Hypothyroidism appointments

The thyroid gland produces the hormones triiodothyronine (T3) and thyroxine (T4), which help regulate metabolism. Metabolism can affect your weight, body temperature, and energy. An under or overactive thyroid can alter your heart rhythms, which may lead to heart failure.

Hypothyroidism: An underactive thyroid gland slows down the metabolism, which can lead to weight gain and fatigue. Other symptoms of hypothyroidism include:

• Sensitivity to cold
• Constipation
• Change in menstrual periods
• Muscle pain/ weakness
• Joint pain/ stiffness
• Dry skin and hair
• Increased cholesterol levels
• Hoarseness
• Depression
• Confusion and memory problems

Hypothyroidism is commonly caused by Hashimoto’s disease, an autoimmune disease in which cells in the thyroid are mistakenly attacked by your body’s immune system. An underactive thyroid can lead to heart problems, mental health problems, nerve damage, infertility, and other complications.

Hyperthyroidism: An overactive thyroid gland produces excessive levels of T3 and T4 hormones. This can produce symptoms such as:

• Weight loss
• Rapid heartbeat (tachycardia)
• Nervousness or anxiety
• Tremor (trembling in the hands and fingers)
• Diarrhea
• Increased appetite
• Changes in menstrual cycles
• Sensitivity to heat and excessive sweating
• Sleep problems
• Fatigue
• Bulging eyes (common in Grave’s disease)
• Hair loss, or thinning of hair

Hyperthyroidism can lead to complications such as heart problems, brittle bones, eye problems (especially common with Grave’s disease), and thyrotoxic crisis. This last condition results in a sudden increase in the severity of your symptoms and delirium. A thyrotoxic crisis is a medical emergency and requires immediate care.

Hyper/ hypothyroidism treatments are meant to manage hormone levels.

For an underactive thyroid, your doctor may prescribe you a hormone replacement medication that will replace the hormones that your thyroid gland is not producing enough of. The most common medication used for this therapy is levothyroxine, which increases the levels of T4 and T3 in your blood.

For an overactive thyroid, your doctor may prescribe methimazole or propylthiouracil, both of which block your thyroid’s ability to make T4 and T3. You may also be prescribed radioactive iodine, an oral tablet that shrinks your thyroid glands. This leads to a decrease in thyroid hormone production but usually results in permanent damage to the thyroid gland. After taking this medication, you may be prescribed hormone replacement therapy to keep hormone levels balanced.

Thyroid panel tests are used to determine the levels of T3 and T4 hormones in your blood. Low amounts of these hormones indicate an underactive thyroid gland (hypothyroidism), where excessive levels of T3 and T4 indicate an overactive thyroid (hyperthyroidism).

Detecting an under or overactive thyroid can help doctors diagnose thyroid-related disorders such as:

- Thyroid cancer

- Goiter: An enlargement of the thyroid gland which can cause pain, hoarseness, swelling, and dizziness.

- Hashimoto’s disease: An autoimmune disorder that attacks cells in the thyroid gland, resulting in hypothyroidism.

- Thyroiditis: Inflammation of the thyroid, which can result in hypothyroidism or hyperthyroidism.

- Grave’s disease: An autoimmune disorder that results in hyperthyroidism.

A comprehensive thyroid panel will evaluate your thyroid function with 3 different tests:

- TSH test: A thyroid-stimulating hormone (TSH) test is a lab test that evaluates how well your thyroid is working by measuring your thyroid-stimulating hormone. Your doctor may recommend a TSH test if you're experiencing symptoms of hyperthyroidism or hypothyroidism, including anxiety, weight gain/loss, tiredness, hair loss, irregular menstrual periods, changes in your heart rate, puffiness, and more.

- T4 Test: A thyroxine (T4) test measures the level of T4 in the blood.

- T3 Test: A triiodothyronine (T3) test measures the level of T3 in the blood.

Other blood tests that may be performed during a thyroid panel include:

- Thyroid antibody test: This test measures levels of thyroid antibodies that are produced to determine whether or not the immune system is mistakenly creating antibodies to attack the thyroid gland. By doing this, thyroid antibody tests can help detect underlying autoimmune causes of hyper/hypothyroidism such as Grave’s disease or Hashimoto’s disease.

- Thyroglobulin: This test measures the thyroglobulin protein, which is produced by the thyroid gland or thyroid cancer cells. A thyroglobulin test can help detect inflammation of the thyroid gland- especially in patients who have had their thyroid gland removed due to thyroid cancer.

A blood sample is taken to measure TSH levels. To do this, your doctor will insert a small needle into a vein in your forearm. Before the needle is put into your skin, the area will be sanitized. You may feel a pinch as the needle punctures your skin, but this discomfort should subside within a few seconds.

Blood drawn from your arm is deposited in a small vial or tube. Once the desired amount of blood is taken from the arm, the puncture site will be cleaned and bandaged. The vial will be given to the lab for analysis.

