Thyroid Hormone Therapy Consent

Purpose of Treatment

Desiccated thyroid hormone (e.g., NP Thyroid, Armour Thyroid) is prescribed to support metabolic and cognitive function in patients with symptoms of thyroid dysfunction, even when standard labs (TSH, Free T4) are within normal limits. This includes symptoms such as fatigue, hair thinning, brain fog, weight gain, constipation, cold intolerance, and slowed metabolism.

 

Expected Benefits:

Desiccated thyroid hormone has been used safely for decades in clinical practice to support:

• Improved energy and mood
• Enhanced metabolism and weight regulation
• Reduced brain fog and improved cognitive clarity
• Better bowel regularity and cold tolerance
• Alleviation of symptoms related to suboptimal thyroid function 
   

Risks and Side Effects:

As with any hormone therapy, thyroid hormone therapy carries potential risks and side effects, which may include: palpitations, rapid heart rate (tachycardia), anxiety, tremors, insomnia, excessive sweating, diarrhea, restlessness or agitation, potential increase in bone loss or arrhythmias. Patients with cardiac conditions should inform their provider before initiating treatment. Treatment will be adjusted or paused if signs of cardiac sensitivity or adverse effects occur.
 

Alternatives to Thyroid Hormone Therapy:

You may choose not to undergo thyroid treatment. Other options include:

No Treatment: Symptoms may continue or worsen over time.

Other Hormonal Options: Use of synthetic thyroid hormone (e.g., levothyroxine).

Lifestyle Modifications: Incorporating diet, exercise, stress management or supplements to alleviate symptoms.

Specialist Consultation: Referral to endocrinology for further consultation.

 

Off-Label Use and Informed Consent:

The use of desiccated thyroid hormone (e.g., NP Thyroid, Armour Thyroid) for treating fatigue, brain fog, hair loss, or cold intolerance is considered off-label by the U.S. FDA. “Off-label” refers to legally prescribed medications for uses not formally approved by the FDA. This treatment plan is based on clinical judgment, symptomatology, and medical literature. Desiccated thyroid has been used safely for decades in such contexts.

 

Treatment and Monitoring:

This treatment typically includes natural desiccated thyroid hormone taken orally, with dosing based on clinical response, not TSH alone. The therapeutic goal is to optimize Free T3 levels between 4.0 and 7.0 pg/mL, while avoiding signs of over-replacement.

• Monitoring will include labs such as Free T3, Free T4, and symptom assessment.
• Patients are advised to report any unusual symptoms promptly.
• Dose adjustments are made based on symptom improvement and lab results.

Please initial below to acknowledge the following:

I confirm that I have reviewed and understand the potential risks, benefits, alternatives, and the off-label nature of thyroid hormone therapy.

AUTHORIZATION

I voluntarily request and give my informed consent for Alexander Medical, LLC and its healthcare providers to initiate or continue thyroid hormone therapy as described.

I authorize the providers to perform any additional tests, evaluations, or procedures reasonably necessary to support my care. I understand that this treatment is elective and that I may stop at any time by informing my provider.

 

ACKNOWLEDGMENT

I have read (or had read to me) this entire consent form. I have had the opportunity to ask questions and all questions have been answered to my satisfaction. I understand the risks, benefits, and alternatives, and off-label nature of this therapy, and I consent to the use of thyroid hormone therapy.