Treatment

Treatment for Hashimoto's disease may include observation and use of medications. If there's no evidence of hormone deficiency, and your thyroid is functioning normally, your doctor may suggest a wait-and-see approach. If you need medication, chances are you'll need it for the rest of your life.

Synthetic hormones

If Hashimoto's disease causes thyroid hormone deficiency, you may need replacement therapy with thyroid hormone. This usually involves daily use of the synthetic thyroid hormone levothyroxine (Levoxyl, Synthroid, others).

Synthetic levothyroxine is identical to thyroxine, the natural version of this hormone made by your thyroid gland. The oral medication restores adequate hormone levels and reverses all the symptoms of hypothyroidism.

Monitoring the dosage

To determine the right dosage of levothyroxine initially, your doctor generally checks your level of TSH after six to eight weeks of treatment and again after any dose changes. Once the dose that normalizes your thyroid tests is determined, your doctor is likely to check your TSH level about every 12 months as the dosage you need may change. Excessive amounts of thyroid hormone can accelerate bone loss, which may make osteoporosis worse or add to your risk of this disease. Overtreatment with levothyroxine can also cause heart rhythm disorders (arrhythmias).

If you have coronary artery disease or severe hypothyroidism, your doctor may start treatment with a smaller amount of medication and gradually increase the dosage. Progressive hormone replacement allows your heart to adjust to the increase in metabolism.

Levothyroxine causes virtually no side effects when used in the appropriate dose and is relatively inexpensive. If you change brands, let your doctor know to ensure you're still receiving the right dosage.

Also, don't skip doses or stop taking the drug. If you do, signs and symptoms will gradually return.

Effects of other substances

Certain medications, supplements and some foods may affect your ability to absorb levothyroxine. However, taking levothyroxine four hours before or after other medications could remedy the problem. Talk to your doctor if you eat large amounts of soy products or a high-fiber diet or if you take any of the following:

• Iron supplements, including multivitamins that contain iron
• Cholestyramine (Prevalite), a medication used to lower blood cholesterol levels
• Aluminum hydroxide, which is found in some antacids
• Sucralfate, an ulcer medication
• Calcium supplements

Is a combination of hormones needed?

Levothyroxine is the synthetic form of the natural T-4. T-4 is converted into T-3 in the body. While most people are treated successfully with levothyroxine alone, some people don't feel completely normal on levothyroxine.

Researchers have investigated whether adjusting standard hypothyroidism treatment to replace some T-4 with small amounts of T-3 may offer benefit. But, the majority of studies have determined that the addition of T-3 does not offer any advantage over treatment with T-4 alone.

There is some evidence that T-3 may offer benefit to certain subsets of people, such as people who have had their thyroid surgically removed (thyroidectomy). Research is ongoing.

T-3 can be given alone as liothyronine (Cytomel) or in combination with T-4. Taking a combination T-4 and T-3 ends up producing higher than normal levels of T-3, especially soon after the medication is taken. This can cause a fast heart rate, anxiety and trouble sleeping.

But, for those who haven't gotten enough relief from T-4 alone, adding liothyronine to standard levothyroxine treatment for a three- to six-month trial is a long enough period to see if the combination helps you.

Alternative medicine

Standard treatment for Hashimoto's disease is levothyroxine, the synthetic form of thyroxine (T-4). However, extracts are available that contain thyroid hormone derived from the thyroid glands of pigs. These products — Armour Thyroid, for example — contain both levothyroxine and triiodothyronine (T-3).

Doctors have a number of concerns about thyroid hormone extracts such as Armour Thyroid, including:

• The balance of T-4 and T-3 in animals isn't the same as in humans.
• The exact amount of T-4 and T-3 in each batch of a natural extract product can vary, leading to unpredictable levels of these hormones in your blood.