Need Help Please !

[49stinks]

Dr. Dr. Lupo,

My current endro is in Ft. Myers (previous home town), and I am looking for a Sarasota endro who understands these issues I am having.

Diagnosed with hypo 1999 – had many side effects when trying to increase synthroid then levoxyl to get “in range.” Finally felt best being slightly hypo on 50 mcg brand levoxyl and 12.5 mcg. brand Cytomel taken each morning. Labs pretty stable until June 2010. My TSH went up to 7.75, had many uncomfortable symptoms. Made several adjustments to meds.

Constant loud heartbeats waking me up at night, tightness and lump in my throat, and swelling of my neck under my chin. I also had more energy than I have had in years, so I know I was hyper. My endro told me my labs were “perfect” and there was nothing wrong with my thyroid, to go to heart doc, then to gyn. EKG and US already done, basically normal. My blood results for FSH, estradiol, anti mullerian show I am in menopause, so  I need a endro who understands. I am 49, no kids, having irregular menses past year, only one very light since mid June. My gyn recom Vivelle dot patch 0.025 ?

My upper neck is visibly swollen since a thyroid med change in August, can hear a clicking when I swallow, and tightness in my throat seems to happen most times after taking meds, and gets better as the day goes on. I am also having pains and slight swelling on the sides of my neck, where my arteries are. My docs say my thyroid does not appear enlarged, most be something else, maybe GERD per PCP, but I am extremely sensitive/allergic to many meds, and I think I may be having an allergic reaction to my cytomel or levoxyl, which I know is rare, but is this possible? Is there an alternative to Cytomel to try?

Ferritin levels have been low for about a year, trying to see if it would help my occasional RLS, and I am wondering if this increase has made any impact on the T4 conversion process or may be adding to these current side effects. Last Ferritin level was 34. THank you.

[49stinks]

And would my care/treatment be different if it is Hashis instead of just hypo?

Do you have any hypo patients who have experienced thyroid changes with menopause? For some reason, I seem to be needing less and less thyroid meds these past few months now that I am in menopause. And/or could it be because my ferritin and iron levels are up?

I am feeling better now that I cut back my cytomel to 5 mcg once a day, although this may still be too much as I have been up since 4 am !

Thanks again.

[Mark Lupo, M.D.]

Thyroid antibodies should be part of this evaluation to confirm Hashimoto's....
We don't use compounded or "natural" thyroid meds.

[49stinks]

I did have a thyroid ultrasound done when this all first started in August - said thyroid did not appear enlarged, numerous innumerable small solid thyroid nodules present, findings secondary to chronic thyroiditis or multinodular goiter. Suggested correlation with thyroid antibody test, but endro wouldn't do tests.

Do you prescribe natural thyroid meds?

Thank you for your time.

[Mark Lupo, M.D.]

Would consider thyroid/neck ultrasound to evaluate the area.
There is no alternative to cytomel (except generic) and we usually use 5mcg dosing 1-2x/day.
Another option, if thyroid levels stable and ultrasound ok, would be to have an ENT evaluation.