Health Chats
Thyroid Disorders: When Your Thyroid Malfunctions
Monday Jan 17, 2011, 08:00PM - 09:00PM (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.
MLupoMD:
This is unusual but I have seen similar case -- usually (assuming you are taking meds consistently) the issue is absorption and some patients need very high doses of medication.  The less likely issue is pituitary problem - would carefully review labs with your endocrinologist to see if this is possible.  Also test TSH using 2 different labs to confirm.
Judyfox:
I take 75 mg of levoxyl for hypothyroidism. My endocronologist says my thyroid has shrunk but there are no nodules. It was diagnosed about a year ago. Do you think it's good to eat food with a lot of iodine?
MLupoMD:
Extra iodine is not likely to help hypothyroid patients who are on medication and well-replaced.
MLupoMD:
Too much iodine can bind up (block) the thyroid or even cause hyperthyroidism - so would not go out of your way to get excess iodine.
ybsick:
I had been on synthroid for over 20 years switched to armour and did great for several yrs when the shortage hit my TSH went to over 50 I couldn't hardly function.  I took medi stim and GTA forte for a yr and I am now down to just the glandular formula feel good but still struggle with metabolism issues to lose weight
MLupoMD:
Would get back on thyroid replacement medication to keep TSH stable.
JR1952:
Hi, I am a Male 58 YO and have been treated for hypothyroid. I have Bradycardia, LVH and occasion brain fog. Fatigue is and issue along with pressure in the throat and neck, often painful.How often should one go to the DR about this? (Currently at 75 MG of levothyroxin) Is throat pain/pressure an issue?
MLupoMD:
Would see a doctor about all these issues - make sure TSH is ok on 75mcg and consider ENT evaluation for neck and throat pressure - thyroid is possible, but not common cause.
Kparanoid:
I sent a message earlier so I am sorry if I am repeating for you...I went through a year treatment of Depo Lupron for endometriosis.  Towards the end of the year 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.  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?
MLupoMD:
if thyroid levels normal, cannot attribute weight to thyroid problem -- remember, hypothyroidism only contributes 5-15 pounds of weight, so most weight issues are not thyroid.  Would see general endocrinologist to see if it is another identifiable endo/metabolism issue.
rnjar:
I have hashimoto's.  I sometimes get a tightness in my neck for a few days & then it goes away.  My TSH has remained stable, ultrasound is fine.  Is this my thyroid causing this?
MLupoMD:
If there is no thyroid enlargement on ultrasound then tightness is not likely due to thyroid -- most common cause would be acid reflux (even without symptoms of heartburn)
goatgirl:
Hi Dr. Lupo.  My mother was diagnosed with Hashimoto's Thyroiditis earlier this year.  Up until her diagnosis we did not think we had a family history of any thyroid disorders.  Now I am wondering what are the chances of me developing a thyroid disorder?  At my annual check-up this year I had a thyroid function test run.  The result came back at 3.17 and was considered "normal".  Is this something I should keep an eye on?  What are some of the signs and symptoms I should look for?  Thank you for your time in answering my question.
MLupoMD:
3.17 may be borderline - would test TPO and Tg antibodies to see if you have early hashi and to be on look-out for future increase in TSH reflecting hypo.  Would go to AACE to look for patient info on hypothyroid symptoms (symptoms are numerous and non-specific, but worth looking at info).
suzieq321:
My 12 yr 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?  Thanks in advance.
MLupoMD:
Odds of remission depend on many features - My approach is to try antithyroid meds like she is doing and save RAI or surgery for back-up plan.  Many pediatric endos treat for several years with tapazole before considering RAI or surgery.
kl42:
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? Cause you to have a hyperthyroid problem? If your on thyroid replacement hormones? thanks Kevin
MLupoMD:
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.
tweide:
My T4 and TSH results are in the normal range and I have several small nodules (less than 1 cm, first discovered in Jan 2010), and I experience a number of symptoms: feeling something stuck in my throat, very sensitive to cold (causes cramps in my hands, mainly in my middle fingers), and weight gain. I also have had sudden-onset vertigo since 11 Mar 2010 - could my thyroid issues be related to the vertigo? Thank you -
MLupoMD:
Not likely thyroid related symptoms given your thyroid history - would see ENT for throat and vertigo issues.  General doctor for the cold/crampy hands.
catcooter:
I am not seeing my questions go thru either, I have several issues I need help with. I was getting too much levothroid and am trying to get things evened out now.  I have suffered with joint and muscle pains for several years. No one will help me with diagnosis.Can this be caused by my hormone being off only? My hair is falling out.  Sores don't heal easily.  Is it worth pursuing fibromyalgia diagnosis and possible disability?  OR, is this just my thyroid med.  I have no live glad. I take .1 5x a day and was to take half the other two days.  For over a month I took a full .1 by accident in my med holder.  I didn't catch the symptoms due to heavy stress.  SEVERE anxiety and irritability.  Will just going back to my regular weekly dose be safe or should I taper back?  I really need help since I also have the painful foot. I say from a back injury, doc at hospitol said no, thyroid.  I am sorry if I am repeating myself. I know only so many can get thru!
MLupoMD:
Catcooter - can you be more specific about your thyroid question?  I cannot make specific dose suggestions - would talk to your doctor about dosing to keep TSH in the normal range.
Lifeisgood4463:
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 anything to help it?
MLupoMD:
Sore tongue is unusual, but could be related to anti-thyroid meds (usually it's a bad taste, not sore tongue).  Graves 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.
sandy95010:
Hi.  I"m 48 and have been dx'd hypothyroid for 10 years.  Regulated on Levoxyl well  - felt great - for the last 5 years.  now I have mixed symptoms...hypo & hyper:  extreme cold for certain periods of the day, sleeplessness, anxiety, weight gain.  My TSH is .07 then lowered meds and re-tested only to have it be even lower 6 weeks later .03.   Brain FOG is my biggest issue.  I have had antibiodies - pretty high - in the past.  not recently tested.   i don't have a lot of money to spend on repeated tests and doctors.   Are there lower cost options for testing places?   and any thoughts on my suddenly testing low TSH but feeling hypo still?
MLupoMD:
Testing costs can sometimes be negotiated with labs -- tell them you are willing to pay accepted medicare rates, if they won't take it, go to another lab and ask.
MLupoMD:
The low TSH should be addressed and lowering the dose is appropriate as low TSH increases risk of heart disease and bone loss.
shennigan:
Is it common to have more problems with my thyroid during the winter months.
MLupoMD:
Not usually....unless you live in very very cold (arctic) climates, then thyroid replacement requirements may increase.
ChitChatNine:
How do antit-hyroglobulins indicate a change in possible cancer activity in a person who's had small occurance?
MLupoMD:
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.
snarky348:
I'm a 33 yr old male who was just diagnosed with a TSH of 7.54, Free T4 1.00. My thyroid has always been normal as it was 3.024 just 6 months ago.  There are 2 concerns that I have:  I spoke with my doctor on the phone and he is not interested in checking a T3 or antibody test.  Does this seem appropriate to you to start me on Synthroid without checking anything else?