Health Chats
Thyroid Disorders: When Your Thyroid Malfunctions
Wednesday Jul 28, 2010, 07:30PM - 08:30PM (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 currently Secretary of the Academy of Clinical Thyroidologists and was President of the group from 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.
Hi Dr. Lupo...I seem to have on and off bouts of shortness of breath...can this be related to thyroid function? I am on 100 mcg of levothyroxine and 10 mg? I think it's mg of cytomel. I have seen a pulmonologist and nothing on x-rays, etc. My thyroid Dr. also has me on iron pills every day and I have been on them for some this typical of someone with Hasimoto's?
Iron pills must be taken 4 hours apart from thyroid meds.
Cytomel (which is a more active thyroid hormone) may cause a feeling of shortness of breath.
I was just diagnosed with hypothryoidism 2 weeks ago, now taking 50 mcg. of Levothyroxine x 13 d,  I feel much better, but now experiencing some headaches with mild BP elevation in the 140 range.  Is this normal and should it level out on its own? (I have Atenolol 25 mg that I can restart if needed.)
If you recently stopped atenolol, that alone could cause headaches and high BP.  Would give it some more time with the levothyroxine as it may take some time to get used to - in meanwhile, monitor BP and share results w/ your doc.
Hi Dr Lupo, I have both Hashimoto's and Grave's Deseases. I was HYper, w/operation in 1979, became HYpo. My  question is.  My last blood test, everything is in normal range, but Throglobulin AB which is 1466... normal range  <20 IU/ml,
The immune system sometimes has a good memory - so even after thyroid surgery, Tg antibodies may persist.  This is not significant to your thyroid replacement treatment.
Thanks in advance for reading this.  I've had a total thyroidectomy over 5 years ago.  My tsh  has always been suppressed (undetectable) with my free T3 and free T4 being in the normal range.  Both my ob/gyn and endo think this is fine for trying to conceive.  They say that as long as the frees are within range, it is fine for being able to conceive. I've read conflicting things however.  What are your thoughts?
NO - an undectable TSH is not normal and not ideal for conception/pregnancy.  If you are on thyroid meds, would decrease the dose to keep TSH in the low normal range but not greater than 2.
What is your suggestion for Doctors who use labs with outdated normal level ranges i.e., 0.5 -4.5 or 0.5-5.0, and therefore refuse treatment to patients who are within these ranges but still have a TSH >3.0 and have symptoms.  Many times insurance does not allow to change doctors or doctors are all in the same network and use the same lab.
Cannot make a doc do something he/she is not comfortable with....but a trial of meds in these cases is often useful.
My husband has a good TSH 1.xx but a below range FT4 and low range FT3.  His doctor says he is fine because his TSH is normal.  He has muscle/joint pain, fatigue, extreme irritbility, inability to handle stress, insominia, he is very active but has a bit of middle weight.  Would this be a thyroid problem or possibly a pituatory problem?
In this case, would consider testing total T4 and total T3 - if these are low, then must eval for pituitary problem.  If normal, then no evidence of either thyroid or pituitary based on the TSH in that range.  Consider sleep apnea and/or low testosterone as other causes of symptoms.
How do I interpet my lab results. November FT4 0.99, TSH 0,66 , Jan FT4 0.66, 4.71, April FT4 1.03 TSH 3.23 FT3 3.23
need reference ranges, but appears fairly normal with some fluctuation in TSH that may not be significant and recommend repeat levels in 3-4 months to determine trend.
can a tsh level of 5 normal t3 and t4 give u very bad muscle aches and tightness in chest neck and back? fatigue? and be the cause of anxiety.. and why would tsh be out of range but t3 and t4 in normal range? is this a specific kind of thyroid disorder? my endo seems confused.. and i am VERY sensitive to synthroid. i hv side affects and hv to take the lowest amt no matter what my levels are
Not likely to be onlycause of these symptoms, but would try to slowly titrate meds (consider another brand if not tolerating synthroid) to get TSH in target range and re-evalute.  High TSH and normal T4/T3 is called subclinical hypothyroidism
I have become very sensitive to cold.  If I fall asleep by my patio door in the winter months, I often awake with the shakes and have trouble breathing.  I also don't seem to sweat as I used to or run fevers. When I take my own temperature it is often below 98 degrees, when my normal has always been 98.6 I am 57 and post menopausal.  My mother and younger sister have both had their parathyroids removed.  I am told by my doctor my thyroid is normal.  Can my symptoms be related to problems with thyroid/parathyroid?
