Thyroid disorders affect an estimated 200 million people worldwide, including an estimated 27 million Americans. In fact, thyroid disease is more common than diabetes or heart disease. Yet it is believed that more than half of all thyroid problems remain undiagnosed. 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.
On Monday, January 17, 2011, endocrinologist Mark Lupo, MD, held
a health chat discussing thyroid cancer, Graves disease, Hashimoto's disease, 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).
Here are 10 questions posed by MedHelp members during
the chat and answers provided by Dr. Lupo. (Questions and answers have been edited for clarity. To read the full chat archives, click here.)
Question
1:
Is it
better to have my hypothyroid treated by my general practitioner, or should I
see an endocrinologist?
Dr. Mark Lupo:
In most
cases, a GP can treat hypothyroidism. In some cases the patient may
want to consult with an endo to make sure treatment is optimal and there are no
nodules or other thyroid-related issues that need to be addressed.
Question
2:
Can diet,
exercise or change in your weight affect your TSH or free T3? Should your
numbers be rechecked if you lose weight? Can a 10-pound weight loss
(due to diet and exercise program) affect your numbers or cause you to have a
hyperthyroid problem if your on thyroid replacement hormones?
Dr. Mark Lupo:
Weight
changes can alter thyroid hormone replacement requirements so retesting is
important. But for patients with normal thyroid, weight changes are
unlikely to cause thyroid lab abnormalities in most cases.
Question 3:
I have been
on levothyroxin (50mcg) and I have no energy and can't lose weight. I have been
on the pills for the past 2 years. Is there any way to lose weight and keep it
off?
Dr. Mark Lupo:
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.
Question 4:
I went through a year
treatment of Depo Lupron for endometriosis. By the end of the
first year of treatment, I gained almost 20 pounds without changing diet or
exercise. I had my thyroid tested and it was within
range. I was told my B12 level was extremely low and had to start
B12 injections. I saw a dietitian but only lost 7 pounds while
others were losing 15 to 20 pounds. I followed my diet to the
T! I have increase my exercise from walking to jogging to running
and still have had no luck losing weight. What can I do?
Dr. Mark Lupo:
If thyroid
levels are normal, you cannot attribute weight gain to a thyroid problem. Remember,
hypothyroidism only contributes 5-15 pounds of weight, so most weight issues
are not thyroid. I suggest you consult a general endocrinologist to see if there is
another identifiable endo/metabolism issue going on.
Question 5:
In the last
health chat you mentioned a new drug that has no fillers or
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?
Dr. Mark Lupo:
Yes --
several patients have tolerated it well. Tirosint is the
name of the medication. Other options are to use the 50mcg tablets of levoxyl or
synthroid -- these are dye-free.
Question 6:
How do
antit-hyroglobulins indicate a change in possible cancer activity in a person
who's had a small occurence?
Dr. Mark Lupo:
If
Tg-antibody is positive, we cannot rely on the the quantitative Tg
value. The trend in Tg-Ab then is a surrogate for Tg activity, so an
increase is concerning for recurrence.
Question 7:
I was
recently diagnosed with Graves disease but swear I think I cycle back and forth
between hypo and hyper. Is this possible with
Graves? Also, I suffer from a very sore tongue which I assume is a
related symptom. Have you seen this and is there anything I can do to help it?
Dr. Mark Lupo:
A sore tongue
is unusual, but could be related to anti-thyroid meds (a more common side effect is a bad
taste in the mouth, not sore tongue). Graves disease does not usually swing hyper/hypo
but some autoimmune thyroid disease can do this -- you may need more frequent
testing and close monitoring of dose adjustments.
Question 8:
My 12-year-old daughter was diagnosed with Graves disease a year ago. We have
chosen to have her take Tapazol and this has worked well for her right
now. I was just wondering if maintenance is going to be difficult
through her teens into adulthood? Is remission a true possiblity in
most cases or just rarely?
Dr. Mark Lupo:
Odds of
remission depend on many features. My approach is to try antithyroid meds like your daughter is taking and save RAI or surgery as a back-up plan. Many
pediatric endos treat for several years with tapazole before considering RAI or
surgery.
Question 9:
What are
the risk associated with the removal of one's thyroid glands? When is it an
indicator that it should be removed? What if it is swollen occasionally?
Dr. Mark Lupo:
Risks include 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.
Question 10:
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. What do you think?
Dr. Mark Lupo:
I would give
it some more time. The ENTs I work with usually wait 3 to 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.
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