|
|
|
|
|
TREATING HYPERTHYROIDISM 12/1/2007
QUESTION-My mother
had been diagnosed as Hyperthyroidism and she is now having her medication
to controlling her thyroid hormone for 3 months which will be continue for a
year if her thyroid level still in high risk, what I want to ask are :
1.how to gain her weight since she is so underweight (her BMI is only 19)?
2.what supplements should I give her that wouldn't interfere her current
medication?
3.Did she need any special diets? because I found on online journals that
hyperthyroid patient should consume any diary products, spinach etc
4. Is Hyperthyroidism curable or just treatable?Thank you, Amelia Pranatio
RESPONSE-1.If her hyperthyroidism is controlled, she should be able to gain
weight by consuming more calories than she usually needs.
2.Perhaps extra vitamins would be useful, but basically she just needs a
healthy diet.
3.She should avoid large amounts of iodine- milligram amounts- but I do not
think any food would be a problem.
4.The last question is complicated. Probably the autoimmunity to the thyroid
persists, but for the vast majority of people, treatment is effectively
curative.
L De Groot, MD
TREATMENT OF HYPERTHYROIDISM
QUESTION-I would like to ask a question for the thryoid disease manager web site. =
=0A=0AI am 58 and have Graves disease being controlled by carmbimazole 10mg=
daily. I am feeling very well and able to live a full and active life. La=
st test results l.4 TSH : 11 T4: 4.4 T3. I have tried coming off twice b=
ut symptoms return and will continually try to reduce or come of this drug =
if blood test results allow.=0A=0AIf this is not possible what are the lo=
ng term consequences of staying on cambimizole compared to the multitude of=
cases I have heard of and read about that have had disastrous results for =
RAI treatment and the resulting hypothyroidism.=0A=0AI understand the risk =
of a sore throat and the need to have a immediate test but would like to kn=
ow what other risks are involved in long term use of this drug.=0A=0ADoes d=
iet and stress reduction play any part if reducing symptoms?=0A=0AMany tha=
nks=0A=0AJane Sinclair=0A=0A_______________________________________________=
RESPONSE-It is possible to stay on Carbimazole for a long, long time. The one problem is that often you are not actually sure what your thyroid function is and if you feel unwell for another cause there is a tendency to ascribe it to the thyroid and the drugs may be increased or decreased. Therefore you still have the tendency to develop an overactivity. This is not the case if you have radioiodine although you are absolutely right that you may develop hypothyroidism, but that is easily managed by replacement thyroxine therapy. Most clinicians would recommend a specific therapy if you relapse after antithyroid drugs.
It is possible that the disease may "burn out" but this is relatively unlikely.
I hope these comments are of some help.Yours sincerely,PROFESSOR JH LAZARUS
POSSIBLE HASHIMOTO’S THYROIDITIS
QUESTION-On September 13, 2007 I had a right thyroid lobe, partial thyroidectomy. =
=20
I have been symptomatic for five years since the birth of my daughter in =
May of 2002. I have been sensitive to the heat and the cold, I have =
night sweats, I'm constipated, insomnia, heart palpitations, ice cold =
hands and feet, dry skin, my memory and concentration is terrible, I =
have vertigo and dizzy spells, my reflexes are exaggerated, my eyes get =
very dry, I'm terribly moody and tense, I'm depressed, my heart races, I =
have terrible headaches, I'm very tired but on edge, the muscles in my =
back (mainly my shoulder blade area and now the muscles in my chest) =
burn and ache, sometimes I have a low grade fever, and my face gets hot =
frequently; my skin is also hot to the touch throughout my body (only to =
me). Prior to the surgery, my voice was so hoarse that many people =
couldn't understand me. I would get frequent sore throats and my neck =
would be very tender.
