Health Chats
Thyroid Disorders: When Your Thyroid Malfunctions
Wednesday Jul 28, 2010, 07:30PM - 08:30PM (EST)
Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
, Sarasota, FL
Thyroid disorders affect an estimated 200 million people worldwide, and an estimated 27 million Americans. More than half remain undiagnosed. In fact, thyroid disease is more common than diabetes or heart disease. 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. Come join Dr. Lupo in an hour long chat discussing thyroid cancer, Grave's Disease, Hashimoto's, 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).<br/><br/> Mark A. Lupo, M.D. is board-certified in Endocrinology and Internal Medicine and has a subspecialty focus in thyroid and parathyroid disorders. Dr. Lupo is currently Secretary of the Academy of Clinical Thyroidologists and was President of the group from 2008-2009, member of the American Thyroid Association (ATA), American Association of Clinical Endocrinologist (AACE), AACE Nuclear Medicine Task Force, ATA Programming Committee, Endocrine Society, Florida Medical Association, and American Mensa Society. Dr. Lupo serves as the moderator for the patient-oriented Medhelp International Thyroid Disorders forum.
MedHelp:
Hello everyone and welcome to today's health chat with Dr. Mark Lupo. We'll be starting at 7:30PM (EDT) but please feel free to submit your questions now.
MedHelp:
Welcome back Dr. Lupo! So glad to have you here today.
MLupoMD:
Nice to be back doing a live health chat!
mtgardner:
How does Hashimoto's relate to high cholesterol and high LDL and will good control of thyroid levels lower both Total Cholesterol and LDL?
MLupoMD:
Hashimoto’s causes hypothyroidism which decreases liver clearance of cholesterol (mainly LDL).  Correcting the hypothyroidism usually helps lower cholesterol and should usually be done before starting cholesterol medications – but many patients still need cholesterol meds.
DarthVoVo:
could a thyroid disorder cause beta thallesemia?  I noticed mention of anemia as a possible side effect of a thyroid disorder.
MLupoMD:
No, beta thallesemia is inherited and would not be caused by a thyroid problem.
ampky:
My TSH is around 5 and am not on thyroid medication. The hypo symptoms are affecting only the left side of my body (i.e. neuropathy, ataxia, etc) Is this possible/conceivable?
MLupoMD:
Not likely that left hemi-body symtpoms would be due only to a mild thyroid disorder.  However, even mild hypothyroidism can cause worsening neuro symptoms, so treating to a target TSH of 0.5-2.5 is reasonable to see if this helps.
sheppo:
In Jan 2010 I had a tsh test done and my level was .01.  I was referred to an endocronologiist who the put me on enderal 3x a day  and tapazole 2 x a day.  I felt better, but was having some muscle discomfort.  I had been retested in 2 months and my tsh level was 4.86.  That seemed good enough so I was cut down to 1 tapazole per day.  Was retested and the tsh level was steady at 4.86.  feeling better I thought that I would take myself off tapazole and then I started having symptoms again.  I went to the dr. and she had my blood tested and it came back normal.  Even though I had a normal reading, but had all the classic symptoms.  I called my endocronologist and he was furious with me that i was not taking my meds.  Went back on the meds and the symptoms subsided.  I am periomenopausal and this is really frustrating for me.    I guess my question is is it normal fto have a normal reading, but still have the symptoms.
MLupoMD:
Sometimes the symptoms lag behind the numbers -- seems like you could use a low dose of methimazole still, then re-evaluate.  Also stopping inderal suddenly can cause rebound increase in heart-rate and tremor.
binjie:
I start to have one thyroid pain & cause my one ear and half head pain since 7/11/10 and was misdiagnosed as infection and treated with antibiotics for 10 days, and my another thyroid start pain, then find out my TSH only 0.03 and FT4 a little bit high and has been taken ibuprofen till now, and my ultrasound indicate nodules. My 1st endocrinology appointment will be 8/17/10 (this will be the first time I can see a doctor, my family doctor has being in vacation). By then, my problem will be delayed one more month. What consequences could be because of this delay? What should I do? What medicine could I take?
Thank you
MLupoMD:
With the pain, would consider a transient subacute painful thyroiditis as the cause of low TSH.  This is treated mainly with anti-inflammatories (like ibuprofen) and beta-blockers (like inderal) to slow heart rate and reduce tremor.  Nodules are sometimes seen but may be transient - so repeat ultrasound in 3 months is usually helpful.  Also would repeat thyroid labs just prior to endo consult to see the trend.
victoriasf:
Are there any natural alternatives for controlling your thyroid levels if you're Hypo?  For example.....diet, vitamins, exercise, acupuncture, etc.  Thanks so much!
