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:
In these cases we usually repeat TSH in 6 weeks to make sure it is not a transient problem and with that lab usually test a TPO antibody to see if it's autoimmune...
michther:
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. I know you don't have a crystal ball but what do ya think. Thanks for any info you can give me.
MLupoMD:
Would give it some more time - the ENTs I work with usually wait 3-6 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.
NevaQ:
I have been on 30mg of Methimazole since being diagnosed with Grave's about 5 months ago.  I have gained over 25 lbs!  My eyes have been very puffy as if I've cried all night. Last night, I couldn't get to sleep because my eyes felt like they were sinking into my skull.  I am terribly forgetful & have frequent head aches... I never felt like this before, It seems like my symptoms have gotten worse with medication. What should I do?
MLupoMD:
Get retested - 30mg of MMI is a big dose for 5 months and you may be hypothyroid and need a dose decrease.  The weight gain is common in treatment of hyperthyroid and can be 15-20 pounds on average.  Puffy eyes may be hypothyroid OR Graves eye disease.
neurotic:
I have sometimes a rapid heart rate just by taking a few steps.  I was diagnosed with Thyroditis, I have six nodules and high thyroglobulin AB(557).  Is the rapid heart rate associated with this?
MLupoMD:
If you are hyperthyroid due to the thyroiditis (ie, silent or subacute thyroiditis and not chronic(Hashimoto's)) then the increased heart rate can be related.
victoriasf:
I am 29 years old.  My aunt and sister both have hypothyroidism and were diagnosed in their early thirties after they had children.  What are the chances I will also have hypothyroidism and what are early indicators?  Can hypothyroidism be prevented? Thank you!
MLupoMD:
Would test TSH and thyroid antibodies to see if you are at risk.  The family history does increase your risk and there is no proven way to prevent hypothyroidism.
lcroberts:
I have been hypothyroid and on levothyroxine for fifteen years.  I have never been diagnosed with thyroid nodules until my annual appt. With my endo. This year.  He referred me for US which found e following:  "multiple small heterogeneous and hypoechogenic areas scattered throughout. Gland, smaller areas of 4-6mm which appear to represent cystic change.  Superior nodule on right which appears mixed echogenicity but could represent conglomeration of smaller nodules 6x4x3cm. Rt. Lobe measures 3x1.1x0.9cm. Left lobe measures 4x0.9x1.1cm and shows superior hypoechogenic nodule 1.1x0.4x0.3cm and mid hypoechogenic nodule of 0.9x0.4x0.3cm. Left lobe is heterogeneous butlessso than right.  
MLupoMD:
Would see an endo who does his/her own ultrasound so you can get a better idea of what is going on -- this is likely your Hashimoto's (you are hypo on meds) causing heterogeneity.  On the right, I assume you meant 6x4x3MM not CM.  The left 1.1x0.4x0.3cm area sounds like a pseudonodule (common in Hashi) by dimensions
Pam:
Hi Dr. Lupo!  Thanks for answering questions tonight.  In the last health chat you mentioned a new drug that has no fillers of 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?
MLupoMD:
Yes - several patients have tolerated it well - Tirosint is the medication.  Other options are to use the 50mcg tablets of levoxyl or synthroid -- these are dye free.
sweetluna:
Hi Dr. Lupo, my daughter was diagnosed with hypothyrodism about 6 months ago and I had parvovirus last year. Do you think I could have given her parvo and she got her thyroid condition because of it? she is on levothyroxine and they say it's for life but I'm concerned about taken meds and having it cause other issues later.
MLupoMD:
Probably not due to the virus you had.
margypops:
Thank you for this chat Dr Lupo  I have had two tests for hypothyroid, both times told negative ,I was only given the TSH test although I did request having been told that I should ask ,for T4&T3 ..I do have most of the symptoms,two weeks ago I started to take Iodine which is much advertised as a natural supplement, after 5 days I felt extremely sick, with symptoms so severe I thought I would have to go to the ER they did subside after 3 days .I have two questions, why would iodine affect me like that , and if I get tested again exactly what should I tell them I want .thank you Dr Lupo
MLupoMD:
Iodine (in excess)  can block thyroid or cause hyperthyroidism.  Asking for TSH, T4, T3 and TPO/Tg antibodies would be the most comprehensive testing for thyroid, but all these do not need to be done on routine basis.
laure67:
I have been on levothyroxin 50mcg and I have no energy and cant lose weight.. I have been on the pills for the past 2 years. Is there any way to lose weight and keep it off?
MLupoMD:
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.
mommao3:
I have hypothyroidism. I have taken 200mcg for years. Yes, I was horrible about taking it. I took it regularly for 2 weeks before another blood test. It was 0.04?? It was extremely way below normal. No one has ever called me since Nov. just the postcard so I started taking 2 pills daily (yeah, I know...self prescribing) I feel a million times better. I'm going to suggest retesting on 31st at appointment but she generally keeps the number on the low end of the scale and honestly I don't feel any better. What is a good level to keep it at and shoot for?
MLupoMD:
It is very tough for any doc to adjust meds if you are not taking it consistently -- would make an appointment to discuss your dose and labs with your doctor and not self-medicate by doubling your dose - that can cause dangerous heart problems.
MichaelKX:
Hi to everybody. I did some routine tests, as i do every year.
Back one year ago my results were normal.