TSH tests are quick and do not require sedation. You will be cleared to leave the clinic and resume your daily activities once the testing is finished.

You should receive the results of your TSH test within 1-3 days of your appointment. Your primary care provider will inform you of the results of the analysis. Depending on the findings, you may be asked to come back to the clinic for follow-up testing to definitively diagnose any thyroid conditions. Thyroid cancer, for instance, requires a biopsy or diagnostic imaging test (such as a CT or X-ray scan) before treatment can begin.

The results of a TSH test do not necessarily indicate a hormone condition. TSH levels correspond to levels of T3 and T4 in the blood. Because of this, you will likely be asked to undergo further testing before you are diagnosed with a thyroid condition. TSH tests are commonly performed in tandem with other thyroid tests as a part of a comprehensive thyroid panel. These tests measure various determinants of thyroid function, such as T3 and T4 levels. Comprehensive thyroid panels are commonly performed for individuals at risk of a thyroid condition, or for individuals taking medication that affects thyroid function - such as lithium.

Thyroxine blood tests are used to determine the levels of T4 hormones in your blood. There are two forms of T4: free T4 and bound T4. Free T4 flows freely through the bloodstream on its own. Bound T4 attaches itself to proteins in the blood. Low amounts of these two types of the T4 hormone indicate an underactive thyroid gland (hypothyroidism), where excessive levels of T4 indicate an overactive thyroid (hyperthyroidism).

Detecting an under or overactive thyroid can help doctors diagnose thyroid-related disorders such as:

- Thyroid cancer

- Goiter: An enlargement of the thyroid gland which can cause pain, hoarseness, swelling, and dizziness.

- Hashimoto’s disease: An autoimmune disorder that attacks cells in the thyroid gland, resulting in hypothyroidism.

- Thyroiditis: Inflammation of the thyroid, which can result in hypothyroidism or hyperthyroidism.

- Grave’s disease: An autoimmune disorder that results in hyperthyroidism.

A blood sample is taken to measure T4 levels. To do this, your doctor will insert a small needle into a vein in your forearm. Before the needle is put into your skin, the area will be sanitized. You may feel a pinch as the needle punctures your skin, but this discomfort should subside within a few seconds.

Blood drawn from your arm is deposited in a small vial or tube. Once the desired amount of blood is taken from the arm, the puncture site will be cleaned and bandaged. The vial will be given to the lab for analysis.

T4 tests are quick and do not require sedation. You will be cleared to leave the clinic and resume your daily activities once the testing is finished.

You should receive the results of your T4 test within 1-3 days of your appointment. Your primary care provider will inform you of the results of the analysis. Depending on the findings, you may be asked to come back to the clinic for follow-up testing to definitively diagnose any thyroid conditions. Thyroid cancer may require a biopsy or diagnostic imaging test (such as a CT or X-ray scan).

Levothyroxine is a prescription medication used to treat thyroid conditions. It is a hormone replacement drug usually prescribed to treat hypothyroidism, a condition in which the body does not produce enough thyroid hormone to properly regulate your metabolism and weight. Levothyroxine may also be prescribed to help treat thyroid cancer.

Hypothyroidism affects almost 5% of the U.S. population. Without the proper amount of thyroid hormone, people with hypothyroidism often suffer from fatigue, poor growth, constipation, weight gain, hair loss, muscle pain, depression, and more.

Levothyroxine is generally used to treat thyroid conditions, including hypothyroidism and thyroid cancer.

The thyroid is often referred to as the body’s thermostat; it produces thyroid hormone, the chemical responsible for stabilizing your weight, regulating your metabolism, and maintaining your mental health. People with hypothyroidism can no longer produce this hormone in sufficient quantities, causing a range of health conditions from depression to weight gain. For patients with hypothyroidism, levothyroxine is prescribed to supply the body with the level of thyroid hormone it needs. Levothyroxine supplements - and in some cases, completely replaces - your body’s diminished supply of thyroid hormone, helping you feel like yourself again.

Alongside surgery and radioiodine therapy, levothyroxine is sometimes prescribed to help treat thyroid cancer.

There are some thyroid conditions, however, that levothyroxine is not approved to treat. These include benign thyroid nodules, goiters, and subacute thyroiditis.

While levothyroxine may cause you to experience some adverse side effects, it is important to remember that your doctor prescribed levothyroxine because its ability to stabilize thyroid hormones in your body outweighs the side effects it may produce.

You may experience some hair loss as you begin taking levothyroxine. This is temporary and does not generally persist as you continue taking levothyroxine.

Rare but serious side effects may include:

Arrhythmias Myocardial infarction (heart attack) Dyspnea Muscle spasm Headache Nervousness Irritability Insomnia Tremors Muscle weakness Increased appetite Weight loss Diarrhea Heat intolerance Menstrual irregularities Skin rash

Notify your doctor if you experience any of these adverse effects.

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