The thyroid is the gland in your neck associated with metabolism—the processes by which your body makes use of energy. Autoimmune thyroid disease is common in lupus. It is believed that about 6% of people with lupus have hypothyroidism (underactive thyroid) and about 2% have hyperthyroidism (overactive thyroid). A thyroid gland that is functioning improperly can affect the function of organs such as the brain, heart, kidneys, liver, and skin. Hypothyroidism can cause weight gain, fatigue, depression, moodiness, and dry hair and skin. Hyperthyroidism can cause weight loss, heart palpitations, tremors, heat intolerance, and eventually lead to osteoporosis. Treatment for both underactive and overactive thyroid involves getting your body’s metabolism back to normal.
Thyroid Hormone Replacement
Levothyroxine (Synthroid, Levothyroid, Levoxyl, Unithroid)
Liothyronine (Cytomel)
Liotrix (Thyrolar)
Natural thyroid (Armour Thyroid, Nature-throid, Westhroid)
Thyroid replacement is used to treat people with underactive thyroid, whether it is caused by autoimmune disease, radioactive iodine treatment, or surgical removal. The main medication used to treat hypothyroidism is levothyroxine sodium (Synthroid, Levoxyl, and Levothroid), a synthetic version of thyroxine (T4), a thyroid hormone your body produces naturally. Other medications are also available, namely liothyronine, a synthetic version of another thyroid hormone called triiodothronine (T3); liotrix, a synthetic combination of T4 and T3; and desiccated natural thyroid (natural thyroid hormone prepared from dried porcine [pig] thyroid). Since these medications simply supplement a hormone that is missing, the only real safety concern is ensuring that you take the right amount. Therefore, your doctor will need to regularly check your thyroid and TSH levels to make sure you are receiving the correct dosage.
Thyroid hormone stays in your body for a long time, so you will only need to take it once a day, usually in the morning. It is important to take this medication without food, because food can affect your body’s absorption of the hormone. In addition, remember to take your thyroid medication at the same time of day, and do not stop taking your medication without first discussing the decision with your doctor. Many people need to take thyroid medication for the rest of their lives.
Remember to tell your doctor about any other medications you may be taking, since certain drugs can interact with your thyroid medication. These include oral contraceptives, estrogen, testosterone, certain anti-seizure medications, cholesterol-lowering medications (statins) and some antidepressants. Certain foods can also interfere with your body’s absorption of thyroid hormone, including iron, calcium, and soy.
If you are pregnant or may become pregnant, it is perfectly safe to continue taking your thyroid medication. It is important for pregnant women to maintain appropriate levels of thyroid hormone in the body to provide the healthiest environment for fetal development. When you first learn that you are pregnant, you should contact your doctor so that s/he can check your thyroid hormone and TSH levels; these levels should also be checked once during each trimester.
Anti-thyroid Medications
Propylthioracil (PTU)
Methimazole (Tapezole)
Propylthioracil (PTU) and methimazole (Tapezole) are medications used to treat overactive thyroid. They work by slowing down the production of thyroid hormone and do not cause permanent damage. When taken appropriately, these medications can control hyperthyroidism in just a few weeks; however, the main problem with anti-thyroid medications lies with the fact that the underlying problem returns once they are discontinued. Therefore, many people are encouraged to seek more permanent treatments, such as radioactive iodine treatment or surgical removal. Side effects of anti-thyroid medications include skin rash, upset stomach, drowsiness, and a bitter aftertaste. Rare but serious side effects include sore throat, fever, chills, jaundice, decreased white blood cells, and liver disease.
Your doctor may also prescribe a medication called a beta blocker (a drug usually given for high blood pressure) to block the action of thyroid hormone in your body. While beta blockers will not change the levels of thyroid hormone in your blood, they will make you feel better by reducing some of the symptoms of hyperthyroidism, including increased heart rate, shakes, and nervousness. These drugs work within hours and may help to quell these symptoms before other drugs have a chance to take effect. However, speak to your doctor if you have Raynaud’s phenomenon (color changes in the fingers and toes with cold exposure), since beta blockers worsen this condition.
