Hashimoto disease

Hashimoto's thyroiditis most commonly affects middle-aged women and is associated with an array of symptoms that include chronic fatigue, dry hair, chronic irritability, difficulty concentrating, constipation, and chronic nervousness. Without treatment, signs and symptoms gradually become more severe and your thyroid gland may become enlarged (goiter). In addition, you may become more forgetful, your thought processes may slow or you may feel depressed.

Affected patients tend to report decreased quality of life. HT is an autoimmune disorder in which the body produces an antibody that attacks the thyroid gland resulting in inflammation, and often decreased thyroid function (hypothyroidism).

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 do 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 (Levothroid, Levoxyl, Synthroid). 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.

Soon after starting treatment, you'll notice that you're feeling less fatigued. The medication also gradually lowers cholesterol levels elevated by the disease and may reverse any weight gain. Treatment with levothyroxine is usually lifelong, but because the dosage you need may change, your doctor is likely to check your TSH level every six to 12 months.

Monitoring the dosage

To determine the right dosage of levothyroxine initially, your doctor generally checks your level of TSH after a few weeks of treatment. Excessive amounts of the hormone can accelerate bone loss, which may make osteoporosis worse or add to your risk of this disease. Overtreatment with levothyroxine also can 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 because you're feeling better. If you do, signs and symptoms will gradually return.

Effects of other substances

Certain medications, supplements and even some foods may affect your ability to absorb levothyroxine. 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 (Questran), a medication used to lower blood cholesterol levels
• Aluminum hydroxide, which is found in some antacids
• Sodium polystyrene sulfonate (Kayexalate), used to prevent high blood potassium levels
• Sucralfate, an ulcer medication
• Calcium supplements