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Thyroid disorders affect an estimated 200 million people worldwide, including an estimated 27 million Americans. In fact, thyroid disease is more common than diabetes or heart disease. Yet it is believed that more than half of all thyroid problems remain undiagnosed. Untreated thyroid disease may lead to elevated cholesterol levels and subsequent heart disease, as well as infertility and osteoporosis. Research also indicates a strong genetic link between thyroid disease and other autoimmune diseases, including certain types of diabetes, arthritis and anemia.


On Monday, January 17, 2011, endocrinologist Mark Lupo, MD, held a health chat discussing thyroid cancer, Graves disease, Hashimoto's disease, hypothyroidism, hyperthyroidism and other thyroid diseases, symptoms, medications and treatments, including thyroid surgery, Radioactive Iodine treatment (RAI), fine needle aspiration (FNA) and thyroid stimulating hormones (TSH).

Here are 10 questions posed by MedHelp members during the chat and answers provided by Dr. Lupo. (Questions and answers have been edited for clarity. To read the full chat archives, click here.)

 

Question 1:

Is it better to have my hypothyroid treated by my general practitioner, or should I see an endocrinologist?

Dr. Mark Lupo:

In most cases, a GP can treat hypothyroidism. In some cases the patient may want to consult with an endo to make sure treatment is optimal and there are no nodules or other thyroid-related issues that need to be addressed.

Question 2:

Can diet, exercise or change in your weight affect your TSH or free T3? Should your numbers be rechecked if you lose weight? Can a 10-pound weight loss (due to diet and exercise program) affect your numbers or cause you to have a hyperthyroid problem if your on thyroid replacement hormones?

Dr. Mark Lupo:

Weight changes can alter thyroid hormone replacement requirements so retesting is important. But for patients with normal thyroid, weight changes are unlikely to cause thyroid lab abnormalities in most cases.

Question 3:

I have been on levothyroxin (50mcg) and I have no energy and can't lose weight. I have been on the pills for the past 2 years. Is there any way to lose weight and keep it off?

Dr. Mark Lupo:

Take in less calories than you burn off -- no thyroid tricks to weight, it's the same for people with and without a thyroid problem.

Question 4:

I went through a year treatment of Depo Lupron for endometriosis. By the end of the first year of treatment, I gained almost 20 pounds without changing diet or exercise. I had my thyroid tested and it was within range. I was told my B12 level was extremely low and had to start B12 injections. I saw a dietitian but only lost 7 pounds while others were losing 15 to 20 pounds. I followed my diet to the T! I have increase my exercise from walking to jogging to running and still have had no luck losing weight. What can I do?

Dr. Mark Lupo:

If thyroid levels are normal, you cannot attribute weight gain to a thyroid problem. Remember, hypothyroidism only contributes 5-15 pounds of weight, so most weight issues are not thyroid. I suggest you consult a general endocrinologist to see if there is another identifiable endo/metabolism issue going on.

Question 5:

In the last health chat you mentioned a new drug that has no fillers or dyes. Could you let us know if that drug is still showing any promise? If not, are there any others available to those of use who are allergic to dyes and fillers?

Dr. Mark Lupo:

Yes -- several patients have tolerated it well. Tirosint is the name of the medication. Other options are to use the 50mcg tablets of levoxyl or synthroid -- these are dye-free.

Question 6:

How do antit-hyroglobulins indicate a change in possible cancer activity in a person who's had a small occurence?

Dr. Mark Lupo:

If Tg-antibody is positive, we cannot rely on the the quantitative Tg value. The trend in Tg-Ab then is a surrogate for Tg activity, so an increase is concerning for recurrence.

Question 7:

I was recently diagnosed with Graves disease but swear I think I cycle back and forth between hypo and hyper. Is this possible with Graves? Also, I suffer from a very sore tongue which I assume is a related symptom. Have you seen this and is there anything I can do to help it?

Dr. Mark Lupo:

A sore tongue is unusual, but could be related to anti-thyroid meds (a more common side effect is a bad taste in the mouth, not sore tongue). Graves disease does not usually swing hyper/hypo but some autoimmune thyroid disease can do this -- you may need more frequent testing and close monitoring of dose adjustments.

Question 8:

My 12-year-old daughter was diagnosed with Graves disease a year ago. We have chosen to have her take Tapazol and this has worked well for her right now. I was just wondering if maintenance is going to be difficult through her teens into adulthood? Is remission a true possiblity in most cases or just rarely?

Dr. Mark Lupo:

Odds of remission depend on many features. My approach is to try antithyroid meds like your daughter is taking and save RAI or surgery as a back-up plan. Many pediatric endos treat for several years with tapazole before considering RAI or surgery.

Question 9:

What are the risk associated with the removal of one's thyroid glands? When is it an indicator that it should be removed? What if it is swollen occasionally?

Dr. Mark Lupo:

Risks include damage to the nerve leading to voice box and damage to glands that control calcium balance, in addition to anesthesia and usual surgery risks. It is very important to find a surgeon who does thyroid surgery on a regular basis.

Question 10:

I had total thyroid removed Nov. 30 and I still have a very weak voice. The surgeon recommended silicone injections as a possible solution. He stated the nerve was stretched due to very large portion wrapped around it. How long does the lack of voice last after surgery and are these injections a success for this problem? He did say it more likely will come back in time. What do you think?

 

Dr. Mark Lupo:

I would give it some more time. The ENTs I work with usually wait 3 to 6 months before considering surgery for the vocal cords. Usually the voice slowly improves during this time. If there is complete loss, then fat injections (or silicone) may help.

 

 

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