These clinical trials also began to define the adverse-effect profiles associated with these agents; thyrotoxicosis was frequently encountered. Patients treated with l-triiodothyronine3 (100 to 175 mcg/d) normalized BMR faster than did those receiving desiccated thyroid (120 to 210 mg/d) or l-thyroxine (200 to 350 mcg/d) but were more likely to experience angina (32). Desiccated thyroid was also associated with adverse symptoms in other studies; muscle stiffness, psychosis, and angina all occurred (33). In a crossover study of l-triiodothyronine monotherapy (75 to 100 mcg/d), l-thyroxine monotherapy (200 to 300 mcg/d), and desiccated thyroid (1.5 to 3 grains/d), all of these therapies restored BMR and serum PBI; with l-triiodothyronine, however, angina and heart failure occurred. Dose reduction corrected these adverse effects, but authors concluded that l-thyroxine monotherapy or thyroid extract was preferred (34). In a trial of l-thyroxine monotherapy at doses of 200 to 300 mcg/d versus l-thyroxine (80 mcg) plus l-triiodothyronine (20 mcg) daily, patients receiving the combination had such symptoms as palpitations, nervousness, tremor, and perspiration (35). Some early proponents of l-thyroxine monotherapy emerged because of less frequent thyrotoxic effects (24), but it is difficult to determine whether such adverse effects were related to the agent used or its high dosage. Thyrotoxic adverse effects were typically remediable by simple dose reduction (36), so desiccated thyroid remained the preparation of choice (37).
It’s imperative dietitians have a good understanding of the metabolic changes associated with thyroid disease so they can set realistic goals and expectations for clients. Most people with hypothyroidism tend to experience abnormal weight gain and difficulty losing weight until hormone levels stabilize. Moreover, it’s common for patients with Graves’ disease to experience periods of high and low thyroid hormone levels, so it may take several months to achieve a balance. During this time, it’s essential clients focus on healthful behaviors such as eating nutritious foods, exercising regularly, managing stress, and sleeping adequately rather than focus on the numbers on the scale.
You may have read that green, leafy veggies like kale, bok choy, broccoli, and Brussels sprouts can make hypothyroidism worse. But before you keep reading, ask yourself a question: Do you live in the United States? That’s key — because if you do, you likely don’t need to worry about these cancer-fighting veggies messing with your hypothyroidism management. (7)

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