Health Chats
Thyroid Disorders: When Your Thyroid Malfunctions
Wednesday Jul 28, 2010, 07:30PM - 08:30PM (EST)
97953?1440865392
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.
MLupoMD:
Regarding more surgery vs RAI - most would recommend RAI for remaining lobe if Graves, but must be mindful of thyroid eye issues - if present, RAI may worsen.  Prednisone may decrease this risk. If you smoke, stop  - this also makes eye and graves issues worse.  Surgery is also reasonable but has its own risks of parathryoid and voice issues.
painter64:
When a ultrasound report says... IMPRESSION: All glands are extremely inhomogeneous bilaterally what does this mean and what glands do they mean?  It also states that the thyroid is extremely heterogeneous.  Should surgery  be done and remove the thyroid for futher testing?
MLupoMD:
This is likely autoimmune thyroid disease.  Heterogeneous = inhomogeneous.  If there is no nodule, then no need for FNA biopsy.  IN most cases, this is Hashimoto's -- would correlate with TPO/Tg antibodies and TSH levels.
MLupoMD:
Would not see need for surgery based on this alone
mrs_k75:
I have been diagnosed as having hypothyroidism. My T3 was borderline and below normal. Everything thing else was in the normal range. Does that really mean I have hypothyroidism? I also had a total of 23 thyroid antibodies still below what is considered a problem. Do all people have thyroid antibodies? FYI I am on 60mg of armour thyroid and after taking it I had less fatigue and constipation problems. Is it true I will have to take it for the rest of my life now?
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.
MLupoMD:
sorry - that response is for the next ?
MLupoMD:
An isolated low T3 does not mean hypothyroidism.  TSH is a much better test for diagnosing hypo.  If normal TSH - (ie <3) then would not rec thyroid meds in most cases.  Anyone who takes armour or other thyroid hormone who does not need it will briefly feel "better" but then symptoms return --- would get a second opinion before taking thyroid meds long-term.
mtgardner:
How does Hashimoto's infulence total cholesterol and LDL?
MLupoMD:
see above
MissLisa82:
Hi Dr. Lupo,  I just found out I am pregnant a week ago and  have been struggling to get my doctors to prescribe Levo for several months now.  My TSH has been 4.12 and 3.65.  Negative on Tg antibodies but never got TPO tested.  These numbers are normal based on my labs range.  I am scared now that I am pregnant that this will affect my baby.  How will this affect my baby with TSH at my levels?  What can I do to get my Dr.'s to prescibe Levo when they don't believe I need it and what should my TSH be during pregnancy?
MLupoMD:
These levels have very low risk to baby.  Would start thyroid meds to keep TSH in 0.3-2.0 range and test TPO antibodies to clarify as these TSH levels are likely hashimoto's.  Eventually also consider thyroid ultrasound (esp if negative TPO) to look for a nodule.  
carrieb155:
If I'm having an allergic reaction to the yellow dye in levothyroxine. How long would it take to get out of my system? I'm not convinced this is why i keep having the reaction. I read it could also be do to my hormone levels, is that true?
MLupoMD:
It will get out of system very quickly -- 1-3 days or less most likely.  These reactions are not common.  Consider asking about the new med, tirosint, which has no dye or fillers.  OR use the dye-free 50mcg tablets (2/day =100, ie yellow).
honeygirl302:
I have had hypothyroid for at least 10 years. My TSH has been 7 then 9  and I have had no symptoms, I am now 56 in good health and of course menopausal. My TSH is now 12, my T4 is 10.6 and my free T3 is 4.4.I now have symptoms of dry hair and some dizziness, which could also be my menopause since the dizziness comes and goes. Why is the TSH so high if my thyroid hormones are good. My ,internist gave me a script for 25m synthroid. What do you think of L tyroisine? or Armour?
MLupoMD:
This is mild (subclinical) hypothyroidism -- assuming the T4 and T3 are in normal range for your lab.  Would treat with levothyroxine like synthroid to avoid heart problems associated with low thyroid.  L-tyrosine will not resolve this problem.  Armour is inconsistently available and not always reliable in my opinion - I don't prescribe it.
YankeeGirl28:
Is there any relationship between hypothyroidism and anemia?  Also, could taking medicine, such as prednisone, for an extended period for ulcerative colitis lead to hypothryoidism?  I have problems w/ anemia and cannot tolerate the oral meds (tried quite a few) because they irritate my intestinal system too much and cause a flair in the colitis.  I typically go in every 6 months for a series of 3 bi-weekly venofer infusions and that seems to get my anemia under control and my levels back to a normal range for 5 to 6 months.  The hematologist has run tests and they cannot determine the cause of my anemia.  I appear to be part of the group that doesn't have a known cause.  Thank you.
MLupoMD:
Hypothyroidism can cause anemia.  Prednisone is not a common cause for hypothyroidism, but high doses can alter thyroid labs.  With the UC, would screen for hashimoto's/hypothyroidism and also consider GI bleed as source for anemia.
Cherie762:
Hello, I am the community leader of the hysterectomy forum. I have noticed a very large percent of my posters also are hypothyroid, often hashimotos..Why is this?
MLupoMD:
not sure why -- may be more hypothyroidism/hashi in patients with endometriosis which is also thought to be autoimmune.
kaittisler:
I've read that a diet void of sugars and flour can set your thyroid straight...any insight?
MLupoMD:
not heard of this -- doubt it's true.  Minimizing sugar in the diet is healthy however....
wardb:
How does exercise impact on thyroid function? Does significant exercise result in a greater requirement for thyroid hormone?
MLupoMD:
For most of us, exercise has no impact on thyroid requirements.  For ultra-athletes, there may be an increase demand that a normal thyroid would automatically adjust for, but patients on meds would need an increase.  We also see this in hypothyroid patients who spend time in south pole....
rnjar:
Since I was diagnosed with hashimoto's , i have noticed I have become very sensitive to allergy meds, is there a connection?
MLupoMD:
Not sure of any connection - but patients w/ hashi tend to have more allergies/asthma tendencies, but I have not seen sensitivities to antihistamines.
bridgeovertroubledwater:
Why is it that some people can take Thyroid medication and never need to change over to adding T3.  Is this because some other gland is not working correctly and not convertin the T4 to T3?
MLupoMD:
T4 to T3 conversion happens mostly in the liver -- so patients with hypothyroidism can take T4 alone and have normal T3 levels.  Most evidence does not support a need for taking T3 meds.
mammo:
Is it correct that one must never take a generic synthroid medication?
MLupoMD:
Generics are the same levothyroxine active ingredient and work well for many people, but there are over 30 manufacturers of generic meds, so you may get a different source when you refill which may not have same absorption.  Ideally, it's best to get the medication from same source each time.
sue19581977:
I had throid cancer in 2006 and it was removed. It was papillary cancer. I currently have blood work done every 3 months and am on .88 synthroid  My
Tsh is .14 and doc believes it is to low and wants to change my meds again. I was on 100 synthroid 3 months ago and Tsh was at .14 then also and has not changed.  Everything i have read, Tsh level is fine. Please advise
MLupoMD:
It depends on the cancer risk level -- if very low risk for recurrence (ie, excellent response to initial therapy) then TSH may be 0.3-1.0.  Otherwise, current level is probably ok.