by THYROID TREATMENT IN ALLOPATHIC
In one double-blind, placebo-controlled study, researchers examined the effect of Ashwagandha on 50 people with mild hypothyroidism that didn’t reach a clinical level. The researchers gave the participants 600 milligrams of Ashwagandha root daily for 8 weeks.
Your thyroid is a butterfly-shaped gland in your neck, just above your collarbone. It is one of your endocrine glands, which make hormones. Thyroid hormones control the rate of many activities in your body. These include how fast you burn calories and how fast your heart beats. All of these activities are your body's metabolism. Thyroid problems include: Goiter - enlargement of the thyroid gland Hyperthyroidism - when your thyroid gland makes more thyroid hormones than your body needs Hypothyroidism - when your thyroid gland does not make enough thyroid hormones Thyroid cancer Thyroid nodules - lumps in the thyroid gland Thyroiditis - swelling of the thyroid To diagnose thyroid diseases, doctors use a medical history, physical exam, and thyroid tests. They sometimes also use a biopsy. Treatment depends on the problem, but may include medicines, radioiodine therapy, or thyroid surgery. Dept. of Health and Human Services Office on Women's Health
Treating Hypothyroidism Naturally — and SafelySome patients choose to supplement their treatment with alternative therapies, often to help with symptoms like fatigue, weight gain, stress, and mental fog. Treatments can include yoga, meditation, hypnosis, vitamins, or special diets. One small study of 20 female patients with hypothyroidism found that yoga did help patients manage their disease symptoms. While patients with thyroid disease are often careful to eat a diet low in iodine (which can worsen hypothyroidism once a patient has it), or to take vitamin D or calcium supplementation, no diet or nutrient can cure thyroid disease. (13,11)And many experts stress that while these complementary and alternative therapies can supplement traditional treatment, they cannot replace it. Additional reporting contributed by Melinda Carstensen and Stephanie Bucklin.
If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).
If Graves' disease affects your eyes (Graves' ophthalmopathy), you can manage mild signs and symptoms by using artificial tears and lubricating gels and by avoiding wind and bright lights. If your symptoms are more severe, your doctor may recommend treatment with corticosteroids, such as prednisone, to reduce swelling behind your eyeballs.
Hypothyroidism is most commonly treated with thyroid hormone replacement therapy, and the most effective way to treat hypothyroidism is with synthetic T4 medication. (7,5) While these hormones are identical to the natural T4 that the thyroid makes, several factors can affect the exact dosage you need. These include your age, the severity of symptoms, and your overall health profile.
TakeawayAyurvedic medicine is one of the oldest medical systems in the world. At this time, there’s limited research looking at the effectiveness of Ayurvedic medicine for thyroid disorders. Ayurveda encourages you to eat a diet high in whole, unprocessed foods, which may help improve your overall health. There’s also some evidence that the Ayurvedic herb Ashwagandha may have benefits for hypothyroidism, although more research is needed.Ayurvedic medicine can be a nice addition to standard Western medicine practices, with beneficial diet, exercise, and other lifestyle changes. Some supplements can interact with other medications you’re taking, so it’s a good idea to talk to your doctor before adding a new Ayurvedic herb to your diet.
Causes of primary hypothyroidismIn Western countries, the most common cause of primary hypothyroidism is autoimmune thyroiditis. However, in many parts of the world, iodine deficiency remains an important cause. Other common causes of hypothyroidism include thyroidectomy, radioiodine therapy, and drugs such as amiodarone, lithium, thionamide, iodine, interferon, sunitinib, rifampicin, and thalidomide. Transient hypothyroidism may occur in subacute (de Quervain’s) thyroiditis and also in postpartum thyroiditis. In both of these conditions 75%–85% of patients regain normal thyroid function.12 Congenital hypothyroidism, due to thyroid gland agenesis or dyshormonogenesis, affects about one in 4000 newborns and is the commonest congenital endocrinopathy.13
ElderlyThe levothyroxine dose requirement gradually decreases with age,82,83 thought to be due to age-related decreases in thyroxine degradation84 and in lean body mass.85 Furthermore, levothyroxine replacement may precipitate severe angina or myocardial infarction in an elderly person with asymptomatic ischemic heart disease. Therefore, in people over the age of 65 years, levothyroxine should be started at a small dose (25–50 μg/daily) and dose titration should be carried out slowly.There is a high prevalence of suboptimal thyroid hormone replacement in the elderly. In a cross-sectional study involving elderly people aged 65 years or over on levothyroxine, 41% and 16% had suppressed and raised TSH suggestive of over-replacement and under-replacement, respectively.8 The risk of under-replacement of levothyroxine is less certain in this population, with studies showing an association between raised TSH and a lower mortality rate in the very elderly population.26,86,87 In contrast, the potential hazards of over-replacement of levothyroxine in the elderly population have been highlighted by the associations between suppressed TSH with reduced bone mineral density88,89 as well as increased risk of fractures.90 In a recent large cohort study of elderly people above the age of 70 years, levothyroxine treatment has been found to be associated with an increased risk of fractures.91 Although thyroid function tests were not analyzed in this study, there was a correlation between the risk of fractures and the dose of levothyroxine, suggesting that the increased fracture risk may be related to over-replacement of levothyroxine. Several epidemiological studies have also shown an association between low or suppressed TSH and atrial fibrillation.92–95 However, all of these studies, except the Framingham study,92 have excluded patients on levothyroxine and, therefore, it remains unclear whether suppressed TSH due to exogenous levothyroxine is as deleterious to the heart as endogenous subclinical hyperthyroidism. Nevertheless, taken together, these observations underline the importance of careful monitoring and optimizing thyroid hormone replacement in the elderly with hypothyroidism.
