Health Chats
Thyroid Disorders: When Your Thyroid Malfunctions
Monday Jan 17, 2011, 08:00PM - 09:00PM (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 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.
Hello everyone and welcome to today's health chat with Dr. Mark Lupo. We'll be starting at 8:00PM (EDT) but please feel free to submit your questions now.
Welcome back Dr. Lupo!  We are all so happy to have you here today.
Is it better to have my hypothyroid treated by my general practitioner,or should I see an endocrinologist?
Thanks for having me - great to be back!
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.
Is it acceptable for endocrinologists to monitor thyroid disease in a patient using a periodic TSH test only? If not, how could a patient convince their endocrinologist to more routinely test levels of thyroid hormones (free and total) and antibodies?
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.
I have read a lot about adding T3 to Synthroid T4 for relief of hypothyroid symptoms. Is this safe and how should it be taken?
Over 10 studies have looked at this issue - most with no proof that T3 helps much.
However, in some cases the addition of 5mcg 1-2x/day of T3 can be helpful -- the T4 dose must be decreased if this is done.
If you are taking medication for Hypothyroidism. Do you have to take it for life?
In most cases, this is lifelong, but many patients get started on thyroid meds they don't really need.  Seeing an endocrinologist can help determine if meds are needed lifelong.
I have been treated for hypothyroid disorder for a couple of years (Synthroid 100 mcg).  Recently my primary instructed me to take the OTC Prilosec for 6 weeks to clear up an issue with heartburn.  I try  to space the two meds by at least 4-5 hours so there is no interaction.  Should I increase the time or is this sufficient amount of time?  Thank you.
Prilosec and other proton-pump-inhibitors are designed to decrease stomach acid and in 1/3 of patients this may result in increased synthroid (or other thyroid med) needs.  
However, taking the med 6 hours 4 hours later doesn't really make a difference (in contrast to calcium/tums or sucralfate or iron) as prilosec lowers stomach acid for 24 hours and does not interact directly with the synthroid in the stomach.
Hi my name is Natalie and I am 36yrs of age. I am married but no babies for the past 8yrs. I think i have thyroid problem and need help. Any advice?
For thyroid - test TSH and TPO/Tg antibodies - if all normal, then thyroid not likely contributing to infertility
I always am getting a sore throat and pain in the throat. I cannot talk loudly.  When I talk softly, I have to use a lot of efforts. Is this related to a thyroid disorder? What to do?
Thyroid is a possible cause, but not most common cause -- would see an ENT to look at vocal cords directly to determine the cause.
Now up to 120mg (2 grains) of Armour, I am still partially symptomatic for hypothyroidism, with consistent weight gain, hair loss and brain fog. Although my TSH is is extremely low, both my Free T3 and Free T4 are within normal range. My body cannot metabolize synthetic medications, thus I am limited in my options, but it does appear as if the Armour is not working consistently, and I am so tired of being tired. Any suggestions, please?
I do not have any suggestions except possibly taking armour 2x per day but lower total dose as current TSH is too low - increasing risk of heart problems and bone loss.  There may be other causes to fatigue - work with your primary doctor on this as well.
My TSH started increasing between my 2nd & 3rd children. I was put on levothyroxin when I got pregnant with my 3rd in late '03.  My TSH remained steady for a long time w/my meds at 50mcg.  After my 2nd miscarriage ('08; 1st was '03), my TSH was up again.  My meds were increased & I had my 4th child in '09 at age 41.  Although my TSH started increasing a bit toward the end of my pregnancy, it was fine 6w & 9w postpartum (back down to ~1.15).  In 10/09 my TSH went up to 2.43, meds upped from 88-100mcg, re-check 11/09, TSH up again to 2.69; meds upped to 125; 12/09 re-check & TSH was down to 1.86.  (MY "normal" needs to be below 2 or I have symptoms.)  In 3/10 I had my vit D & TSH checked. My TSH was up to 2.94, so my meds were upped 125-150.  My TSH has been steady around 0.5 since then.  I've not made dietary changes, I'm still breastfeeding and I always take my meds in the morning on an empty stomach.  Is it just age or something else that's causing this?  I have a strong family history too.
This is a specific question regarding dose titration - there are many causes for increasing med requirements including worsening thyroid function, age, other meds, absorption....
Hi, I am wondering what symptoms of thyroid problems I have. I have psoriatic arthritis.  Could I also have a thyroid disorder? Is it common if I have arthritis? I get quite tired  and my eyes feel tired plus, I feel quite weak.  Does it sound like I have a thyroid disorder?
You should be tested for thyroid as patients with one autoimmune disease are at higher risk for others.  But the symptoms are very nonspecific and may not be thyroid related.
does total thyroidectomy because of thyroid cancer always need higher dose of radioactive iodine, 100 versus 30 or 50, or is higher dose given because of lymph nodes involved.  Also does thyrogen given just before treatment work better than becoming hypo naturally and is it safer to become hypo by withdrawing meds. versus thyrogen?
The issue with RAI dosing (or no RAI after surgery) is based on staging of cancer - if lymph nodes are involved, there is a tendency to give a higher dose such as 100mCi or even more.  Thyrogen works as well as withdrawal for remnant ablation in patients with cancer confined to the thyroid and surrounding lymph node areas.
Scientific studies of thyroid patients show such huge variability in their test results, that the conclusions have been that using these test results as a diagnostic for thyroid problems appears futile; therefore diagnosis by testing needed to be replaced by a clinical approach.  Why has the medical community gone away from the long time, and more successful practice of the past, where thyroid patients were treated clinically for symptoms, rather than the current practice of relying almost solely on TSH, and to a lesser degree on a combination of TSH and FT4, but rarely including symptoms?  
There is a difference between traditional endocrine approach and alternative medicine -- you should chose the doctor that you feel best suits your needs and philosophy.
I'm a 32-year-old female and my mother has a thyroid condition. I was recently tested and my TSH is 2.37 uIU/mL. I've read that this is normal but can develop into hypothyroidism in the future. Are there any steps I can take now to reduce the likelihood of developing hypothyroidism? Thanks so much!
TSH is currently normal, but with family history could test TPO and Tg antibodies to determine your risk of future problems.
I was diagnosed with Hashi's in 08, my TSH was 187.23, it has never fallen below 25.00. I am feeling so lousy! I plan on calling tomorrow for a new endo Dr. as the last one initially seemed great, but has made me feel crazy as he believes I should be feeling great now. What should I explain to the new Dr. if the Joslin Clinic provides me with a new one? Is it possible that I feel worse now than I did in 08?