Health Chats
Thyroid Disorders: When Your Thyroid Malfunctions
Wednesday Jun 03, 2009, 07:00PM - 08:00PM (EST)
Thyroid & Endocrine Center of Florida
, Sarasota, FL
Thyroid disorders affect an estimated 200 million people worldwide, and an estimated 27 million Americans. More than half remain undiagnosed. In fact, thyroid disease is more common than diabetes or heart disease. 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. Come join Dr. Lupo in an hour long chat discussing thyroid cancer, Grave's Disease, Hashimoto's, 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).<br><br> Mark A. Lupo, M.D. is board-certified in Endocrinology and Internal Medicine and has a subspecialty focus in thyroid and parathyroid disorders. Dr. Lupo is President of the Academy of Clinical Thyroidologists (2008-2009), member of the American Thyroid Association (ATA), American Association of Clinical Endocrinologist (AACE), AACE Nuclear Medicine Task Force, ATA Programming Committee, Endocrine Society, Florida Medical Association, and American Mensa Society. Dr. Lupo serves as the moderator for the patient-oriented Medhelp International Thyroid Disorders forum.
Hello everyone and welcome to today's health chat with Dr. Mark Lupo. We'll be starting in an hour but please feel free to submit your questions now.
As you submit your questions, please remember to keep them brief and on the topic of thyroid disorders. Thanks for your cooperation.
Welcome Dr. Lupo! So glad to have you here today.
Hello, Dr. Mark Lupo. May I ask what some of the symptoms of Thyroid Malfunctions are? I have been having very strange vision problems and a Daze Feeling 24/7 and I was wondering if these might be symptoms of a Thyroid Problem. My mother has been diagnosed with a Thyroid problem and I have had a blood test to see if I do too, but I haven't received the results yet. Thanks, I greatly appreciate your time and consideration!!!!
Mark Lupo, M.D.:
There are many possible symptoms - too many to list - but checking thyroid levels (TSH and T4 mainly) is the right place to start.
Is it possible to have a thyroid problem or some type of endocrinology problem even if a TSH or T3 or T4 are within normal ranges?  Do I need to do a freeT3 and free T4, rT3, and TH index testing to confirm?  
Mark Lupo, M.D.:
If the TSH, T4 and T3 are normal there is little chance of a thyroid problem.  The rT3 is not clinically helpful (in standard practice).  TPO antibody may be of some help to determine future risk for thyroid problems.
I was diagnosed with Grave's disease several years ago and took radioactive iodine.  I now take thyroid replacement.  Will I have Grave's disease all my life?
Mark Lupo, M.D.:
You still have "Graves" which is an immune system attack on the thyroid, but at this point the chronic problem is hypothyroidism due to the radiation which will require lifelong replacement medication.
Both my legs and left hand are swollen. My doctor thinks the cause is a thyroid disorder.  What do you think?
Mark Lupo, M.D.:
Difficult to know with limited information.  If the thyroid blood tests are normal, then this is not likely thyroid related. Also, being only left hand swelling would be unusual for thyroid (ie, usually total body swelling).
Dr Lupo, I had some blood testing done 2 months ago and it revealed a TSH of 9.06. I mentioned it to my husband's endocrinologist and he ordered some labs for me this past month. He did a free thyroxine-1.0, thyroglobulin antibody 20.0-neg. thyroid peroxidase ab-high-168. He ordered 50mcg synthroid which the nurse told me was to suppress the gland. That confuses me because I thought my gland was underactive, why would it need to be suppressed? What do these test results mean? I was taking about 1 mg of iodine in kelp after he ran the tests and I got these results and he didn't do a TSH on this test. Thank you!
Mark Lupo, M.D.:
You have Hashimoto's with early hypothyroidism. The synthroid is not to supress the gland, but to supplement the low thyroid hormone status to bring things back to normal.  The iodine is not likely to help that much and in some cases too much iodine can be detrimental to the thyroid.
