Health Chats
Thyroid Disorders: When Your Thyroid Malfunctions
Wednesday Jun 03, 2009, 07:00PM - 08:00PM (EST)
97953?1440865392
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.
iris986:
Are there any foods you need to stay away from when taking Synthroid?
Mark Lupo, M.D.:
Not necessarily, but taking the synthroid with high fiber foods, iron supplements and calcium can decrease the absorption.  The key is consistency with taking the synthroid in the same way every day and preferably at least 20-30min before a meal.
cbma:
My doctor considers Hurthle cells found in my nodules to be premalignant and that I should remove my thyroid soon. But the pathologist told me that my Hurthle cells are due to my thyroiditis and it is very common to have them.  What do you recommend when you find Hurthle cell metaplasia in a patient's biopsy report?
Mark Lupo, M.D.:
This sounds like hashimoto's thyroiditis and the pathologist is right that hurthle cells are common in this setting and in other normal thyroid nodules.. There is a misconception among some docs that hurthle cells are always bad - this is simply not the case.  If there are other features of thyroiditis in the FNA sample, then the presence of hurthle cells is usually benign.
Dahlia130:
I am hypothyroid but yet experience some of the symptoms of being hyperthyroid. How is that possible? Getting my labs in line with being asymptomatic is a constant challenge.
Mark Lupo, M.D.:
You can't have both at the same time and the symptoms of each are non-specific, meaning that even patients without thyroid problems can identify with both hyper and hypo symptoms.  Keeping the TSH in target range (0.5.2.5 for most labs) is the goal.
sharnstne:
My son just got his test results back. His TSH is 414, was rested now 415. Should I be concerned?
Mark Lupo, M.D.:
do you mean 4.14 or four hundred and fourteen???
Mark Lupo, M.D.:
If truly four hundred  -- this is a severe abnormality and T4 and T3 levels need to be tested -- these are likely low -- which would reflect hypothyroidism and a need for levothyroxine.  If the T4 is high - then further testing for a pituitary problem is in order.  If you meant 4.15 then this is a high-normal TSH that can usually be monitored depending on symptoms and overall health, etc.
Regalhank:
What about sub-clinical thyroid disease?  My "numbers" always come back normal--a little on the low side, I think--so I cannot convince the endo that there is actually something going on.  What further test might reveal what I'm sure is a thyroid issue?
Mark Lupo, M.D.:
This depends on the individual case - depending on the situation and the symptoms, we sometimes use medications to bring the levels back to normal to see if the patient feels better.
bird115:
Can a Complex cyst be a clinical feature of Hashimoto's or does it need to be a solid nodual?
Mark Lupo, M.D.:
Nodules in Hashimoto's is common - it can be complex or solid.  Depending on size and ultrasound characteristics, it may need FNA biopsy.
Claude22:
What is your opinion on the copper nutritional supplement as described by John on his website ithyroid.com
Mark Lupo, M.D.:
I am not aware of this.  There is no study that supports the use of copper for thyroid health, beware of well-marketed attempts to sell you products!
mclamb:
Can depression be a symptom of hypothyroidism? I'm not sure whether it may be the cause.
Mark Lupo, M.D.:
Yes - untreated hypothyroidism can cause depression and this should be corrected as part of the treatment (and often before starting depression meds, depending on the severity of the situation).
chinacat09:
Dr Lupo, as I was being evaluated for vague symptoms such as unexplained weight gain, mild edema, fatigue.. My TSH and T4 was checked; I was wondering why no one ever seems to pay attention to the T3.  As I understand, T4 is converted by the body to T3, but I am wondering can there be some disorder of T3 when TSH and T4 is normal?  Would it be important to also check T3, or any other Thyroid or Endocrine value, for that matter?
Mark Lupo, M.D.:
In most well designed studies, TSH and T4 are adequate to detect thyroid disease.  More thorough testing with T3 and thyroid antibodies can sometimes complete the evaluation if there is a strong family history or symptoms/signs of a thyroid problem.
frustrated953:
My doctor said I have hypothyroid because my T3 has gone from 160 to 130 to 105 and my TSH has dropped to 0.475. Is this a sign of hypothyroid?
Mark Lupo, M.D.:
This is not specific - The TSH is normal at 0.475.  The T3 is still within normal range (and tends to fluctuate during the day, so following a trend can be misleading).  Checking a free T3 may be helpful next time, but at this point the labs do not point towards hypo or hyper thyroidism.
itsme1234:
had total thyroidectomy for pap. carcinoma about a year ago.  1 parathyroid was implanted into SCM during procedure.  WBS w/ I-131, no RAI treatment.  on synthroid and 50000 IU vit d for low vit d labs.  been having altered taste since sometime after thyroidectomy.  things just taste bad, for example dairy tastes spoiled.  could it be related to thyroid or vit d issues and if so, what could be done?  thanks!    
Mark Lupo, M.D.:
Taste alterations are not common for this situation (in absence of receiving I-131 therapy).  You could try a different vitamin D (like calcitriol) to see if this helps -- ask your doctor.
mclamb:
what is hypothyroidism and hyperthyroidism?
Mark Lupo, M.D.:
This is too broad a question -- would go to aace.com or thyroid.org and look on the patient information pages.
cbma:
What is your opinion on PEI- percutaneous ethanol injections- do you perform this procedure in your practice?
Mark Lupo, M.D.:
PEI is not used much in the USA, but some of us use it and find it a nice alternative to surgery for treatment of benign large cysts of the thyroid.  There is also growing interest in using it for select thyroid cancer lymph nodes.  I only use it currently for cysts.
Lori575:
Hi.....I have antibodies for both Graves and Hashimotos....can you have both at the same time??
Mark Lupo, M.D.:
They are both autoimmune thyroid diseases -- consider it a spectrum of thyroid problems with hashi being a destruction leading to hypo and graves a stimulation leading to hyper..  In graves you can have all the antibodies so if you are hyper, then this is graves (not hashi).  It can be complicated sometimes.....
bird115:
Is there any connection between thyroid problems and womans facial hair?
Mark Lupo, M.D.:
usually it is scalp hair thinning and not facial hair -- facial hair is more likely genetic, PCOS or other causes.
smc44:
I have been diagnosed with multiple nodules in my thyroid and have had a fine needle aspiration biopsy.   The results were benign. What are the chances of the nodules turning malignant?  Is it better to have the thyroid removed surgically? My Ts3, Ts4, TSH results were all normal.