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.
Mark Lupo, M.D.:
In general practice a benign FNA biopsy carries a 2-11% chance of being wrong.  Ideally it should be 1% or less, but that is for select expert settings.  We usually monitor nodules with benign FNA findings and repeat FNA for growth of 20% or more and consider surgery if there are compressive symptoms due to the nodule(s) OR if there is a suspicious FNA finding.
How hypothyroidism can effect conception?
Mark Lupo, M.D.:
Hypothyroidism can decrease fertility and lead to miscarriage, pre term delivery and developmental problems.  this should be treated with a goal TSH of 0.5-2.0 prior to conception and closely monitored to keep within this range during pregnancy.
Can your synthroid dose change with an increase/decrease of exercise. For example I have taken 2 months off (I run long distance in college) and I am going to start back up again and will get to around 70 miles per week in a few months
Mark Lupo, M.D.:
It might with this significant of a change, so would recheck the levels to be certain -- in general there is not a significant impact even w/ strenuous exercise.
I am on synthroid due to a tt with papillary microcarcinoma.  I was just told my iron is low and i need to take a daily iron pill.  I seem to remember something about not taking these two things together because it effects the absorption.  Is this true and if so, how far apart can I take them?
Mark Lupo, M.D.:
It is important to take the synthroid in the am and the iron in the evening.  This is the easiest strategy, but in any scenario there needs to be 4 hours separating the two.
Help! New to this! Diagnosed Hypothyroidism in Jan. -TSH was 5.66.  Sent to GP - He prescribed Levothyroxine 50 mcg, After 6 weeks TSH level was 2.8  Yesterday, went for TSH test and it is currently 2.92.  I visit my GP tomorrow to go over the result.  Should my med be changed?  I am still having thyroid symptoms (not as severe). But, fatigued and hair loss still.  Also, should I be seeing an Endocronologist or the GP?  FYI, my T3 or T4 have never been checked. Should they? Thank you    :-D
Mark Lupo, M.D.:
You had mild (subclinical) hypothyroidism.  The levels are better but our target is usually 0.5-2.5 for general hypo treatment, so a slightly higher dose may be appropriate.
Does it make a big difference whether your doctor goes by the traditional "normal" TSH range or the new AACE range?  Is it ever taken into account (in terms of whether to consider any treatment) whether the patient has other significant health problems when TSH levels are on the borderline of the range or fluctuate up and down over time?
Mark Lupo, M.D.:
This will depend on the individual patient's situation.  We often will monitor borderline levels particularly if they are not reproducible with followup testing.  If there is a persistent mild abnormality, then depending on the symptoms (and overall health status) medications can be considered to "correct" the abnormality.  Our office uses the AACE range.
I have had an ultrasound back in 2006 and was diagnosed with a multi-nodule Goiter and swelling on the right side. my blood work was ok. Now my Thyroid is double the size with sore throat and headache. I can't even seem to get out of bed anymore. Do you think the symptoms are coming from the Thyroid itself?
Mark Lupo, M.D.:
Enlargement with soreness may be thyroiditis -- would check thyroid levels again and if abnormal consider seeing an endocrinologist.  It may be worth repeating the ultrasound to document a change in size since 2006.
Last month test results are T4- 10.32 ug/dl, T3 uptake -0.93,  TSH 0.864, thyroxine 11.2 ug/dl, T4 free direct 1.47ng/dl. This last states high. HMO clinic said lab probably mistake. If not so what can it mean?
Mark Lupo, M.D.:
The free T4 direct can sometimes be falsely low or high.  With the other values being normal, most likely the thyroid is functioning normal.
My biopsy says I have Hashimotos, the treatment for Hashimotos is a thyroid hormone replacement pill but what if all my lab tests are normal?
Mark Lupo, M.D.:
We only treat hashimoto's if it is associated with hypothyroidism (high TSH and normal or low T4 and T3).  If the TSH is a little high, sometimes we use levothyroxine to prevent goiter growth in hashimoto's but this is based on patient's individual situation.
