Live WebChat - NOW - with Dr. Mark Lupo, Endocrinologist

[ChitChatNine]

We'd like to welcome Dr. Mark Lupo, Endocrinologist, as our guest this evening from 5:00-6:00PM EST.  Dr. Lupo will be answering thryoid-related questions which were previously posted by our community members earlier this week.  

After a member-question is posted by Co-CL ChitChatNine, Dr. Lupo will answer the question with a few minutes for member comments and then another question will be posted.

I know we'll enjoy this WebChat and thank Dr. Lupo for his time!  

Let's give Dr. Lupo a warm welcome!

Your Community Leaders
Cheryl, Laura & Stella

[mommy2two2008]

Welcome and thank you Dr. Lupo!!

[laura1967]

Welcome Dr Lupo and thank you for giving your time to us tonight....hello from Fort Myers!!!

[mommy2two2008]

That's a good idea Laura - HELLO FROM LOUISIANA!

[mommy2two2008]

Will the questions post on this thread??

[Mark Lupo, M.D.]

Happy to be here.  

[Jennifer1987]

Thanks for being here, really appriciated! HELLO FROM IRELAND!

[baz5]

Thank you for your time! :)

[Mark Lupo, M.D.]

I will go ahead w/ first question as I cannot see live chat/posts.

Low vitamin D is common, would look at PTH & calcium levels first.  Then if normal, consider looking at celiac sprue antibodies.  

[ChitChatNine]

QUESTION #1:

From:  ChitChat9
Parathyroid Disease ?

Dr. Lupo,

In women over 45 yrs old who have been diagnosed with a Vitamin D Defficiency, do you find that most have this defficiency due to "lack of sunshine" without an underlying reason (i.e, parathyroids not working right), or that many who are seen by an Endocrinologist are diagnosed with parathyroid issues causing this defficiency.  I ask this ? because my primary doctor was very quick to diagnose the cause as  "lack of sunshine" even with my history of thyroid cancer.   My Endo took it much more seriously and is ruling out other possible causes (including a repeat serum Vt D test as well as Intact PTH, & rerunning thyroglobulins, etc.), before I start Vit D Treatment.  First labs were Vit D at 9.4

[mommy2two2008]

Can Vit D def. cause a person to tingle in the throat and tongue?  If so, is a safe test theory to take some form of calcium with Vit D OTC?  I have tested my cal 2 times wth my doc.  Last was 9.3.  I know that is a good number.  I get some sporatic tingles, last was Wed, Thurs and Fri.  I took some Caltrate and it stopped after 2 days.  I no longer feel it.  I just wondered if it was coincidence.

[Mark Lupo, M.D.]

SEE ANSWERS BELOW

First of all...Thank you for your time.  I have a few round about questions.  I have some heart issues in which my HR can run low for days and then drop low along with some really rough chest pains, floaters, blurred vision etc.  Anxiety is not the issue with them.  So I guess this is the one I'm most concerned with.  



I also have really bad muscle spasms threw out my body during the winter months and in the summer I get lightheaded very easy, so in order this is also a concern.  

The the third question is just plain aggravation with Doctors.  LOL Sorry.  Thank you again for your precious time.  Amy



1 a,b.)  I would like to know the relationship between thyroid issues and heart issues?      (Example, angina, PVC's and PAC's, cholesterol increases and hsCRP)
IF THERE IS EXCESS THYROID HORMONE IT WOULD CAUSE PVC AND PAC.  TOO LITTLE WOULD INCREASE CHOLESTEROL.  BOTH CAN AGGRAVATE ANGINA.


2 e.)  The relationship between thyroid and FMS and CFS symptoms?  (PlateletGal could probably word it much better than I.)
THERE IS SOME RESEARCH (NOT IN MAINSTREAM ACADEMIC THYROID) THAT HYPOTHYROID IS ASSOCIATED W/ FM AND CFS SYMPTOMS - SOMETIMES TREATING W/ T3 CAN BE HELPFUL TO THE MUSCLE SYMPTOMS.


3 e.)  Why most Doctors will not run a T3 or FT3 along with the TSH, T4 and FT4?

TSH IS THE STANDARD OF CARE BASED ON MULTIPLE STUDIES. IN SOME CASES T3 LEVELS ARE HELPFUL TO EVALUATE HYPOTHYROID, BUT ARE MOST HELPFUL IN HYPERTHYROIDISM.

[Mark Lupo, M.D.]

LOW CALCIUM CAN CAUSE THE TINGLING SENSATION -- AND LOW VIT D CAN CAUSE LOW CALCIUM -- THAT'S WHY THERE MAY HAVE BEEN SOME BENEFIT

SORRY ABOUT THE ALL-CAPS, JUST FIGURED IT WOULD BE EASIER TO RECOGNIZE MY POSTS IN THE THREAD.

[ChitChatNine]

If anybody has any comments on the discussions, feel free to post them after Dr. Lupo has answered!

I'll go first ... Celiac Sprue .. I never thought of that and thanks!  I am awaiting results as I write this and am going to ask my Endo about this, too!

