Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
Dr. Lupo, questions since reading chat archives
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Dr. Lupo, questions since reading chat archives

I have some questions for you based on the questions and answers from the transcripts.

I understand that risk of osteoporosis increases with hypothyroidism. Why is that?

If 100mcg levothyroxine is available dye free by taking two 50mcg, would there be a reason to not opt for the latter? Why is dye added?  

A response suggested TSH, T4, T3 and TPO/Tg antibodies is the most comprehensive test panel but not necessary on a regular basis. My dx was based on TSH and T4. Do I need the others at some point?

You mentioned that patients with hashi do have more allergies and asthma. Would it be important to know if my hypo is hashimoto's? When I had my blood work in Dec, it was routine blood work + allergy testing through bloodwork because of my bothersome allergies and allergy induced asthma. The lab work revealed hypothyroidism and now here I am trying to gain a better understanding of my health. Wondering if my worsening allergies is linked somehow.

Regarding allergies, my lab work did not reveal remarkable allergies.  My doctor said symptoms were likely reflux, suggest Rx zantac. I opted to not start the med at the same time I started levothyroxine because if I'd had a negative reaction to one or other, it would be more difficult to sort out which. Iin a response in chat, you said acid blockers decrease stomach acid and possibly the absorption of levothyroxine. If I opt to take an acid reducer, does it change how soon I would need new labs?  

Again, thank you for any comments. This is a very, very helpful and informative forum.  I appreciate this community.
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excess thyroid hormone increases osteo risk (not levo meds themselves)

dye is added to provide color to tell the doses apart. 50mcg is dye free

you should know why you have hypo - so antibody testing for Hashi is appropriate

the effect of stomach acid on absorption is debated, but probably some patients need dose change.  I consider repeat labs in 2 months.

there is also a gelcap formulation (tirosint) that is dye free and may not have the gastric acid issues that is an option for patients who are not stable on T4 tablets.
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One more question regarding osteoporosis.  Is it appropriate to have a baseline DEXA scan? Thanks.
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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
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