The goal of treatment is to improve symptoms and restore normal body function through replacement of thyroid hormone. For most people, this usually means lifelong treatment.
If you have primary hypothyroidism, you will usually need lifelong treatment with levothyroxine (often simply referred to as thyroxine) tablets. This medication is taken once per day, as soon as you wake in the morning at least 15-30 minutes before breakfast. The dose needs to be carefully monitored with blood tests to ensure the correct dose is given and avoid hormone levels getting too high. If this occurs, symptoms can develop such as an increase in heart rate, unexplained weight loss, anxiety/nervousness, sweating, diarrhoea and an intolerance to hot temperatures. It is common for doses to be adjusted at the start of treatment until you reach a stable dose and to make sure you are receiving the optimum dose that brings your TSH level into a normal range.
Once the dose is stabilised, your doctor will recommend yearly check-ups to monitor your thyroid hormone levels and adjust treatment if necessary.
For some people who take thyroxine, symptoms persist even though medication is taken routinely and TSH levels return to normal. These symptoms may be caused by other health problems, that your doctor will be able to determine. Symptoms may also persist because the dose of thyroxine may not meet the needs of every individual patient, for reasons that are not yet clear. Combined treatment of T3 with thyroxine is sometimes prescribed, although there is no evidence to show it works better than thyroxine alone2.
Treatment of hypothyroidism with desiccated thyroid extract (made from porcine (pig) thyroid) is not approved as a medication in Australia. This is because the amount of thyroxine absorbed from desiccated thyroid extract can vary from one batch to the next, and result in variable blood test results. There also remains the remote possibility of the extract containing animal transmitted viruses.
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If you have subclinical hypothyroidism and some symptoms, your doctor may decide on a trial of thyroxine for a few months to see if it helps.
If you have subclinical hypothyroidism and few or no symptoms, you will require follow-up blood tests to ensure that you are not developing clinical hypothyroidism. Depending on the level of TSH and if thyroid antibodies are found, these tests should initially be performed every 6-12 months.