I visited four Endocrinologists and each would tell me upon examination =
that I definitely had thyroid disease, but when my blood work would come =
back within the normal range, they would send me away. Most of the =
doctors would just give me some more medicine to deal with the symptoms. =
I am currently taking 800mg of Ibuprofen three times a day for the =
achiness and headaches, Xanax 0.5mg four times a day for the nervousness =
(which by now is not helping me because I have become immune to them), =
Inderal 120mg three times a day, Topamax 25mg one time a day (somewhere =
along the line a doctor put me on this for headaches but it doesn't help =
but I'm still on it). And I also take Fish Oil 1000mg six times a day =
for my muscle aches and the constipation. =20
By the time I visited the fourth Endo, he ran a test called a SED Rate =
on me along with many thyroid labs and it came back 32. It is now up to =
54. All other labs were normal. My C-Reactive Protein was also =
elevated. =20
I was so persistent that the thyroid was the cause of my problem, I had =
a friend of mine (who is an ultrasound technician) scan my thyroid. She =
came upon a nodule. I had an "official" scan done and then a thyroid =
uptake scan (29%) and the scan showed the nodule to be cold. =20
I visited one surgeon who would not do the surgery because I was =
possible "hyperthyroid". My TSH was always normal but always ran =
between 0.6-0.8. He explained that removing part of my thyroid would =
just intensify the symptoms. =20
The next surgeon I visited agreed to take it out. I wanted it out =
because of the possibility of cancer. My Aunt died of thyroid cancer. =
My mom also is hypothyroid and my paternal grandmother is hyperthyroid =
(but nobody would listen to the family history either). Anyway, I had =
the surgery and the pathology report came back noncancerous Follicular =
Adenoma and the surrounding thyroid gland demonstrated chronic =
lymphocytic thyroiditis. =20
My labs before the surgery were: TSH 0.98 (0.46 - 4.68) =
T3 Uptake 27.20 % (23.50 - 40.5)
08/29/07 T4 11.2 =
(5.53 - 11.0) FTI 3.04 (1.65 - 3.89)
My labs after the surgery were: TSH 1.91 (0.46 - 4.68) =
T4 9.1 (5.53 - 11.0)
09/27/07 SED Rate 54 =
Thyroid Peroxidase < 10 (0-34)
ANA =
Negative Antithyroglobulin Ab < 20 (0-40)
Okay, so after this long story, here is my question. I'm going to see =
an Endo in Columbus Ohio at the Ohio State University. Her name is Dr. =
Elizabeth Diakoff. I'm confused as to how I can have Hashimoto's =
Disease with no antibodies present in my body? Also, my primary care =
doctor has not started me on any thyroid medication because he said my =
thyroid is working just fine and he is not going to give me anything =
until it isn't. The surgeon explained that I needed to be on thyroid =
medicine so that the left side of my thyroid did not work too hard and =
become enlarged. I'm confused as to why this was not started as soon as =
I was out of surgery.
I am not feeling better at all. My neck is still swelling and I am =
still getting the tender throat and the sore throat, so I know the =
thyroiditis is still there. Plus the SED Rate being elevated tells me =
that as well. I still feel exactly the same as I did before the =
surgery. Actually, I didn't expect to feel any different. But to know =
that I'm not nuts and to actually have a "diagnosis" is very comforting. =
It was just a shame that it took cutting open my throat to get that =
diagnosis. I wish more doctors would "listen" to how we feel and not go =
by the numbers.
I'm not real familiar with this disease. My Primary Care Doctor is =
treating it like it is Viral Thyroiditis because of no antibodies in my =
blood. But I've read that you can still have Hashimoto's with no =
antibodies. I'm just going by what the pathology report said. And when =
I research lymphocytic thyroiditis, it takes me to Hashimoto's. My =
tonsils are very large and trap a bit of bacteria. I do get sore =
throats frequently. My dr. believes that I am getting Strep which is =
traveling down to my thyroid which is causing the thyroiditis. He put =
me on a month supply of antibiotic, but this has not helped.
Any suggestions? What should I ask when I go to my appointment? Should =
I demand to be put on some medicine even though my labs are normal? =
What will be my options? Should I just have the other side removed?? =20
I'm so tired of feeling sick. It's been five very long years.
Thank you so so much for taking the time. Sincerely,Dani
RESPONSE-Although you have a family history of thyroid disease your
antibodies as you say are negative. However patients with Hashimoto's
disease have been described with negative circulating thyroid antibodies.
Although you had a follicular adenoma the surrounding thyroid gland did
demonstrate chronic lymphocytic thyroiditis, i.e. Hashimoto's disease and I
think it is safe to say that you have that condition. I would agree that if
your thyroid is OK (and your TSH and T4 are normal), then you do not
necessarily need thyroxine at this point.
I do not believe your complaints of sore throat etc., are necessarily
related to Hashimoto's thyroiditis. I think it possible that you do have an
unassociated mild infection and I am surprised that the antibiotics have not
helped.
Although I would say that thyroxine is not indicated it may be that a trial
of thyroxine for six weeks at 0.1 mgs a day may be worthwhile. I do not
think the other side of your thyroid should be removed.Yours
sincerely,PROFESSOR JH LAZARUS
THYROID ANTIBODIES AND THE RISK OF
MISCARRIAGE 2 Apr 2007
QUESTION-I found your excellent Home-Page when browsing the internet
concerning a question, which is very important for me. I'm pregnant in week
20 and suffering from hypothyroidism. It is unclear, whether I have
Hashimoto thyroiditis, since antibodies were never detected, the ultrasound
images of the thyroid gland were normal (no reduction of the echo or other
abnormalities), the only thing was that the gland is asymetric and small
with a volume of 10 ml and my Tsh was over 3,5. I'm taking
Thyroxin-substitution every day and the dose was also controlled and
increased during pregnancy. My questions:
1. Does autoimmune thyroid disease like Hashimoto increase the miscarriage
rate only in first trimenon of pregnancy or also in the second and third?
