Changing Your Thyroid Prescription
The Thyroid Foundation of America has become aware that the Food
and Drug Administration has determined that different brands of
thyroid hormone tablets are similar enough to make changes between
brands or from brand to generic tablets appropriate. We do not agree.
Physicians evaluate the effectiveness of thyroid hormone treatment
by measuring the serum TSH test. TSH stands for Thyroid Stimulating
Hormone which is made in your pituitary gland and reflects the amount
of active thyroid hormone in your system. If your thyroid hormone
levels are too low, TSH will be high. If you have too much thyroid
hormone, your TSH will be low or absent. Even slight changes in
TSH level could signify a serious health risk. The problem is that
most patients and many physicians may not be aware that a change
in thyroid prescription may change the TSH and pose serious health
risks.
Who is at risk?
If the thyroid hormone level rises above normal as a result of
a medication change elderly individuals have an increased risk for
osteoporosis and for heart rhythm problems, including atrial fibrillation
which can cause heart attacks, strokes, or heart failure. Anyone
with underlying heart disease could be at markedly increased risk
for these complications. Patients with thyroid cancer are often
given thyroid treatment to raise thyroid hormone levels above normal
to suppress cancer cell growth. They too could have heart problems
if new treatments further elevated their thyroid hormone levels.
Should the thyroid level fall as a result of a change in thyroid
hormone medication, pregnant women who have been appropriately regulated
on their previous medication could be at risk for hypothyroidism.
Even mild degrees of hypothyroidism have been shown to increase
a pregnant women’s risk for miscarriage, a low birth weight
baby, hypertension at the time of delivery, and a possible IQ deficit
in their baby.
If Your Physician Changes Your Prescription
TFA recommends that you stay on whatever brand of thyroid hormone
that your doctor prescribes. If your doctor does recommend a different
thyroid medication for you, TFA recommends that you discuss with
your doctor having a repeat TSH test in 4 to 6 weeks. If your TSH
level is no longer normal, your doctor will advise you about an
appropriate adjustment of your thyroid hormone dosage based on the
results of your new TSH test. Six weeks after this adjustment, a
final TSH test should be done to ensure stability and appropriate
hormone levels. We note that it is likely that there will be a cost
for such a change because of the need for extra office visits and
extra TSH tests which may or may not be covered by your health insurance.
We urge you to discuss these issues with your physician.
In some states, a pharmacist may make the recommendation for a
change to a different brand or generic thyroid hormone. If so, discuss
the changes with your physician who is better informed about your
overall medical health and in the best position to make that decision.
We would also appreciate it if you would answer our TFA
Thyroid Treatment Questionnaire giving us your experiences if
you do change your medication.
If you have questions about this or other thyroid issues, please
contact us by phone at 800-832-832.
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