + excessive sweating, warmth production = speaks, thinks too quickly = abnormal nervousness (with sensation of inner + his heart beats to0 quickly trembling) = trembling fingers = agressivity, anxiety - important weight loss although increased food ]- poor sleep, intake = __muscle weakness Each time the patient increases the dose of his thyroid medication, he or she may experience during 2 to 3 days some moderate symptoms of thyroid excess (adaptation period). But if these symptoms persist 4 — 5 days or more and/or become more severe, then the dose is excessive and the patient must 1. stop taking all coffeinated drinks; 2. reduce the dose (take e.g. 15 - 30 mg/day Armour Thyroid® or 1/4 ~ 1/2 tablet of Novothyral® less ~ if extremely overdosed, stop 2 days and restart again the treatment on a lower dose) B ADA! The following circumstances may require to : ~ REDUCE THE DOSE : in the summer and in the South (warmer climate), at the sea side (more iodine), during major mental stress (excess adrenaline) or important reduction of physical activity (the recovery period after surgery, new more sedentary job), - INCREASE THE DOSE : in the winter and in the far North (colder climate), in the mountains (less iodine), during a chronically increase in physical activity. ARE THERE ANY SIDE EFFECTS ? Normally, no short term side effects. ‘The hypothyroid patient only corrects a deficiency in substances which belong to his body. He takes supplementary of substances that arc identical to those produced by his thyroid gland (which does not produce sufficiently). His body only receives substances for which it is made. On a middle and long term basis, no side effects neither if the hypothyroid patient is treated adequately. However, taking insufficient or excessive doses during a long time must be avoided. This can be easily avoided if the program is followed correctly and the patient knows how to recognize the signs of a too low and a too high dose of thyroid hormones. BENEFITS : For the hypothyroid patient : an improvement sometimes very clear of his health, of the quality of his life, of the functioning of all the tissues of his body (who receive a better blood supply) and possibly a longer life span, AND IF THE PATIENT STOPS HIS TREATMENT ? Because the therapy with thyroid hormones just corrects the lack of thyroid hormones and does not stimulate the function of the thyroid gland, a stop of the treatment will be followed by a slow return to the initial metabolic state (before treatment) with a progressive reappearance of hypothyroid symptoms during the weeks, the months and the years that follow this stop. When stopping the treatment, you as a patient should not be afraid of experiencing a more severe thyroid deficiency than the one that existed before taking any treatment. On the condition of course that the treatment hhas been well conducted and that no other major medical problem (disease or accident) has occurred in the ‘meanwhile © T. Hertoghe, Brussels, 9-99