衛教單張

Recently, some family doctors call to ask about the treatment of hypothyroidism. What can be done to make up for it? In addition to increasing the dose of thyroxine, factors affecting the absorption of thyroxine should also be considered.

Lifestyle change and nutritional supplements are mostly ineffective, while thyroxine does not "creep in" until three to six weeks later, so it's a long wait for doctors, patients and families.

What can we doctors do? In addition to prescribing and waiting, since no quick fix is available, check for any obstacle before TSH concentrations return to normal.

• Drugs: Everything that affects the absorption of thyroxine, including the patient's favorite stomach drugs and antacids (Sucralfate in particular), should be discontinued as far as possible. Calcium and iron supplements which are popular among people should be taken at prolonged intervals. Thyroxine should be taken on an empty stomach, and it is not suitable to take antacids or stomach medicines at the same time. There are also antiepileptic drugs being used (phenytoin, carbarmazepine, phenobarbital), which are likely to interfere with the uptake of thyroxine, which should be discussed in the long term with neurologists or psychiatrists.
• Special factors: no medication, wrong dosage of medication, wrong time of taking medication, improper drinks (such as milk) or diets combined with other supplements.
• Disorders: autoimmune thyroiditis (in which thyroxine levels in the body are getting lower and lower), or other disorders that cause euthyroid sick syndrome (ESS), resulting in your patient’s T4 too low or too small to fix, provided that ESS is not a condition that requires thyroxine supplements but to deal with relevant disorders.

After eliminating the above factors and giving a correct dose, patience should be required.