(I'm a bit afraid about that)
2. If having Hashimoto : is there also an increased risk of having
antiphospholipidsyndrome? I knwo that when having APS the risk for
miscarriage is quite high in the second and third trimestre and I heard,
that there is an association between APS and Hashimoto??
3. Can Hashimoto or other autoimmune thyroid diseases present a echonormal
picture in ultrasound? What could be the cause for my hypothyroidism if not
an autoimmune disease? Because of the possible impact of autoimmune thyroid
disease on pregnancy I would "prefer" - of course - a non autoimmune cause
for my hypothyroidism
Thank your very much for your answers! You see that I'm a bit afraid about
possible pregnancy complications linked to autoimmune thyroid disease. I
already read your related text on the home-page but the questions above
remained. Would you be so nice to write me a mail to MH.
RESPONSE- I will try to answer your various - and legitimate -
queries:
First, your hypothyroidism seems to be extremely mild since the only
diagnostic proof was a serum TSH above 3.5 mU/L. This, in itself, classifies
you in the category of 'subclinical' hypothyroidism (meaning with normal
thyroid hormone levels). You did not mention however whether the slightly
elevated TSH was discovered once you were pregnant, or already known before.
I would also have liked to know your serum thyroid hormone levels and the
dosage of thyroxine you take now.
Question 1: miscarriages are increased mainly in the first trimester in
women with Hashimoto's disease.
Question 2: there is an association between the APS and Hashimoto's disease.
Question 3: normal ultrasound patterns can be found in Hashimomoto's
disease, either because the chronic 'inflammation' process is very mild or
so diffuse that it cannot easily be seen. Also, thyroid echography is
operator-dependent and therefore the conclusions depend in part upon the
experience of the radiologist. Hypothyroidism can be due to several other
causes, and this is not the place for a sientific discussion about those.
Finally, having reached 20 weeks of gestation, taking the thyroxine
correctly with adeqaute controls and monitoring of thyroid function tests
should reassure you concerning the remainder of your pregnancy which I wish
you to be uneventful and highly successful.Prof Daniel GLINOER
PREGNANCY AFTER RAI TREATMENT 24 MARCH 2007
QUESTION-My husband had a diagnostic
scan of 111MBq (3mCi) of RAI in December 18,2006.I am presently in the 9th
week of pregnancy. My question is - I am very much tensed whether my child
will have any problem,due to the effect of RAI.How safe was it to conceive
now?Thanks.Elizabeth.
RESPONSE-While there are suggestions that it is wise to wait at least three
months after RAI to initiate pregnancy, there actually are no data proving
that you have any increased risk. L De Groot. MD
TESTS
DURING PREGNANCY
14.02.07
QUESTION-My pregnant daughter was refused a scan at 20 weeks by NHS even
although she is taking thyroxine. Is a scan not advisable to check the
baby's growth? She did, however, pay for this privately but should a 20
week scan not be automatic under these circumstances?Kathleen Armour
RESPONSE-Some obstetric services only do a booking scan at 12 weeks. Others do a 12 and 20 week scan. I am afraid I do not know any evidence as to which strategy is more effective.
If your daughter is on thyroxine, and has increase the dose when she become pregnant, and is being monitored from the thyroid point of view, it is probably not necessary to do a 20 week scan. However, if there is any doubt about the progression of the pregnancy then such a scan should be done. As far as I am aware a 20 week scan is not specifically indicated in this situation. PROFESSOR JH LAZARUS
TREATMENT OF SUB-CLINICAL HYPOTHYROIDISM 08.02.07
QUESTION-I am a 25 yr old Dentist,a case of Sub clinical Hypothyoidism.In Dec 2006 during treatment for a chronic cough my physician advised me to get a routine Thyroid function test done.(I have a family history of Hypothyroidism,both maternal and paternal).T3,T4 were normal,TSH 6.9.I was then referred to an Endocrinologist who got my weight checked.I had gained 7 kgs in the past months from 50 to 57.Anti-TPO was negative.The Doctor started me on 100 mcg of Thyroxine sodium on 29 dec 2006.Following medications,i experienced palpitations,breathlessness,severe irritability and joint pains that persisted for the next 1 week.After 1 month, i had gained another 3 kgs and now weighed 60kgs inspite of cautious dieting and regular exercises.The dose was raised to 150 mcg.My medico friend who knew my medical status discussed it with his Endocrinology professor who felt the dose was too high for my case.He advised to completely stop the medications immediately and start afresh in April with fresh tests.IAM CONFUSED NOW!!!
The following are the doubts in my mind which i would be grateful if u can clarify
1.Should i stop the medications immediately ?
2.Are my symptoms due to overtreatment?