these aren't parathyroid symptoms (but would test calcium) and if thyroid levels normal, cannot likely attribute to thyroid
I am reading Mark Starrs book about Hypotyriosm type 2. What do you think about that? Is it true and what should I do? My natural body temperatur is 35,5 degrees celcius. Does that mean that my Thyriod is bad fuctioning? I have some other typical "thyroid syptoms" but T3 and T4 is ok.
Basal body temperature is not a current standard for assessing thyroid.  TSH, T4 and T3 are the current standards.  "thryoid symptoms" are very nonspecific and therefore very common, but if you have normal labs, would not recommend thyroid treatment.
Hi Last year I was diagnosed and treated for hypothyroidism and am currently taking 50 mcg. levothyroxin per day.  Should I be treated by a GP or an Endocrinologist? Does it matter?  What lab tests should they be checking and how often?
Most primary docs can treat hypothyroidism.  TSH and T4 testing 1-2 x / year is usually adequate.
I have had a ultra sound done every year for the last three years and within the close margins this is what the impression has been....Normal size thyroid, Right lobe measures 4x2x1.5 and the left lobe 4x1.5x1.5cm. Two solid isoechoic nodules in right upper pole measure 12x9 and 10 x 9mm respectively. Two isthmus nodules measure 10 x 10 and 12 x 11 respectively. There is no adenopathy. Impression, Multiple thyroid nodules.Do I need to worry or have a FNA. on these nodules. Thanks.
Solid nodules above 10mm should be considered for FNA biopsy but most (95% or more) of isoechoic nodules like these are benign.
What is thyroiditis and is radioactive iodine/uptake scan reasonable remedy/cure for it?
it is an inflammation of the thyroid.  Most commonly, we see chronic thyroiditis (hashimotos') but can also be subacute --- so if hyperthyroid labs (ie, low TSH) then the scan is used to diagnose thyroiditis (versus graves), but iodine treatment is not used for thyroiditis
It's me Melisa again, sorry i submitted my question before I finished. My th AB 1466, Th peroxide AB normal < 10. normal range is > 35.  Why is it so hihg, what can I do ? Thank you for your help. Melisa
see prior answer - would not worry about the level of Tg antibody, but would consider neck ultrasound to make sure there is no nodule remaining in thyroid.
My question has to do with my pathology results. They indicate that the 4.2cm nodule is benign but there were indications of thyroiditis. I am not exactly sure what this means. My blood labs came back today all within normal range so I am very confused why I have this lump on my neck and why I feel so miserable? My Dr has refered me to a surgeon and I will be making a decision of removal in the next month or not to have it removed based on their recomendations. With my mother having thyriod cancer I feel it may be best to have it removed? But still unsure of the best way to move forward.
Would test TPO and Tg antibodies (blood) to look for hashimotos' (ie chronic thyroiditis).  A 4.2cm nodule is large and with the family history would at least do another FNA biopsy, but many experts would suggest surgery.
I was diagnosed with Graves disease in Apr 2010. I started  taking Methimazole 50mg/day, down to 10mg/day. Went Hypo in June 2010. Since I started on the MMI, I have gained 40 lbs.! !  I have an enormous appetite and crave things like pasta, breads, and sweets....things I rarely ate before. Walking on my treadmill is dicouraging, as I am not seeing the results I did before I started taking MMI. My Endo tells me to hang in there...still has hope for me with the meds....and that my body is being a little stubborn. I was also put on a beta blocker in Apr, but stopped taking that in June.