Errors in the treatment of the thyroid gland – the endocrinologist explains what patients with hypothyroidism hurt

Patients with hypothyroidism are treated with thyroxine preparations, which must be taken regularly in order to compensate for the deficiency of thyroid hormones. As a rule, the reception scheme, even in the case of a complex individual situation, is very simple. However, both for him and for the substance itself, questions constantly arise – and, as a rule, the same.

A book is published by Bombora Publishing House endocrinologist Stanislav Khan “Thyroid passion. Autoimmune thyroiditis, hypothyroidism: why does the immune system work against us? We publish a fragment of it, which explains why it is important to strictly adhere to the dosage of the drug, but you can vary the time of its intake, whether it is allowed to drink thyroxine with vitamins, and who decided that patients needed different amounts of the hormone at different times of the year.

There is a myth among people that all hormones are scary, although in reality this is not the case.

Thyroid hormones are essential for the normal functioning of our body: they provide energy, start
and support many vital and necessary processes.

With autoimmune thyroiditis, the “station” for producing these hormones (i.e. the thyroid gland) begins to fail, the hormones become scarce, and the body experiences a deficiency.

This is especially acute in young patients who want to live “to the fullest” (this is not about “giving everything”, but about physiological processes), but they do not have enough strength and “fuel” for a adequate standard of living. Logically, I lead you to the conclusion that we will correct this situation… by compensating for this deficiency with the right dose of a certain hormone.

We need to introduce you to two more important terms: compensation and decompensation. I use the term “compensated hypothyroidism” in the context of “the hormone deficiency has been corrected” or that the disease is under control. In other words, the patient receives the right dose of hormones and he takes it regularly. An antonym of this concept will be the term “decompensation”, that is, “the hormonal deficit has not been eliminated”.

Long ago there were times when hypothyroidism systematically led first to the patient’s critical condition, which is called “myxoedematous coma” (today this condition is almost
does not occur), then death inevitably occurred. This was due to the fact that there was practically no knowledge of this disease, and there was nothing to compensate for the lack of hormones. But time passed, and the first similar medicine was an extract from the thyroid gland of a sheep, which was first used in 1891, first in the form of an injection, and then in the form of a tablet.

In 1914, a substance called thyroxine was isolated from the thyroid gland for the first time, but it was not possible to synthesize it in the laboratory at that time. And it was not until 1924 that this hormone was finally obtained by a conditional industrial method, but due to its high cost, it was not widely used. A little teaser: some “specialists” are actively persuading patients to take (drum roll!) dried thyroid glands from various animals. Yes, yes, I’m not joking, and it’s happening in the 21st century: these unfortunate healers are just parasitizing the popular terms “natural”, “natural”, that’s all.

And it wasn’t until the 1970s that thyroxine was used everywhere, first in the United States and then in the rest of the world.

Thyroxine is an industrially produced analogue of our own hormone, which is produced naturally by the thyroid gland. Yes, it is artificially produced, and yes, it is a synthetic analogue of a natural hormone, but it is safe and identical to our own hormone.

Thyroxine is prescribed for primary hypothyroidism and in some cases of subclinical hypothyroidism: as a general rule, the TSH should be above 10 mU/l for this, as it has been proven that at this level patients have a increased risk of cardiovascular disease. In this way, we seek to compensate for the lack of hormones, improve the patient’s condition and reduce symptoms. This therapy is also used in the hypertrophic form of AIT (when
the thyroid gland increases), since thyroxine contributes to a decrease in the volume of the gland.

Many nowadays go crazy in pursuit of beauty and take thyroxine without indications, that is, with an absolutely healthy thyroid gland. Typically, this is done in the fitness industry in order to lose weight and “cut,” not to mention “just like that” dates.

And the worst thing is that many doctors practice this approach. I will even say more: studies are described in the scientific literature when hormones were prescribed to patients without disease, but with complaints that usually appear with hypothyroidism (decreased performance, fatigue, hair loss, etc.). In one of these studies, two groups of healthy patients, again, were identified. The first group received thyroxine, and at a fairly large dose of 100 micrograms, the others received a (dummy) placebo for 12 weeks, then the groups changed. The authors concluded that thyroxine was no more effective than placebo in improving cognitive function and psychological well-being in study participants. So “treating” only the symptoms with thyroxine is not worth it.

In addition, such experiments with taking thyroxine “for beauty” or unreasonable therapy with this hormone harm the body, as they lead to an overdose. As a result, the risks of cardiovascular diseases increase, bone mineral density decreases, anxiety increases, etc.

The classic recommendation is to take the tablet in the morning on an empty stomach at least 30 minutes before meals (ideally 40-60 minutes), without mixing with other medications and drinking plenty of water. In a study involving patients with elevated TSH levels on thyroxine therapy, there were
found that eating breakfast within 20 minutes of taking the drug resulted in higher TSH levels compared to when the same patients ate breakfast 60 minutes after taking the drug.
paratha.

This drug is absorbed primarily from the jejunum and ileum, but the acidic environment of the fasting stomach is important. While taking thyroxine
With food, absorption is reduced compared to fasting. In a study in healthy volunteers, dietary absorption of thyroxine was documented to be 64% compared to 80% absorption on an empty stomach.

Additionally, a large meta-analysis found no difference in TSH concentration between the more traditional morning intake and the less popular evening intake (at least 2 hours after dinner). In general, for some patients, such a diet is also possible – this is discussed individually.

To confirm all of the above, I want to cite the results of an experiment in which patients with newly diagnosed hypothyroidism were prescribed thyroxine either 30 minutes before breakfast or in the evening. After 12 weeks of observation, the achieved level of TSH was comparable in the two groups.

But there are myths about taking thyroxine. For many patients, a certain time of taking the drug is dictated as a prerequisite for this treatment.

For example, I often hear the following from patients: “I was told to take it strictly at six zero zero. I set an alarm this time, take a pill and go to bed. In fact, such a recommendation is not justified, since it is the reception rules described above that are much more important, and not a precise astronomical time.

Patients often ask what to do if it is more than an hour before breakfast after taking a pill. I repeat it is important to respect the condition “at least 40 to 60 minutes”. There’s nothing wrong with taking a pill in the morning, then going to work, going to the office, and only then having breakfast two to three hours after waking up. It is not critical. It is also important to understand that thyroxine is a conditionally “capricious” pill and that certain drugs, such as iron or calcium, bile acid resins or proton pump inhibitors, used in gastroenterology, may interfere with its absorption. It is desirable to take thyroxine and such drugs at intervals of two to four hours.

I want to pay special attention to all kinds of vitamins, given the special love many people have for them.

Despite the fact that such studies have not been conducted, it can be expected that their calcium and iron content will lead to impaired thyroxine absorption. Therefore, if you decide to take something (although it is often not necessary), carefully study the composition of this drug or vitamin-mineral complex.

There is another myth associated with hypothyroidism that many doctors still have in mind to this day: the dose of thyroxine must be adjusted according to the time of year.

Such a misconception may be based on the results of a 2018 study conducted in Japan. TSH concentrations were observed to show annual variations over a six-year period: they decreased in summer and increased in winter. For this reason, many clinicians to this day (thankfully it is becoming less common) increase the dose of thyroxine in the winter and reduce it in the summer.

However, these results did not carry significant weight to implement them in clinical practice. Moreover, many studies did not find such a relationship at all: for example, when analyzing more than 460,000 test tubes with blood, no influence of the season on the level of TSH was found. been found.