3. Why am i continuing to gain weight inspite of treatment?
4.Is subclinical Hypothyroidism mandatory to be treated?
5.Is this condition likely to cause any future problems,as in conception and delivery?
6.Is Hypothroidism related to Lichen planus?(I have lichen planus of the skin) Dr. Nair
RESPONSE-In answer to your questions relating to your question of subclinical hypothyroidism:
1. Yes I would stop the medications immediately and re-test everything in six weeks time. The guidelines state that subclinical hypothyroidism should not be treated until the TSH rises above 10. However it is reasonable to individualise in some cases.
2. It is difficult to be categoric as to whether your symptoms are due to over-treatment, but certainly some of them sound like this.
3. This is difficult to answer. Although the weight increase is a worry, I would rather look at the thyroid function tests in the future and if you do need treatment then the weight will be easier to lose if you are on adequate thyroxine replacement therapy.
4. I have already answered this in my response to question 1. You say the anti-TPO antibodies are negative but you have a positive family history. If they continue to be negative I would check the antithyroglobulin antibody levels (these are not normally done in the laboratory, but can be done if specially requested). It may be worthwhile having an ultrasound of your thyroid as well to see whether there is any evidence of autoimmune thyroiditis.
5. I presume from your question that you are a female. If there is mild hypothyroidism then fertility may be impaired and the risk of miscarriage is increased. If you did become pregnant, then thyroxine treatment would be indicated if your TSH level is high, and it would certainly be worth screening in early pregnancy. If you are already on thyroxine and become pregnant, there is a requirement for an increased dose during pregnancy and this should be implemented as soon as
possible.
6. There are one or two isolated case reports of patients with different forms of lichen planus who have got thyroid disease, but there is really no evidence that the two are connected. Yours sincerely, PROFESSOR JH LAZARUS
THIRTEEN YEAR OLD WITH THYROID NODULES AND LOW TSH 07.02.07
QUESTION-I have a 13 year old daughter who displayed a large lump on her neck after Thanksgiving. An ultrasound showed at least 7 nodules on both sides of her thyroid. The largest one (3cm), we believe resulted from the cyst bleeding into itself. We have completed three blood panels to confirm a suppressed TSH. A biopsy on 3 nodules was done: two were benign, but 1 (the largest) was "inclusive but could not rule out a low grade tumor". The first pediatric endocrinologist and the surgeon recommended removing the entire thyroid. We felt this was too drastic for an "inclusive biopsy."
My thyroid doctor met with the pathologist and said the samples were too poor to send out for a second opinion. In addition, as a result of that meeting, the pathologist revised his original report to read epithelial cells, instead of "neoplasia". With surgery looming over our heads, we wanted more proof that Surgery was the only option.
Last week my daughter had a radioactive scan (no uptake was done). The large nodule was "HOT." Our understanding of this meant that the risk of cancer was greatly reduced. The NEW pediatric endocrinologist still recommends surgery due to her suppressed TSH, claiming that eventually she will become hyperthyroid, and risk bone loss. He also mentioned that she would probably not need medication. Thyroid issues run in our family. When my mother was approaching 50, she had multiple nodules and had 1/2 her thyroid removed. When I was 38, I also had multiple nodules and had 1/2 my thyroid removed. I am currently taking levoxyl. At the advise of two doctors, we are
having my 11 year old daughter checked with an ultrasound, as she has an enlarged thyroid.