Now the results came as this

T3 1.5 nmol/l (normal range is 0.92-2.33nmol/l)
T4 80,87 nmol/l (normal range is 60-120nmol/l)
TSH 1.6 mIU/ml
A-TPO 189.1 IU/ml (the normal range is between 0-40) *Positive*
ATTG 500,0 IU/ml (the normal range is between 0-125) *Positive*
Antistreptolysine 0 was at the highest peak of 200 IU/ml *Positive*
CRP was negative
RF was negative

These high results for A-TPO and ATTG alarm me, i was pretty fine last year, but now i dont know.
MLupoMD:
Looks like autoimmune thyroid disease (usually hashimoto's) currently with normal thyroid funciton - would repeat TSH 1-2 x per year to monitor.
Judyfox:
Has there been any research about why there are so many thyroid problems now? Thank you.
MLupoMD:
Yes - it's ongoing, no conclusions yet...only theories.
Dagero:
I have recently been diagnosed with borderline underactive thyroid. I have started taking Kelp for the iodine. How do I improve the situation without resorting to daily meds which create problems with my stomach? Dave, Johannesburg, South Africa
MLupoMD:
iodine sometimes helps - especially in iodine deficient areas of the world, but too much iodine can cause problems as well.
trish934:
What are the risk associated with the removal of your thyroid glands? When is it an indicator that it should be removed? If swollen occasionally.
MLupoMD:
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.
LM174:
I have had hashimotos for 16 yrs (I was only 23 and after my 1st baby when I started medication).  Is it better to take medication at bedtime or first thing in the morning?  Also I do tend to like a coffee in the morning and hope it's not hindering it's effectiveness.  When I lost 10kg the dr reduced my medication due to my body processing it more effectively (that's my theory) but I am now back up there and am still on the lower dose of 150mg.  Any tips would be great. Regards Leah.
MLupoMD:
consistency of the routine is key - can take either time of day and coffee is not a problem for most -- key is consistency.
tlc63:
I was diagnosed w/ hypothyroid (3.5) in 2003 & put on the lowest dosage of Synthroid until 2009 when my new Dr. suggested we up it to get myTSH below 3.0 & to help with my weight & fatigue problems. I was sent to an Endocrinologist who upped Synthroid to 88mg. & I was told that's all he could do for me after 6 months & no change in TSH, weight or fatigue. He said I'd quote, "Need to exercise & eat like a marathon runner to see any results." I'm so tired of not being able to lose weight, it's been 7 yrs. & I've gained 20 lbs. on a 5' frame & I'm miserable at 150lbs.  Please help.