Hi Dr. Lupo. I had a tt on Nov. 08 due to suspicion of cancer. It turned out to be benign. My energy has improved, but i still have muscle aches and joint pain/ popping. My last TSH was 2.09 and T4 was 1.7. Five weeks ago, I increased my Synthroid to 200 from 175. It helped with my energy level. Do you think another increase would help reduce or get rid of the muscle aches and joint pain. Any other suggestions. My next blood test is scheduled for 2 weeks from now. Will get TSH, T4, free, T3, tyroglobin, tyroglobin abtested. Any other suggestions as to why the body aches, joint pain stiffness, and popping remains?
Mark Lupo, M.D.:
It may tke more time to improve with the new dose of synthroid -- you don't want too much synthroid as this can cause heart problems and bone loss -- so careful monitoring is appropriate.  If the other symptoms persist, rheumatologic evaluation may be in order.
I read that Oprah has thyroid issues. She has a lot of money and obviously a team of doctors at her beck and call. What can the average woman do to get the same treatment she has gotten to get to the bottom of any problems (if any)?
Mark Lupo, M.D.:
Even with her "team of doctors" she is still having issues it seems -- underscoring that many of the symptoms that appear to be thyroid have multiple other potential causes that need to be addressed.  The "average" person can get excellent thyroid results with proper medication and monitoring -- the other issues usually boil down to lifestyle -- proper eating, exercise, stress management, etc .
How come RAI is not recommended anymore for Microcarcinomas variant of Papillary cancer of <1cm or less? What is the chance of reoccurence in thyroid tissue that's left over after total thyroidectomy?
Mark Lupo, M.D.:
There is a low risk of recurrence in these microcancers that are a single focus without invasive features or aggressive cellular features.  Long-term monitoring is important but RAI has not been proven to beneficial in this group.  There is about a 2/1000 chance these spread outside the neck.
I have Hashimoto's and in addition to thyroid antibodies I also have low level adrenal antibodies with normal-low cortisol and ACTH of 30pg/ml. My sister has Addison's. What tests and measures should i take so that Addison's does not sneak up on me? Thank you.
Mark Lupo, M.D.:
Following the am cortisol may be helpful, but moreover being mindful of Addison's symptoms of nausea, weight loss, light-headedness, etc which would prompt testing sooner.
I had a TSH 3rd generation test done with result 1.66. I also had a thyroglobulin antibodies result <20 ref range <20 iu/ml and a thyroid peroxidase result <10 ref range <35. The doctors say all is normal. My question is could I still have thyroid problem? T3 and T4 were not tested.
Mark Lupo, M.D.:
With these results, there is a low chance of a thyroid problem.  The T4 and T3 are not likely to add much in this situation.
Do you think there is any connection between thyroid problems and Sarcoidosis?
Mark Lupo, M.D.:
This would be rare but sarcoid could infiltrate the thyroid and cause under-activity.
What is the best way to go about stopping the birth control pill without it messing up your thyroid medication dose? I tried stopping the pill at one point and it put me into hyperthyroid mode (I guess because of a decrease in estrogen?)
Mark Lupo, M.D.:
Less estrogen usually means a need to decrease the dose.  Usually we repeat thyroid labs 6 weeks after changing oral estrogens (patches, etc) and re-evaluate levothyroxine dose requirements - not all women need a dose change, but being aware of the possibility is important.
Hi, I just had a thyroid uptake done today, and was told my level for 6 hours was 17 percent. Can you please explain if this is normal or not? Thank you!
Mark Lupo, M.D.:
This is in the high range of normal for most labs.  But the more important question is the thyroid labs - if you have hyperthyroidism, with this uptake at 6h then it is either Graves or a "hot" nodule(s).
I recently had some blood work done to check my cholesterol and was told by my Dr that it was a bit high. He then checked also my thyroid. Apparently that isn't working as it should :(  I have re-done my blood test again and my cholesterol level is coming down so would my thyroid come back to normal once my cholesterol is at a normal level?
Mark Lupo, M.D.:
High cholesterol does not cause a thyroid problem.
Mark Lupo, M.D.:
But thyroid problems (low thyroid) can cause high cholesterol.