With this information, would you also recommend surgery, or would you recommend another course of treatment? Do you have any resources I could contact, or research regarding suppressed TSH, or prognosis without surgery, in teens? My husband does not believe surgery is necessary and wants to take a wait and see approach. I am afraid this is only postponing the inevitable, risking bone loss during critical growing years. Thank you for your opinion. A concerned mother. Dear Mrs Fisher,
RESPONSE-I understand your concern for your daughter who has been found to have multiple nodules in association with a positive family history. Although the nodules are "hot" on scan this does not entirely exclude a cancer. In my opinion thyroxine treatment is unlikely to succeed in reducing the size of all these nodules significantly. There is no other recognised tablet treatment for these nodules, therefore I would suggest that surgery is entirely appropriate. It is a safe operation and it means that there can be a complete examination of the tissue that is removed to reassure you that there almost certainly is no cancer present. If your daughter has to take thyroxine substitution therapy after surgery, this is not a major problem.Yours sincerely, PROFESSOR JH LAZARUS
MILDLY ELEVATED TSH 07.02.07
QUESTION-I hope you can answer a question for me. I have an 11 yr old son who is overweight yet very active in 3-4 sports. His dr. ran a bunch of blood work on a fast to check for diabetes which he doesn't have however, I have been concerned with an underactive thyriod for a while since he has put on weight. He is 5'2" tall and weighs 145lbs. He plays soccer, basketball and baseball (year round). He has started other sports as well. He gets a lot of exercise but is always tired and gets winded easily. His TSH is 4.4 which tells me his thyroid might be slightly underactive. Do you have any other ideas or suggestions. He does also have beta-Thalassemia minor (trait) which might add to him being tired. Thanks. Sue Creighton
RESPONSE-Your son's TSH is certainly in the high normal range and I would suggest a repeat of this and a check on his thyroid antibodies (particularly thyroid peroxidase or TPO antibody). If this is positive and his TSH is still in this range I think a trial of thyroxine would be indicated. I think his beta-thalassemia minor trait would only affect him if he was anaemic. PROFESSOR JH LAZARUS
TREATMENT OF HYPOTHYROIDISM- 29.01.07
QUESTION-I'm 25 years old female, and in May 2003 I have been diagnosed with Hashimoto's after having a severe clinical depression and a suicide trial. My doctor started me on Synthroid at a dose of 50mcg. In the past 3 years it put on 200mcg of Synthroid daily with 10mcg of T3( a combination preparation of T4 and T3 ) and I am on an appropriate dose of thyroid based on the blood tests. I asked him about this combination, and he said that in my case it was perfect by the tests, and I'm better now. But I'm worried about the consequences that all this medical treatment will bring me 'cause I'm only 25, and I'm taking it for the rest of my life. What will happened ? What about Vitiligo, Rheumatoid Arthritis, Addison's Disease and Diabetese ? Please help me if at all possible. Jenniffer Mary
RESPONSE-The normal treatment for Hashimoto's thyroiditis is thyroxine. There is no evidence that adding T3 provides any significant benefit. However if you are on it and your levels of T3 are normal this is satisfactory. There is no significant long term effect of thyroid hormone if the levels are checked routinely, and maintained in the normal or near normal range. This is because you are merely taking replacement therapy which is what you would have if you didn't have thyroid disease. The other conditions you mention are certainly associated with Hashimoto's thyroiditis and if you become ill at all your doctor should know that you have Hashimoto's so that appropriate tests for these other conditions may be instituted if necessary. PROFESSOR JH LAZARUS
TREATMENT OF HYPOTHYROIDISM
QUESTION-My elder sister aged 42 yrs old had gone for her blood test and following was the result
thyrotropin sensitive TSH >100.00 HI 0. 35--- 5.00 MIU/L
FREE THYROXINE (FREE T4) 4 LO (9- 23)PMOL/L
FREE T4is reflexively added when TSH> 10.0 MIU/L
The doctor has adviced my sister to take the following medicine and asked to get a scan done next
Week.ELTROXIN 0.05MG.LEVOTHYROXINE 0.05MG
1 tablet each for this week and 2 tablets for the next week after which another bood test is required!
After going through the reports can u suggest your opinion about this case and I would also like to know that if she will have to undergo a surgery or can this be cured with medicines? Thanking you in advance and waiting for ur response so that all the doubts are cleared out soon! An Anxious sister , Jessica,
RESPONSE-Your sister clearly has gross and significant hypothyroidism (under activity). If she is otherwise fit, I would suggest she needs to take to start off 0.1 mgs of thyroxine (I don't think she needs one tablet of each sort, the one brand is satisfactory). One needs about four to six weeks to equilibrate the dose so I wouldn't get a blood test two weeks after starting, I would get it one month to six weeks after starting and be prepared to increase it after that. It can take many months for her to feel well again. PROFESSOR JH LAZARUS
____________________________________________________________________
TREATMENT OF A CYSTIC NODULE 21.01.07
QUESTION-Firstly, I must state that I am not a medical professional. I have just found your website and would like to congratulate you and your team for doing such a brilliant job in giving your time to helping others! I hope you realise that your few words of advice means the world to all those people. God bless you.
Secondly,
may I join in the queue and ask for your professional advice, please? I
have recently been found to have a large, well defined benign thyroid cystic
nodule, measuring 3cm in the lower half of the right hemi-thyroid (biopsy
done). Two further small nodules of 6mm and 10mm are found in the lower
half of the left hemi-thyroid during the scan. There is no cervical
lymphadenopathy seen. My blood test result reads: Thyroid Peroxidase Abs
3.8 u/ml and Anti-thyroglobulin 25.7 u/ml. (I do not understand much about
these technical terms. Are they related to T3 / T4 ?) Other biochemistry
results appear normal.
I questioned my consultant about 'draining' the liquid, but he said it
wasn't possible and instead said I have two options: either to leave it or
have partial thyroid surgery which isn't very helpful.
My questions are:
(1) Is it true that I cannot opt to have the cyst drained? Would draining the liquid out through needle aspiration help, if not completely but partially reduced the size (I understood from the radiologist that 50% of my cyst appeared to be 'liquid'!)? Are there any risks in this procedure?
