I sadly have a close connection with thyroid issues. On my Dad's side of the family, there are multiple autoimmune disorders, specifically hyperthyroidism for which I am the lucky one to have inherited. It has been a little more than a year since I was first diagnosed. I remember feeling the symptoms right after I got COVID-19 in November of 2020. My heart was racing to the point where my resting heartbeat was at 140 bpm, feeling like I was about to faint whenever I walked up or down the stairs, experiencing panic attacks, was losing a lot of weight, tremors, etc. I originally thought it was all COVID-related so I didn't go see a doctor until 2 months later. I went to see my primary care physician and saw that my blood pressure and heart rate were through the roof, in which she needed blood work stat and saw that my thyroid hormone levels were really high. The doctor referred me to the endocrinologist and a cardiologist, in which they put me on a beta blocker and an antithyroid medication called methimazole (also known as Tapazole). However, this blog post is not about me but rather the importance of how much this topic means to me since I have a close connection to it. It is crucial that you, as the reader understand the different thyroid problems and the treatments that go along with them, to educate yourself and even others. You can help someone that has been recently diagnosed and is scared and doesn't know anything about the disorder. By having someone familiar explain the disorder, rather than just them looking it up on Google (which is a scary place), it can really calm their nerves and let them know that they are not alone.
Let's talk about first the definitions of hyperthyroidism and hypothyroidism. Hyperthyroidism has to do with an overactive thyroid, meaning that there is an increase in thyroid hormones, while hypothyroidism is an underactive thyroid, a decrease in thyroid hormones. When it comes to treatment, both disorders involve taking hormone medications, but the mechanisms of action are completely different. According to the article "Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Evaluation and Treatment for Hyperthyroidism and Hypothyroidism," it was mentioned that for patients with Grave's disease, the treatment includes thyroidectomy, antithyroid drugs, and radioactive iodine (Baskin et. al., 2002). Now, you are probably asking yourself, "What is Grave's disease? I thought we were talking about hyperthyroidism?" Well, we are. Grave's disease is an immune system disorder that results in the overproduction of thyroid hormones. In other words, Grave's disease is the most common cause of hyperthyroidism. The most common antithyroid drugs that are used for hyperthyroidism are methimazole and propylthiouracil. In "Update on the Management of Hyperthyroidism and Hypothyroidism," the author wrote that the "treatment is usually initiated with 30 mg of methimazole daily or 100 mg of propylthiouracil 3 times daily" (Woeber, 2000).
For hypothyroidism, the treatment is a little more simple. In the "Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice," Baskin et. al., had mentioned that the standard treatment for hypothyroidism is levothyroxine replacement (2002). The levothyroxine has to be fitted to the patient's needs, not everyone with hypothyroidism has to take the same dosage. However, this type of treatment is lifelong. In the article "Update on the Management of Hyperthyroidism and Hypothyroidism," it was said "Levothyroxine is the drug of choice, because its conversion to L-triiodothyronine will be appropriately regulated by the tissues. The mean dose of levothyroxine sodium required to restore euthyroidism (replacement dose) in adults is approximately 1.6 ug/kg daily" (Woeber, 2000). The patient should be seen by the endocrinologist in 1-to-2 month intervals initially and the dosage of levothyroxine should increase gradually until the patient's thyroid hormones are within normal range, specifically the serum thyrotropin levels (Woeber, 2000).
Now, what happens if a person misses a dose or a couple of doses? I mean let's be real, there are times where. you forget or do not take it at the right time because you were preoccupied. It has happened to the best of us. Sometimes, I don't take my antithyroid medication at the same time because I honestly forget to. Well, I am here to tell you what research told me. When reading a health site called "What Happens if You Miss a Dose of your Thyroid Medication," it was said that missing one dose won't make a difference to the half-life of these medications. Our bodies have hormone reserves due to previous doses which helps if a dose is missed. However, if one misses 2-3 doses, the hormone reserves are exhausted and symptoms slowly occur. It is ideal that the patient takes the dose right when he or she remembers. However, these medications should be taken on an empty stomach, so the patient should not eat anything for 3-4 hours before taking the thyroid replacement drugs (Raghaven, 2017).
References:
Baskin, H. J., Cobin, R. H., Duick, D. S., Gharib, H., Guttler, R. B., Kaplan, M. M., Segal, R. L., Garber, J. R., Jr, C. R. H., Handelsman, Y., Hellman, R., Kukora, J. S., Levy, P., Palumbo, P. J., Petak, S. M., Rettinger, H. I., Rodbard, H. W., Service, F. J., & Tourtelot, J. B. (2020, December 28). American Association of Clinical Endocrinologists Medical Guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocrine Practice. Retrieved March 27, 2022, from https://www.sciencedirect.com/science/article/abs/pii/S1530891X20402356
Raghaven, S. (2017, April 26). What happens if you miss a dose of your thyroid medication ... The Healthsite. Retrieved March 27, 2022, from https://www.thehealthsite.com/diseases-conditions/what-happens-if-you-miss-a-dose-of-your-thyroid-medication-k0417-487329/
Woeber, K. A. (2000, April 24). Update on the management of hyperthyroidism and hypothyroidism. Archives of Internal Medicine. Retrieved March 27, 2022, from https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/485294
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