Concerned about Adenomas and Low Ferritin

[MinnieM]

Dear Doctor.  I am a post meonpausal lady. In 1999, I became aware of a problem. TSH was a 15.  It came down on its own to 7,then doc RX'd Synthroid. 1.25 brought TSH down to 0.90 and was told to come back in a year. Both antibodies were high. I was told I had Hashomoto's thyroiditis. Saw new ENDO and he gave me levoxyl and was pleased with a 3.9 TSH. Feeling like *&%^^, gaining weight and looking like Ms. Piggy. Saw another ENDO. She was happy with a 4.3 TSH as it was in range with her lab and gave me Levoxyl, 1.00 and a tad of cytomel. Getting fatter and eyes were bothering me so saw a GP and he switched me to Armour. 2.0 and then to 3.0.  Wants his patient's TSH in the 1.00 range. Had heart event (A-FIB in May 2005) and ER suspected Thyroid but TSH was 1.2 so this was ruled out. Was converted back to NSR.  
I asked for Ferritin test.Came back 16. Asked for follow up and subsequent tests were 14 and 12. Do not know why this is low as CBC is normal and other iron test are normal, they said. Can you address this?

Had Rt. Parotid ultrasound 2 weeks ago. This showed discrete nodule on rt. thyroid. Biopsy showed Benign Adenoma. 1.7cm. I was told via phone.  (ENT doc)

Should I of asked more questions on this adenoma? Is there a relationship to the low Ferritin level?  Looking at some driver's license pictures, I noticed 3 years ago, eyes were bulging and lower lids sagging. Kind of like a stare.
I seem to be on my own trying to figure this all out and need some answers.  Can you help?  I am on Beta, Ace, Plavix,Armour.
Had Antibodies repeated 2 mo. ago. Normal.
Thnks

[Mark Lupo, M.D.]

I don't think the adenoma and ferritin are related --- the low ferritin means low iron stores in the body -- this may be a precursor to iron deficient anemia (ie, then the CBC would be abnl).  Would watch the the parotid adenoma for increase in size - but the benign biopsy is reassuring.

The armour and the a-fib may be a problem - the t3 in armour can be more stimulating on the heart.  I agree with the TSH around 1, but may be more comfortable with levoxyl or synthroid over armour in your case.  If you stay on armour - at least divide the dose to twice daily.

[MinnieM]

Dear Dr. Mark, I failed to mention that on the Ultrasound report that propmted the biopsy it read:

Rt. lobe is 4cm. x 2 cm.  The gland is inhomogeneous.  There are 2 discreate areas identified that measure 1.4 cm. in size.  (they only biopsied one of them as the other one was too close to a vessel they said)  The Isthmus is 4mm. (whatever this is) Lft. lobe measures 3cm x 1.5 cm with no nodules.

Thanks, doctor.

[Mark Lupo, M.D.]

did you have a thyroid biopsy or parotid biopsy - the ultrasound description is thyroid -- in either case -- follow-up ultrasound in six months to assess size is indicated.

[MinnieM]

I had an ultrasound done of the Parotids, neck and thyroid at the same time. Parotids were good but the adenomas showed up on the rt.thyroid. I agree with you about getting off the Armour and back on Synthroid.  I see an Endo in 10 days.  Yes, I will have another scan done in 4-5 months (ENT DOC) to see what this adenoma is doing.  I have choking like episdoes and radiologist
thinks it is connected to the adenomas.  Thanks for your concern
and all the best to you in the upcoming Holidays.

[ancientmariner]

Low ferritin (less than 80) can cause major fatigue symptoms, and aggravate many symptoms of hypothyroid. It also prevents you from using all the thyroid hormone you're taking into your body every day. You might want to read up on low ferritin, and treat that, then the thyroid treatment will likely work better for you.

[MinnieM]

Thank You for this information.  I aim to take the bull by the horn and find out now about this.  No wonder I feel like ^$%^$^**!  I fall asleep the minute I sit anywhere and feel like Digger O'dell....(-:  All my other tests (CBC, Iron Tests) are normal but the Ferritin is in the cellar. Last one was a 12.

Thanks again,

[ancientmariner]

Ferritin is storage iron, and can be low even if iron levels are normal. So glad to hear you're going to "take the bull by the horns" - you are your own best advocate when it comes to your health, so be informed about things when you see your doc...

[allisonl]

I was wondering if you could recommend the best way to take ferritin. mine was tested in 2000 at 36 and i am starting to see how my labs dont make sense and my medication is at 4.5 grains of thyrolar. speaking of which, i would greatly appreciate it if you would be able to comment about my switching to armour. my doctor is suggesting 240 mg when I am already taking 300mg of thyrolar. I am worried i will gain more weight and feel worse. what do you think about that? should i insist on the 300 mg and do you feel the armour prescription needs to be filled with the armour brand? thank you so much. i have noticed you have a lot of knowledge about these things.

[ancientmariner]

Allison, I'm not allowed to give you advice on this forum, so I can only tell you what I've experienced, or learned from folks on other forums who have experienced the same problems.

That being said, I've heard of a lot of folks who take ferrous sulfate, but also yake vitamin E and C with it. And they say it can take several months to raise your ferritin level - that's the storage iron. Also, you don't want to take your iron anywhere near your thyroid meds.

I know that Armour has a chart for conversion on the package insert, not sure if it's on their website or not (Forest Pharmaceuticals. I have heard that generic desiccated thyroid has been found by people who have used it to be weaker than the brand-name Armour.

Sorry to be evasive, but I'm not allowed to give medical advice here, since I do not have an MD after my name. Only Dr. Mark can do that.

Have you posted this question on NTH? There are a lot of people there who discuss just these questions all the time.

[allisonl]

thank you, that was helpful.