(2) What are the chances of the cysts growing bigger?
(3) Do statistics show a high risk of these cysts turning cancerous over time?
(4) Do you
reckon there is any need for me to go on medication? (I honestly hope not,
as I already feel like a 'walking chemist' taking medicine for angina!)
As a "by-the-way", I will not be going back to this consultant! Thank you
once again for your website and I will definitely look out for that book
"Thyroid Manager". I look forward to hearing from you.
Best regards, Swan
RESPONSE-You have a cyst in the right lower half of your thyroid and two small nodules in the left thyroid. Your thyroid antibodies are negative. They relate to the chance of getting autoimmune thyroid disease and so this is not a problem with you. They are not related to T3 or T4. If your other biochemistry results are normal, then you have a normal thyroid status.In answer to your question:
(1) Yes you can indeed have the cyst drained by a relatively simple procedure of fine needle aspiration. It doesn't always work, but can reduce the size. There are no significant risks in this procedure.
(2) The cyst could grow bigger, sometimes there can be a bleed into the cyst which could cause pain and increase the size. On other occasions it can just grow.
(3) The statistics do not show a higher risk of these cysts turning cancerous. A recognised procedure is to try and drain it and if it occurs more than once, then operation should be considered.
(4) I do not think there is any need for you to go on medication.
Actually the book Thyroid Manager is not in book form it is only available on the web at WWW.thyroidmanager.org. Yours sincerely,,PROFESSOR JH LAZARUS
TREATMENT OF HYPOTHYROIDISM
QUESTION -I am a 50 year young women with thyroid disease. I have had under active thyroid for 20+ years. My problem is they cannot get it regulated. My TSH numbers are between 31 and go as high as 101. The only thing they do is up me medicine change the brand and so on and so on. Mean while I feel awful and have severe heart palpitations. Where and what should I do next?Thanks,Ann in Delaware
RESPONSE-Certainly your TSH should not be as high as this if you are on thyroxine replacement therapy. I suggest you should have an independent heart check and possibly also take beta blockers to counteract the palpitations. Your thyroxine dose should be such that the TSH is around 1 or 2. PROFESSOR JH LAZARUS
ALCOHOL USE WHILE ON THYROXINE 17.01.07
QUESTION -My daughter Jody age 30 underwent removal of her thyroid due to cancer two years ago. We have noticed she has an intolerance to drinking alcohol drinks. By removing the thyroid - does this change her metabolism rate? Thank You. Joyce Caywood
RESPONSE-When the thyroid is removed the metabolism would slow down significantly unless the patient was taking replacement levothyroxine therapy. Assuming that she does take thryoxine therapy her metabolism would not be slowed. It is true that in a hypothyroid (under active) state, the metabolism of alcohol can be altered. PROFESSOR JH LAZARUS
MANAGEMENT OF HASHIMOTO’S THYROIDITIS
QUESTION- I need some advice. I am a 45 year old female, normal weight and was recently diagnosed with Hashimoto's thyroiditis--the labs I remember are TSH 2.17 and thyroid antibodies 481. I also have vitiligo. I saw an internist/dermatologist who diagnosed the thyroiditis. He started me on synthroid 0.05mg two months ago and have not had repeat levels done yet. I have no hypothyroid symptoms.
My GP sent me for an US last week and the results are: rt lobe measures 4.5 x 2.0 .1.4cm in sagittal AP and transverse diameters respectively. A focal area of calcification measuring approx 6m in diameter in the lower midpole of the right lobe. The isthmus is 2mm in thickness. The left lobe measures 4.8 x 1.l x 2.9 cm. In the upper pole, there is an 8 mm focal soft tissue nodule. Both lobes demonstrate increased vascularity in keeping with the patient's history of Hashimoto's. On the right side of the neck there is a normal appearing 2.3 x .4 x 1.1 cm lymph node.
Impression: Coarse area of calcification in the lower midpole of the
right lobe. This is likely benign in nature. The 8 mm hypoechoic
nodule in the left lobe likely represents a thyroid adenoma. This could
be followed up with a repeat study in three to six months to ensure
stability.