If you have subclinical hypothyroidism, discuss treatment with your doctor. For a relatively mild increase in TSH, you probably won't benefit from thyroid hormone therapy, and treatment could even be harmful. On the other hand, for a higher TSH level, thyroid hormones may improve your cholesterol level, the pumping ability of your heart and your energy level.
Standard treatment for hypothyroidism involves daily use of the synthetic thyroid hormone levothyroxine (Levo-T, Synthroid, others). This oral medication restores adequate hormone levels, reversing the signs and symptoms of hypothyroidism.
Although most doctors recommend synthetic thyroxine, natural extracts containing thyroid hormone derived from the thyroid glands of pigs are available. These products contain both thyroxine and triiodothyronine. Synthetic thyroid medications contain thyroxine only, and the triiodothyronine your body needs is derived from the thyroxine.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options.
Future possibilitiesAfter more than 120 years since Murray first successfully treated hypothyroidism with sheep thyroid extract29 and numerous subsequent advances in the field, there remain many uncertainties surrounding the management of this common disease. What is the target thyroid function for hypothyroid patients on levothyroxine replacement? What are the long-term outcomes of different target TSH levels on levothyroxine replacement? Should different age groups have different target TSH levels? Should individuals be assessed to determine their personal TSH reference range for future diagnosis and treatment of thyroid dysfunction? Does FT3/FT4 ratio provide additional information about tissue euthyroidism in patients on levothyroxine replacement? Furthermore, although there is increasing evidence from observational studies for an association between subclinical hypothyroidism and the risk of cardiovascular disease-related morbidity and mortality, randomized controlled trial evidence showing that levothyroxine treatment reduces the risk is still lacking. Interestingly, subclinical hypothyroidism can be viewed as an incipient autoimmune disease that develops into overt hypothyroidism over many years. Identification of biomarkers that are better than current thyroid antibody assays at predicting eventual hypothyroidism could lead to targeted intervention to prevent hypothyroidism. Oral selenium supplementation appears to have efficacy in modifying the natural history of Graves’ orbitopathy,100 and may prove to have immunomodulatory actions in other forms of autoimmune thyroid disease. In pregnancy, results of ongoing and future clinical trials are awaited to inform whether all pregnant women should be screened and treated for subclinical hypothyroidism.It remains uncertain as to why a minority of hypothyroid patients on levothyroxine continue to have residual symptoms despite apparently adequate replacement, and it is hoped that future studies will clarify this enigma. Moreover, despite several randomized controlled trials showing a lack of benefit of combining triiodothyronine with levothyroxine in such patients,51 it is possible that triiodothyronine formulated to mimic the normal physiological profile may have a better outcome. Indeed, a proof of concept study has demonstrated the biochemical efficacy of a combination of long-acting triiodothyronine and levothyroxine on the T4/T3 ratio and TSH over levothyroxine monotherapy.101 Further studies are required to see whether this biochemical advantage translates into clinical benefit. Finally, recent genetic studies have shown associations between common genetic variations and thyroid hormone levels,23–26,55,102 wellbeing in levothyroxine- treated patients,55 and response to triiodothyronine-levothyroxine combination treatment,55 opening the door to the possibility of pharmacogenomics. Future genetic studies may help in identifying the subgroup of patients who would benefit from combination therapy.
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