Hypothyroidism - primary

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Primary and secondary hypothyroidism

Thyroid gland

The purpose of treatment is to replace the thyroid hormone that is lacking. Levothyroxine (T4) is the most commonly used medication. However a form of T3 is sometimes used together with thyroxine. A combination of T4 and T3 is also available.

Most people feel their best when TSH level is brought into the 1 - 2 mcIU/mL range. People get the lowest dose that effectively relieves their symptoms and brings their blood tests into the normal range.

Life-long therapy is needed. The condition will come back if therapy is interrupted. You must keep taking your medication even when your symptoms go away.

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After you start taking replacement therapy, tell you doctor about any symptoms of increased thyroid activity (hyperthyroidism), such as:

• Heat intolerance
• Rapid weight loss
• Restlessness
• Sweating

Myxedema coma is treated with intravenous thyroid replacement and steroid medications. Some people may need supportive therapy (oxygen, breathing assistance, and fluid replacement).

With early treatment, the condition can be completely controlled. However, the condition will return if you do not continue to take your medication.

Myxedema coma can result in death.

Myxedema coma, the most severe form of hypothyroidism, is rare. It may be caused by:

• Certain medications
• Exposure to cold
• Illness
• Infection

Symptoms and signs of myxedema coma include:

• Below-normal temperature
• Decreased breathing
• Low blood pressure
• Low blood sugar
• Unresponsiveness

Other complications include:

• Depression
• Heart disease
• Increased risk of infection
• Infertility
• Miscarriage
• Pituitary tumors

Complications that can occur with too much thyroid hormone replacement include:

• Atrial fibrillation
• Osteoporosis
• Symptoms of hyperthyroidism

Call your health care provider if you have symptoms of hypothyroidism or myxedema.

Also call if you experience these symptoms after beginning thyroid replacement therapy:

• Excessive sweating
• Heat intolerance
• Rapid heart rate
• Rapid weight loss
• Restlessness
• Symptoms of hyperthyroidism

Review Date: 06/17/2008
Reviewed By: Elizabeth H. Holt, MD, PhD, Assistant Professor of Endocrinology and Metabolism, Yale University. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).