QUESTIONS: Should I be followed by an endo? Should I be worried about
the nodule/calification? Is the follow-up US in 3 mos a reasonable
approach? Susan Jacks
RESPONSE-You have Hashimoto's but normal thyroid function, and there is currently no specific reason why you need to take thyroxine. The ultrasound appearances are consistent with Hashimoto's disease. I think you should be followed by an endocrinologist and I agree that three months is a reasonable time for you to be seen. At that time a blood test should be taken to see whether your thyroid function is stable. Palpation of the neck should occur, and if there is considered to be any enlargement of the nodule then this should be subjected to fine needle biopsy. Yours sincerely, Professor JH Lazarus
TREATMENT OF THYROID NODULES- 04/01/2007
I have thyroid solid nodules (upper, lower, right & left lobes). I sweat, have heart palps, always depressed, fatigue and dizzy and tired. I went to the doc had biop was B. Also stated hot. Doc put me on synthyroid 150 mcg that cuased me to have severe palps to the point I was jerking and affected my breathing. I though I was going to die. Stop med went to doc he wanted to do surg. I left never went back. I’m 25, and want your advice. I went to my Ob which did order lab and the test are always normal and not overactive like it showed at first. I have a knot that sticks out on the lower right side that really bothers me. If you have any opinion at all please get back. Tiffany Lee
RESPONSE-Sometimes these nodules may cause a condition known as subclinical hyperthyroidism, which may make you develop palpitations. Thyroxine therapy is unlikey to be effective in this situation. However, you say your tests are always entirely normal and not suggestive of overactivity. If the nodules are bothering you then surgery is definitely an option. If you develop an overactivity, radioiodine treatment is also a reasonable option. PROFESSOR JH LAZARUS
>>> "Barbara Link" <1952bandb@cox.net> 03/01/2007 03:40 >>>
I have Hashimoto Thyroiditis and have not been able to conceive a child, I currently take Synthroid, however what else if any can I take that will help me to conceive.Thank you.onya Rodgers
Dear Ms Rodgers,If you are on an adequate dose of Synthroid this is all that you can do to ensure fertility as far as the thyroid is concerned. If you do become pregnant you should increase the dose of Synthroid immediately by about 50 mcgs.Yours sincerely,PROFESSOR JH LAZARUS
Professor Lazarus,I hope you can help. I am a 27yr old female currently undergoing IVF treatment ( I have PCOS) I have had tests done on my thyroid following 2 miscarriages earlier this year.My 1st test came back at TSH <0.02..2nd test came back at TSH 5.84.3rd test came back at TSH 2.87.There was about 12 weeks from the date of 1st to the date of the 3rd test.On my 3rd test I had my thyroid antibodies tested also and they came back at 670.I am on no medication at all for my thyroid problems and never have been. My Dr has only suggested I get it checked at least every 3 months. I am concerned however that this is what has caused my miscarriages as all other tests came back ok. In your opinion, to achieve & maintain a healthy pregnancy, should I be on any medication? Many thanks for your time! Nikki Burkhill
Dear Ms Burkhill, You do seem to have positive thyroid antibodies and these are actually associated with miscarriage. There is a relatively recent paper which suggests that in your situation it would be reasonable to take thyroxine. This would reduce the chance of having a miscarriage. In the paper, patients like yourself were treated with thyroxine 0.1 milligrams (100 micrograms) a day. I am not sure why your TSH levels were so variable. It may well be that you could have the so called TSH receptor stimulating antibodies (the sort that cause an overactive thyroid). The antibodies you have had tested are probably those that are associated with an underactive thyroid.PROFESSOR JH LAZARUS
Dear Dr.
Lazarus, I have been
diagnosed with Hashimoto's after having a severe
allergic reaction to a sulfa drug, Batrim. I have elevated
tpo and ana tests. I have had a
burning sensation in my thyroid which i annot get to
stop and wondered what i could do. I am on an
appropriate dose of armout thyroid based on the blood
tests. I would very
much appreciate any help on this as I am concerned the
burning is indicative of more of the thyroid being
destroyed and want to stop it if I can.thank you
very much,Susan
L Gold <susanlgold@yahoo.com>
19/12/2006 07:15
Dear Susan, You indicate
you have Hashimoto's disease and that you are being treated with armour
thyroid. You also indicate that you have had a severe allergic reaction to
Bactrim. Armour thyroid is not normally recommended as it is a combination
preparation of T4 and T3 which is not normally necessary for the treatment
of hypothyroidism. In addition it is itself a porcine extract, and the
possibility of allergy in yourself should be considered. It may be
worthwhile switching to regular thyroxine therapy, e.g. Synthroid or Levoxyl
or other synthetic thyroid preparation. Unfortunately whatever you do the
immunological process relating to progressive thyroid destruction and
failure may in fact continue even though you are taking thyroid hormone. PROFESSOR JH
LAZARUS
Susan L Gold
<susanlgold@yahoo.com> 19/12/2006 Thank you for
answering. I was taking armour thyroid (very low dose) before the Bactrim
incident happened and I never had any trouble with the armour. Is it
problematic to be on armour even though it supplies t3 and t4? I had
preferred it over the synthetic brands previously.
