Q: See your doctor if you are experiencing any symptoms of hypothyroidism, had radiation therapy to your head, neck, or upper chest, or treatment with radioactive iodine or anti-thyroid medications. Symptoms usually develop slowly over the years.  You may not notice any symptoms at first or attribute them to other things. If your doctor find that you have laboratory abnormalities compatible with hypothyroidism in the setting of having clinical symptoms, he will recommend to start you on thyroid hormone replacement.  Weight gain Fatigued for no reason Dry skin Pale and/or puffy face Constipation A hoarse voice Your doctor will listen to your symptoms and take a blood sample to test your TSH (thyroid stimulating hormone) levels and the level of thyroid hormone thyroxine. Before starting your thyroid medication, you should ask your doctor about any foods, supplements, or medications you need to avoid. Likewise, you should also talk to your doctor before starting any new supplement or medication to make sure that it will not interfere. Many drugs interact with levothyroxine.  Amphetamines Anticoagulants Tricyclic antidepressants Anti-anxiety medications Arthritis medications Aspirin Beta-blockers Insulin Oral contraceptives Digoxin Anticonvulsants Some cancer drugs Iron replacement therapy Calcium carbonate Aluminum hydroxide Rifampin Hypothyroidism is almost always treated with the synthetic thyroid hormone called levothyroxine (Levothroid, Synthroid) which is a daily, oral medication. When working right, it restores your thyroid hormone levels to the correct balance and reverses the symptoms of hypothyroidism.  If the dosage is correct, you should start feeling less fatigued within one to two weeks. The medication should also help lower cholesterol levels that might have been raised by your hypothyroidism, and it has also been known to reverse weight gain related to the disease. Note that most patients will need to be treated for the rest of their lives. You will likely have your thyroid hormone levels checked on a yearly basis to determine if the dosage is correct or needs to be altered. It can take a few months before your doctor determines the right dosage. The doctor will likely measure your TSH level via a blood test before prescribing an initial dosage. Six to eight weeks after you start your medication, another similar test will be performed to determine if the dosage is right.  A typical starting dose will be calculated by your doctor, based on your weight. This amount may increase every three to four weeks until TSH levels are normal. The proper dosage depends on how elevated your TSH levels are, your age, and presence of any other medical problems that may be affected by thyroid replacement treatment (e.g. heart failure, depression, osteoporosis). If the dosage is too low, symptoms associated with hypothyroidism might still persist, including constipation, feeling cold, feeling sluggish, and gaining weight. If the dosage is too high, you might feel excessive nervousness, have problems sleeping, and suffer from shaking or tremors. Even though you will typically have your thyroid hormone levels checked yearly, there is some chance that your thyroid levels can drop again before your yearly check-up comes along. Watch for signs of hypothyroidism, including sluggishness, constipation, confusion, and a frequent feeling of being cold. See your doctor if you feel like your medication is not working.  If you develop a bowel disease or take medicine that affects your intestinal tract, your thyroid medication may not be getting absorbed correctly. The condition will either need to be treated or your thyroid medication will need to be increased. Similarly, your doctor may increase your thyroid medication dosage if you are taking estrogen or phenytoin. You also need to make sure that you are not taking too much thyroid medication. Over time, an excess can cause irregular heartbeats and osteoporosis. Some foods are known to interact with thyroid medications.  You can still eat these foods, but they need to be consumed several hours before or after you take your medication. These foods include walnuts, soybean flour, cottonseed meal, and large amounts of dietary fiber.  It is best to take your medication on an empty stomach and with a full glass of water.  If you eat a high-fiber diet, you will need larger doses of medication.  Discuss this with your doctor. Levothyroxine is a safe medication and side effects are not common when you are on the right dosage.  Less common side effects include chest pain or discomfort, decreased urine output, difficulty swallowing or breathing, fever, increased blood pressure, irregular heartbeat, menstrual changes, skin irritation, sweating, mood changes, muscle weakness, increased appetite, abdominal cramps, and diarrhea.  See your doctor if you experience any of these side effects. Before synthetic levothyroxine was developed, doctors used to prescribe desiccated thyroid tablets (Armour and Nature-Throid) with thyroid obtained from animal thyroid glands. Since these lacked consistency and potency, such extract is rarely used today, but you can still opt for it if you prefer a natural alternative.  These extracts contain thyroxine and triiodothyronine, two types of thyroid hormones. Synthetic medication, in contrast, only offers a supply of thyroxine, but the triiodothyronine you need can be derived from the thyroxine.  Note that you should only use extracts prescribed by a doctor and not a glandular concentrate sold over-the-counter at a natural food store.
A: See a medical professional. Discuss possible drug and nutritional interactions. Take a prescribed thyroid medication. Work with your doctor to determine the right dosage. Watch for signs of worsening hypothyroidism. Do not take your medication with certain foods. Notice any side effects. Ask about a prescription natural extract as an alternative.

Q: Before you can become a full-fledged mortgage underwriter, you will have to accrue entry-level experience and training. Most entry-level positions for recent graduates will be trainee or assistant positions.  Most mortgage underwriters work for banks, credit unions, or mortgage broker firms.  Search for entry-level mortgage underwriter jobs online. You can use websites like Monster.com or Indeed.com, or apply directly to firms by searching for financial institutions in your area. Assistant or trainee positions often lead to jobs, either at the office you trained with or through connections made at that position. Training periods typically last one year or less, with many training periods lasting only a few months. This training is necessary to get recent graduates experienced in the day-to-day world of mortgage and finance.  Training may entail informal training, formal training sponsored by the firm or company you work for, or some combination of the two.  If your firm or company uses underwriting software, you will be required to take classes and accrue experience working with that company's particular software programs.  Try to make strong connections with colleagues at your entry-level position. Networking is a good way to find jobs in the future, either after your training ends or once you're ready to advance into a new position. Though certification is not a prerequisite for employment, a professional certification can increase an employee's salary by five to 10 percent. In the United States, the National Association of Mortgage Underwriters (NAMU) is the primary institution for mortgage underwriters seeking certification. NAMU offers two primary certification options:  Certified Mortgage Underwriter (NAMU-CMU) - this certification option requires 12 hours of training. The candidate must then score an 85 percent or higher on a 30 question exam and successfully pass a criminal background check.  Certified Master Mortgage Underwriter (CMMU) - this certification option is considered an advanced degree and requires 24 hours of training. The candidate must stills core an 85 percent or higher on a 30 question exam and successfully pass a criminal background check.
A:
Apply for assistant/trainee positions. Acquire on-the-job training. Consider getting certified.