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How a Nurse Practitioner Can Support your Hypothyroidism Journey

Acella Pharmaceuticals, LLC., is partnering with Susan VanBeuge, DNP, APRN, FNP-BC, FAANP, FAAN, to bring greater awareness to the importance of thyroid care and education. This post was sponsored by Acella Pharmaceuticals and should not be construed as medical advice. Please talk to your doctor about your individual medical situation. 

Many hypothyroidism patients may not realize that a nurse practitioner (NP) can provide much of the same type of care as a medical doctor. NPs are highly trained medical professionals who can provide many primary care services or be part of a specialized care team.

What is a Nurse Practitioner?

An NP is a registered nurse who has advanced training and education. In addition to the degree needed to become a registered nurse, NPs also get master’s degrees or doctoral degrees. NPs can:

• Diagnose and treat acute conditions, such as hypothyroidism
• Order diagnostic tests and lab work
• Write prescriptions
• Manage a patient’s overall care as the primary care provider
• Be board certified in specialties such as family practice, women’s health, or endocrinology

NPs focus much of their interaction with patients on disease prevention, health education, counseling and overall wellness.

Facing a Hypothyroidism Diagnosis

If you are reading this article, you may suspect or have been recently diagnosed with some form of hypothyroidism. If your first instinct was to search online, you are probably feeling a bit overwhelmed with all the information coming at you. It may sound very technical, so let’s break it down.

The thyroid gland is a butterfly-shaped gland in your neck that is primarily responsible for metabolism and temperature control. The thyroid gland produces thyroid hormone and is regulated through a feedback loop through the hypothalamus and pituitary gland.

The pituitary gland is considered the master gland of the endocrine system. Think of it as a director of a symphony orchestra and the thyroid gland as part of the orchestra. The body sends signals to the pituitary gland in relation to the thyroid to tell it to stay steady, speed up or slow down production of the thyroid hormone. This feedback loop is constant and ongoing.

When a provider gets lab work to assess your thyroid, they are checking the hormone produced and the signals coming from the pituitary gland that regulates production. The laboratory tests can help pinpoint if there is a problem in the thyroid gland itself or with the pituitary gland. It is important for your provider to understand the etiology to best treat your hypothyroidism. These laboratory tests can help your provider make decisions on how to proceed with treatment, if necessary. But your provider isn’t just looking at paper, they are treating you! You may be asked a series of questions about your well-being, such as:

• How is your sleep?
• Are you fatigued?
• Do you experience brain fog, and for women, how are your menstrual cycles?
• Is your weight stable or have you experienced weight gain or loss?
• Do you have cold intolerance?
• Have you experienced muscle stiffness?
• Do you have depression or are you feeling blue?
• Do you have any complaints of constipation?
• Are you experiencing memory issues?

Your answers to these questions can help your provider determine which tests to order or what kind of treatment may need to be initiated or changed if you are already on a treatment. Your provider will also complete a physical examination of your overall health and assess your thyroid gland for a goiter (enlargement) or nodules.

If the decision to start thyroid replacement hormones for your hypothyroidism is determined to be the best plan of care, your provider will initiate therapy based on clinical practice guidelines. These guidelines are used by all clinicians to provide care. They are based on research from evidence-based studies and clinical experts who have studied the data and agreed on practice guidelines.

The first line treatment of choice is synthetic thyroxine T4, also known as levothyroxine. This treatment is a good one for many patients. Another treatment is T3, or liothyronine, which is used in the treatment of hypothyroidism. Desiccated or natural thyroid hormone is a mixture of T4 and T3 hormone replacement. All types of treatment are within clinical practice guidelines and will be administered based on your needs and response to treatment.

When initiating therapy for hypothyroid disease, the motto is to go “low and slow.” Your provider will take a low and slow approach to initiating and titrating your treatment to the perfect dose for you. This may take one or two dose adjustments, but it is important to be precise in fine-tuning your treatment plan. Once you have a dose change, your provider will ask for laboratory work to be completed six weeks to eight weeks after you've been on your new medication dose. Once the laboratory studies are reviewed, any titration that's necessary can be done at that time. During these visits, it's important to share any symptoms you may be having with your provider so that your treatment plan can be holistic and address any concerns you have.

Proper administration is also important to remember as you take thyroid replacement medication. Thyroid replacement should be taken in the morning and on an empty stomach with a glass of water. You should not have anything to eat or drink or take any medications, herbal supplements or vitamins for one hour after taking your thyroid medicine. This ensures it will be absorbed properly.

If you have questions or concerns, it is important to talk to your healthcare provider. No question is silly, and no symptom you experience is unimportant. In fact, it is important to share your symptoms with your provider, so they know how you are feeling and are aware of any side effects or changes in your health.

Hypothyroid disease is easily managed in partnership with your healthcare provider.

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INDICATIONS & IMPORTANT RISK INFORMATION INCLUDING BLACK BOX WARNING
Important Risk Information

Drugs with thyroid hormone activity, alone or together with other therapeutic agents, have been used for the treatment of obesity. In euthyroid patients, doses within the range of daily hormonal requirements are ineffective for weight reduction. Larger doses may produce serious or even life-threatening manifestations of toxicity, particularly when given in association with sympathomimetic amines such as those used for their anorectic effects.
  • NP Thyroid® is contraindicated in patients with uncorrected adrenal insufficiency, untreated thyrotoxicosis, and hypersensitivity to any component of the product.
  • In the elderly and in patients with cardiovascular disease, NP Thyroid® should be used with greater caution than younger patients or those without cardiovascular disease.
  • Use of NP Thyroid® in patients with diabetes mellitus or adrenal cortical insufficiency may worsen the intensity of their symptoms.
  • The therapy of myxedema coma requires simultaneous administration of glucocorticoids.
  • Concomitant use of NP Thyroid® with oral anticoagulants alters the sensitivity of oral anticoagulants. Prothrombin time should be closely monitored in thyroid-treated patients on oral anticoagulants.
  • In infants, excessive doses of NP Thyroid® may produce craniosynostosis.
  • Partial loss of hair may be experienced by children in the first few months of therapy but is usually transient.
  • Adverse reactions associated with NP Thyroid® therapy are primarily those of hyperthyroidism due to therapeutic overdosage.
  • Many drugs and some laboratory tests may alter the therapeutic response to NP Thyroid®. In addition, thyroid hormones and thyroid status have varied effects on the pharmacokinetics and actions of other drugs. Administer at least 4 hours before or after drugs that are known to interfere with absorption. Evaluate the need for dose adjustments when regularly administering within one hour of certain foods that may affect absorption.
  • NP Thyroid® should not be discontinued during pregnancy, and hypothyroidism diagnosed during pregnancy should be promptly treated.

Indication

NP Thyroid® (thyroid tablets, USP) is a prescription medicine that is used to treat a condition called hypothyroidism from any cause, except for cases of temporary hypothyroidism, which is usually associated with an inflammation of the thyroid (thyroiditis). It is meant to replace or supplement a hormone that is usually made by your thyroid gland.

NP Thyroid® is also used in the treatment and prevention of normal functioning thyroid goiters, such as thyroid nodules, Hashimoto’s thyroiditis, multinodular goiter, and in the management of thyroid cancer.