Are there any other Thyroid test besides the standard to check for Fatigue/Weight Gain as well as other hormone panels?
Mark Lupo, M.D.:
If TSH, Free T4/T3 and antibodies are normal -- then this thorough panel would indicate normal thyroid status.  Talk to your doctor about other potential causes - such as diabetes/prediabetes.
For the past 4 years I have been suffering from nausea, dizziness, cold hands and feet, chills, chest discomfort, blood pressure tends to go a little higher than normal when I am feeling bad, head discomfort (once in a while a headache), and visual disturbances (circle, zig-zag pattern figures-all transparent), pre-syncope symptoms (feeling as if going to pass out).  I have been having severe nausea, dizziness, and most of my usual symptoms since June 18th, but they don’t go away and they are getting worse at times. Also, since August 10, 2008, I have been experiencing swollen glands in my neck area, armpits, and face--they come and go.  At this point, I am really desperate because my symptoms have lasted for about four years and despite efforts at finding what I have nothing, seems to be the problem. Could this be thyroid related or CFS?
Mark Lupo, M.D.:
these are nonspecific symptoms -- certainly thyroid labs should be tested.
Hi Dr. Lupo --- I have questions about iodine deficiency. According to a study by the CDC the number of Americans with low iodine has quadrupled in the last 25 years, but yet physicians continue to say that iodine deficiency in the U.S. is rare. What are your thoughts on this ? Also... here is the link to that CDC study:
Mark Lupo, M.D.:
Good point -- the most critical time is during pregnancy.  Beyond that we need more info on the general population and the incidence of iodine deficiency and impact on thyroid. Screening with urinary iodine may need to be more commonplace.
I was diagnosed with De Quervains thyroiditis after surgery with the residual tissue that's still left. Will I have to worry about it coming back? And will it cause me to have any other problems?
Mark Lupo, M.D.:
This is a usually self limited "palpation thyroiditis" that occurs with surgery and should resolve on its own.
May I ask if Kaleidoscope Vision is a common symptom of the Thyroid Problem Grave's Disease?
Mark Lupo, M.D.:
Not common, but may be a sign of optic nerve involvement -- would see an ophthalmologist.
hi doctor I had papillary thyroid ca in 2007 and my thyroid levels in dec 2008 was in 0.22 and in may 2009 it rose to 0.998.. is there a slight chance that the cancer is back?
Mark Lupo, M.D.:
This is the TSH level -- it is not the test that we use to monitor for recurrence and a change like this does not mean anything about the cancer but it may mean that you need a higher dose of levothyroxine to keep the TSH in the lower range (depending on stage/severity of cancer).  You need to look at the thyroglobulin blood test and neck ultrasound to monitor for thyroid cancer recurrence.
Is Vitamin D insufficiency common in thyroid cases?   My gland was removed due to papillary cancer and now I am low.
Mark Lupo, M.D.:
Vitamin D deficiency is common overall - it does not appear to be more common in the setting you describe unless there is a parathyroid problem.
Dr. Lupo, On 4/23 I had 47 mci's of RAI for Graves. Uptake was 25%. I learned later that was a very high dose for me. I had terrible side effects--huge swollen neck, radiation thyroiditis, terribly sore salivary glands & ears, metalic & loss of taste, bad headache, sore throat. Most side effects after a month have improved. I am concerned about one remaining. After drinking the RAI, my throat became extremely sore all the way down into my stomach--lots of heartburn. Six weeks later it is still there. I was told only to expect a sore throat for a couple of days--that's all, maybe nausea for a day. I should have been told to drink lots of water right after the RAI, I was told to drink water for a couple of days, but not immediately. I am concerned about cancer from the RAI to my throat on down to my stomach. Nuc doc and endo gave me no side effect warnings. Why is my throat still sore? Tested neg. for infection. Cancer is a concern for me. Endo said there is higher risk. Thanks, Sandy