MLupoMD:
Nothing proven - certainly maintaing good health with exercise, nutrition and stress mgt are helpful.  Untreated hypothryoidism (ie, no prescription meds) can have significant health problems - so talk to your doctor about your levels and need for treatment.
abby51:
I have had a thyroidectomy for Papillary and for several years I had an undetectable Tg. Then all of a sudden three years ago I had a slightly elevated Tg at 10.3, TSH is 0.5 and the only other test that is abnormal is a low WBC. On ultrasound, a suspicious spot was found but it does not show on any scans including PET (I have had 2 I-131 scans and 2 PET scans in the last 3 years). I have been seeing an endo and oncologist and both say they are unable to biopsy the spot in my neck that shows on ultrasound and I would need to see the intervention team to do so. Because I am young, work full time, and attend grad school full time I have elected to just wait and see what happens and have been doing so for 3 years. The doctors tell me I cannot keep waiting, however, the Tg has not changed much in the last few years, Would it be okay to continue waiting or should I try to find someone who can biopsy the suspicious spot in my neck. I have 3 doctors who do not agree on the next step.
MLupoMD:
With this rise in Tg levels, it is a good idea to have a more definite answer and possible treatment.  Most masses we can see on ultrasound can easily be biopsied with a small needle.  A second choice/option would be an empiric high dose of I-131 with a post treatment scan that is more sensitive that the diagnostic scan with 4mCi that have been neg x2 for your.  PET is not good a detecting routine recurrence of papillary cancer.
Sherri90049:
Two questions: One) Why do so many endo's looking at TSH lab results still go by the lab's normal ranges when there is ample evidence that the range (0.5-5.0) is too wide? (Even the AACE revised their normal range seven years ago to 0.3-3.0)  Two) Why do the majority of endo's refuse to recognize adrenal fatigue as an actual medical condition when there are so many people clearly suffering from it? (Many of us who do suffer from it are also hypothyroid even though our TSH comes up normal. This causes us to have fits with our endo's who can only say that our thyroids are fine, when they're clearly not. Most of us even improve upon being given thyroid meds. So there must be something wrong with our body's ability to utilize the thyroid hormone that is circulating through our body.) Thank you in advance.
MLupoMD:
Cannot speak for all endos......
MLupoMD:
Normal TSH level is a subject of debate, but many agree that 0.3-3.0 is the expected range for humans.  A trial of therapy is reasonable for patients with TSH >3 in the presence of symptoms especially if there are positive antibodies.  For patients on levothyroxine treatment, we usually target levels in the 0.5-2.5 range but this may vary depending on age and other health issues.
cknight517:
is it possible to be hypo but have all the hyper symptoms?
MLupoMD:
The symptoms are simply guidelines for when to test people and assess response to treatment.  So many people have "hypo" or "hyper" symptoms and have no thyroid disease and some have opposite symptoms of the labs.  So better to go with labs and to recognize that the symptoms are very non-specific.
bunny235:
I am a 22 yr old female that stopped having periods at age 18. It was later found that I had hashimotos and that was considered the reason for the stopped periods. I was put on birthcontrol and 1 month ago I went off of it and my periods have still not returned. It is possible that my hashimotos could still be causing this....my last TSH was .075 and T4 1.3?
MLupoMD:
If levels stable, then not likely that hypo/hashi has impact on periods.  Current TSH is good.
ChitChatNine:
I am on Syntroid 75mcgs for papillary micro supression after a partial thyroidectomy 1/07.  Why do I suffer from anxiety when I take Pepcid on a regular basis (o-t-c Pepcid 1X day)  Thanks.
MLupoMD:
Not sure why pepcid would cause anxiety - if anything, from thyroid standpt, the pepcid would decrease stomach acid and may decrease absorption of synthroid.  Would reveiw w/ your doctor the TSH suppression goal (may be able to go to 0.3-1.0 range if very low risk cancer).
Rainbow_Brite:
Is there any reason that a patient should take medication containing T4 during pregnancy if they are doing well on T3-only medication (Cytomel) before getting pregnant?
MLupoMD:
Tough question -- there is clear evidence that the baby depends on maternal T4 and no clear evidence regarding maternal T3.  The current thyroid/pregnancy advice is to use T4 alone during pregnancy b/c of the critical dependence on normal T4 levels.  Remember - pregnancy is a time when we are treating two patients, not one.
DSA:
I became significantly symptomatic (and lab confirmed) for thyroid deficiency while taking NSAIDS for a shoulder injury.  Can I expect this deficiency to be permanent?
MLupoMD:
NSAIDS can interfere slightly with thryoid function, but should not cause a permanent abnormality.  It may be that you developed a new thyroid problem coincidentally while on the NSAIDS - would retest and followup w/ doctor.
grammys02:
Dignosed with hyperthyroidism in March 2009.  Right side of thyroid removed in Nov. 2009. Large goiter in it. Non cancerous. Off tapozole after surgery.  Last blood work June 2010 showed still hyper, had thyroid scans.  Was told I had Graves Disease.  Trying to learn more about it so I can decide if I want surgery to remove the left side or take the Iodine Radition pill to kill the thyroid production. What is the best way to go since I already had half of my thyroid removed?  I am on Tapazole right now.  I was also wondering what foods you should avoid or eat to make a difference in how your thyroid functions.?
MLupoMD:
minimize foods with excess iodine - otherwise no food restrictions/suggestiosn