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When Treating Hyperthyroidism Results in Too Little Thyroid Hormone

Treating hyperthyroidism may entail destroying the thyroid gland. The result is too little thyroid hormone circulating in the body. How can you treat that?
When Treating Hyperthyroidism Results in Too Little Thyroid ...
Doctor endocrinologist checking tyroide goiter of pregnant woman and holding hands on her throat

An overactive thyroid gland that pumps out too much thyroid hormone can be extremely uncomfortable or even dangerous. When this condition is caused by the immune system attacking the thyroid gland, it is called Graves disease. Complications may include cardiovascular troubles such as rapid heart rate, digestive difficulties such as diarrhea, and eye problems. Grave’s disease may be treated temporarily with thyroid-suppressing medication such as methimazole. If it persists, however, endocrinologists will frequently recommend lasting treatment with surgery or radioactive iodine. Both of these destroy thyroid tissue and result in an underactive thyroid gland that requires supplementation.

Can You Overcome Too Little Thyroid Hormone?

Q. I was diagnosed at 16 with hyperthyroidism. My doctor treated it with radioactive iodine, which immediately made me hypothyroid. As I have gotten older, I’ve never been able to get a doctor to adjust my meds to make me feel good. As long as my blood tests are within the normal range, they say everything’s fine. Do you have any information on treating hypothyroidism?

Laboratory Tests for Thyroid Disease:

A. There is some controversy about the normal range for TSH (thyroid stimulating hormone). This compound is produced by the brain to regulate thyroid activity. It is used as the primary measure of thyroid function. Because it is part of a feedback loop, when TSH is low it means there is lots of thyroid hormone in the system. When TSH is high, it means too little thyroid hormone. The question is how high is high? Sometimes physicians use a cut-off point of 4, but others look for TSH to be much higher before they start treating a patient for hypothyroidism.

In addition, TSH is not the only way to assess how well the thyroid gland is doing. Some doctors also test for T4, T3 and reverse T23. A test for TPO (thyroid peroxidase) antibodies will reveal if a person has Hashimoto’s, an autoimmune thyroid condition. The patient’s clinical symptoms are also important (BMC Endocrine Disorders, April 18, 2019). 

What to Do When You Have Too Little Thyroid Hormone:

There is even more controversy over treating hypothyroidism. Many people do just fine on the usual prescription, T4 (levothyroxine). You may know this by the brand names Levothroid, Levoxyl or Synthroid. But others report feeling better if they also get some T3 (triiodothyronine). This may be especially relevant for people like you who have no functioning thyroid gland (European Thyroid Journal, July 2012).

Your situation is not completely unusual. When the thyroid gland must be destroyed to treat Graves disease, the most common result is that the individual will need to take thyroid hormone in pills. While many people do well on the standard levothyroxine (T4) prescription, a proportion feel better when they are also getting some T3.

Learn More:

You can learn more about the diagnosis and treatment of hypo- and hyperthyroidism in our eGuide to Thyroid Hormones. You may also wish to listen to our interview with Dr. David Cooper, director of the Thyroid Clinic at Johns Hopkins University. It is Show 1162: How to Treat Common Thyroid Problems.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
  • Midgley JEM et al, "Time for a reassessment of the treatment of hypothyroidism." BMC Endocrine Disorders, April 18, 2019. DOI: 10.1186/s12902-019-0365-4
  • Ivkovic S, "Polyneuropathy after radioactive iodine treatment of hyperthyroidism and beneficial effect of combined T4/T3 treatment of hypothyroidism." European Thyroid Journal, July 2012. doi: 10.1159/000337977
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