C~

[manju77]

Hypothyroid questions


I had irregular periods and diagonised with hypothyroidism.The results of my test before i was on levothyroxine on November

TSH 5.934 (High)
Thyroxine(T4) 10.0
T3 uptake 30%
Free Thyroxine index 3.0

Now I am on Levothyroxine on 75 mcg and the results of the tests after 6 weeks are

Free T4 1.9 (0.7-1.8)
TSH 0.04 (0.5-6.00)

My doctor(internist) says the dosage is right as it has lowered the TSH.But I am worried it is too low now and becoming hyperthyroid from hypothyroid.

I got my periods after i was on levothyroxine ,but this  month still i haven't still got my periods yet.Is it  due to the low tsh?.

Will lowering the dosage help ?

[mommy2two2008]

We know you're not screaming!!  Thanks for that.  My doc told me I might have shingles.  I just can't believe that as now that I did try the Caltrate, it has stopped.  I didn't take the antiviral med he gave for shingles and now I am feeling ok.

[Mark Lupo, M.D.]

QUESTION 3

A) In what situations would you/endocrinologists allow a hypothyroid patient to add cytomel to their levothyroxine to try and improve their symptoms?



A)How long does it take for a thyroid gland to stop functioning after becoming hypothyroid due to an autoimmune cause?

VARIES FROM PERSON TO PERSON.  ONE STUDY SAID THAT 5% OF PATIENTS PER YEAR LOOSE THYROID FUNCTION -- SO IN 20 YEARS ALMOST EVERYONE WITH AUTOIMMUNE THYROID DESTRUCTION WOULD BY HYPOTHYROID.

A) I've read in a medical textbook that there is a link between hypothyroidism and low ferritin levels. What causes this?
LOW FERRITIN (IRON) CAN BE CAUSED DUE TO POOR INTESTINAL ABSORPTION DUE TO HYPOTHYROIDISM OR CELIAC SPRUE (GLUTEN SENSITIVITY WHICH IS MORE COMMON IN HASHIMOTO'S PATIENTS).  OR DUE TO HEAVY MENSES WHICH IS SOMETIMES SEEN IN HYPOTHYROIDM.  

[ChitChatNine]

Dr. Lupo may be able to answer your question as we move along a bit later in the WebChat.  The posts are being taken in order from the prior posts .. let's see how it goes but wanted to mention this so you don't think it may be overlooked.

C~

[Mark Lupo, M.D.]

QUESTION 3 ---

I CONSIDER ADDING T3 (AND USE MUCH MORE CYTOMEL THAN ARMOUR - B/C I CAN FINE-TUNE THE T3 AND T4 AMOUNTS MORE PRECISELY) WHEN THERE IS FATIGUE AND BRAIN FOG.  ABOUT 15% OF PATIENTS FEEL IT HELPS SIGNIFICANTLY (ALTHOUGH MANY FEEL BETTER THE FIRST MONTH, ONLY 15% HAVE A SUSTAINED BENEFIT).

[baz5]

Why would my tsh be very high with a low Free t4  only every so often? I do have missed periods...very ofter.  I had to go to the hospital this friday for major dizzyness
(I will bring that up again) BUT they tested my thyroid at the hospital and it was normal.
Whats that about??

[ChitChatNine]

Anbyody have any comments on Dr.Lupo's responses to Questions 1, 2, 3 ?

[Mark Lupo, M.D.]

My 8 year old daughter was born without a thyroid gland and has recently been diagnosed with PVC's in her right ventrical. She is on .88 micrograms of synthroid and has not had a dose change in over 2 years. Could the cause of the PVC's be due to needing a different dose of synthroid? (Hypothyroid) Or could this possibly be caused from the synthroid itself? Her blood test are in the normal range, however she has gained weight, has issues with constipation, is emotional, lacks energy, and has muscle aches in her legs. Her blood is only tested for TSH, T4, and Free T4. Could it be possible that her body is not converting T4 to T3? There must be some type of imbalance in her body for this to suddenly be happening to her heart. I am desperate for answers that I am not getting from our doctors here.Please help with any ideas that you may have. Thank you for your time and thoughts on our specific situation.

IT IS NOT LIKELY THAT THE T4 --> T3 CONVERSION IS FAULTY.  WOULD TEST FREE T3 TO CONFIRM.  IF THE TSH, FT4, FT3 ARE ALL NORMAL THEN THYROID IS NOT LIKELY THE CAUSE -- IF THE TSH IS LOW NORMAL, DECREASING THE DOSE TO SEE IF THAT HELPS THE PVC'S WOULD BE WORTH A TRY, BUT HER OTHER SYMPTOMS ARE MORE SUGGESTIVE OF HYPOTHYROIDISM.

[huncher]

Am new to this thyroid game. After TT and RAI, I have started my back on my Synthroid .125 mg. My question is: Will the Adderall I take for ADD (30mg twice a day) affect the Synthroid???

[Mark Lupo, M.D.]

IF THE TSH IS CONSISTENTLY HIGH AND T4 INCONSISTENTLY LOW - THEN YOU MAY NOT BE CONSISTENT WITH THE MEDICATION....

I AM TRYING TO GET THROUGH PRE-POSTED QUESTIONS FIRST, BUT THANKS FOR THE QUESTION

[mommy2two2008]

As to a person "loosing thyroid function with hashi", is the same true when your a hashi patient with normal labs of TSH, FT4 and FT3? (swelling and non-smooth texture)