Special Considerations for Hypothyroidism

Aging- Thyroid hormone makes the heart work a bit harder. Therefore, doctors opt for more conservative T4 treatment in older adults and in people with coronary artery disease.

Pregnancy- Women may need higher doses of T4 during pregnancy. Doctors may recommend more frequent monitoring, approximately once every four weeks, beginning soon after conception. After a woman's new optimal T4 dose is established, the frequency of monitoring can be decreased to approximately once every trimester. Women who have hypothyroidism whose T4 levels are carefully regulated during pregnancy have normal children. After delivery, a woman's dose of T4 will need to be readjusted.

Surgery- Hypothyroidism can increase the risk of certain complications in surgery, such as infection and abnormal bowel functions, but doctors can anticipate and monitor for these complications. If preoperative blood tests reveal low thyroid hormone levels, doctors will usually delay non-emergency surgery until T4 treatment has returned levels to normal values.If eating is not possible for more than five to seven days after surgery, T4 can be given intravenously.

Hypothyroidism caused by pituitary/hypothalamic conditions - If the cause of hypothyroidism lies outside the thyroid gland itself, your doctor may recommend additional hormone tests before starting T4 treatment. These tests can detect abnormalities that may require treatment with other hormones.

No Symptoms?- In most cases, doctors treat hypothyroidism with T4 even if an affected person notices no symptoms.

Infants- Treatment effectively prevents symptoms in infants, but, if treatment is delayed, some effects of hypothyroidism in these infants may be irreversible.