At 31, what medication can treat my sister’s hypothyroidism?

Question

Hello doctor,

My 31-year-old sister has been dealing with hypothyroidism for five years, but her symptoms keep getting worse even though her thyroid-stimulating hormone (TSH) levels look normal on paper. She is taking Levothyroxine 125 microgram (mcg) of levothyroxine daily, and her TSH is 2.8, but she still has no energy, has gained 30 pounds, and her hair is falling out in clumps.

Her periods became really heavy, lasting eight to nine days with terrible cramps that kept her in bed. The endocrinologist checked Triiodothyronine (T3) and reverse T3. T3 was low at 2.1, and reverse T3 was high at 28.

She also has hashimotos thyroiditis with anti-thyroid peroxidase (anti-TPO) antibodies over 400 and thyroglobulin antibodies at 250. She tried switching to Armour Thyroid, but it made her feel jittery and gave her heart palpitations.

The worst part is brain fog, as she can not concentrate at work and forgets things constantly, which is affecting her job as an accountant. She also developed carpal tunnel syndrome in both hands and sleep apnea that requires a Continuous positive airway pressure (CPAP) machine. Tried a gluten-free diet and selenium supplements, but they did not help much.

I am also worried because she wants to get pregnant next year but is afraid thyroid problems will cause miscarriage. Please tell me, are there different thyroid medications that might work better for hypothyroidism with Hashimoto's disease?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

For pregnancy, her thyroid-stimulating hormone (TSH) level needs to be closer to 2.5 or below. With her TSH at 2.8, a small adjustment in Levothyroxine (a synthetic thyroid hormone) is needed to plan pregnancy.

Now, about the low Triiodothyronine (T3) and high reverse T3, that pattern can suggest poor conversion of Thyroxine (T4) to active T3. In some cases, adding a small dose of Liothyronine (a synthetic form of the thyroid hormone T3) helps improve symptoms. However, T3 use during pregnancy is controversial because most guidelines prioritize T4-only therapy. So if considered, it should be low-dose and closely monitored, ideally discussed clearly with her endocrinologist.

Also, you need the following evaluations to rule out any other complications;

Ferritin (low iron can worsen T3 levels and hair loss).
Vitamin B12.
Vitamin D.
Evaluate heavy periods (possible iron loss or gynecologic causes).

Please consult a gynecologist regarding your sister’s health issues.

I hope this information helps you.

Feel free to ask further queries.

Thank you.