Dear Susan, Thyroid
physicians do not recommend armour, because there is no evidence that a
combination of T4 and T3 is any better than T4 alone. In addition, armour
is an extract of porcine thyroid and, although manufactured in a rigorous
way, still has that potential problem. Synthetic thyroxine is probably
easier to manufacture to tight specifications. In addition the T3 which
armour contains can cause an elevated T3 level in some people which could be
a health hazard. However, many people are on armour and do say they prefer
it, although the reasons are often not very clear.PROFESSOR JH
LAZARUS
>>> Susan L
Gold <susanlgold@yahoo.com>
22/12/2006 16:38 >>>Thank you so
much for answering. Could you
tell me what sort of health hazard is an elevated t3
if the armour were to cause that? also, is it
possible to get Hashimoto's to stabilize or is this a
progressively destructive disease to the thyroid?
Dear Susan, An elevated
T3 affects the heart (causes palpitations etc). It also will accelerate
bone loss.Hashimoto's
is normally a progressive, destructive disease, but it proceeds at variable
rates and can indeed stabilize on occasions.PROFESSOR JH
LAZARUS
______________________________________________________________________________________-
<Wbydddg@aol.com>
19/12/2006 03:59:35 >>>Dx with
Graves in 09/05. RAI 10/05. TSH is still undetectable with normal FT4 levels -
12/06. Is this sub-clinical hyperthyroidism? I was told that it is normal
for TSH to stay suppressed after RAI for a period of months but am concerned
about suppression after 12 months. Glenda B.
Dear Glenda, You are
correct that it is indeed normal and usual for TSH to stay suppressed after
radioiodine for quite a long time, anything up to two years. Technically
you could regard this as subclinical hyperthyroidism, but there is nothing
to do at the moment, providing your T3 level is normal.PROFESSOR JH
LAZARUS
<EFCathome@aol.com> 12/12/2006 03:36 >>>Could you please advise if ear pressure is to be expected after a total thyroidectomy? I had Papillary cancer and removal of my thyroid and 24 lymph nodes about five months ago. It has been 6 weeks since I had the RAI treatment. Thank you.
As far as I know there is no relationship between total thyroidectomy and a feeling of pressure sensation in the ear. However, if this continues you should arrange an Ear, Nose and Throat consultation.PROFESSOR JH LAZARUS
____________________________________________________________________________________________
Rita Johnson <rajmct01@yahoo.com> 08/12/2006 19:58 >>>I am a 54-year old female with a family history of Diabetes. I was diagnosed with Type II Diabetes in 2000, which is under excellent control. I follow a low-carb diet. I was also diagnosed with Graves Disease 6 years ago and followed a course of treatment with Tapizole. When I was no longer able to remain euthothyroid, I received low dose radiation treatment 3 years ago. Over the past year my weight has risen. Two years ago I was 145lbs and now am 176lbs. My blood work shows a range of 5.0, which is in the normal range. I don't remember is this is the TSH or the T3/T4 reading. My doctor just started me on Synthroid at a dose of 50mcg on Monday. I have taken it for 5 days. This morning I noticed a wired feeling, which reminds me of symptoms I had on Tapizole. Is this normal? Will it ease out over a few weeks? Should I be on Synthyroid if my blood work shows a normal range? I did experience mild heart palpitations only once the evening of the second treatment day. I have read it is best to start at a low dose like 25mcg. Is my dose too high? Rita Johnson
Dear Ms Johnson, I presume that your doctor decided that the radiation treatment (which I presume was radioiodine) has eventually caused the thryoid to fail and you need to be on replacement thyroxine. If however your blood tests show normal results then normally there is no reason to give you the thyroxine. When starting thyroxine (Synthroid) most people can indeed start on 50 mcgs a day. If you have heart disease or symptoms of heart disease then it is usual to start on 25 mcgs. 50 mcgs is not a high dose, but blood levels of thyroid hormone should be checked after six weeks.PROFESSOR JH LAZARUS
I read your
column and wondered if I should be worried about a low T3 uptake blood
result. My T4 and TSH were
normal--actually right in the middle of recommended results, but my T3 was
only 22%. What does
this mean? I am a fairly
healthy 44-year-old woman of normal weight. Look forward
to hearing back from you, Laurel
Adelman
Dear Ms Adelman, Thank you for
your letter. I am not quite sure which column you were reading! At any
rate the short answer is that you should not be worried about a low T3
uptake. It is not a test that is done very often now. Low or high readings
of this test can be normal in patients in certain situations or taking other
drugs. If your T4 and TSH are normal then you are euthyroid (normal thyroid
status). I should not worry.PROFESSOR JH
LAZARUS
<Sandieduffy@aol.com>
06/12/2006 18:41:02 >>>I am a 31
year old mother of two healthy boys. In Nov 2002 I was diagnosed as having an
underactive thyriod, obviously I started on a low dose but now am on 200mcg
daily. I have just recently suffered a miscarriage and I'm hoping it was
nothing to do with the thyroid, but obviously the thought is there. I understand
that this could be just a chromosone problem, but it is still in the fore
front of my mind as I would like another child and my TSH levels were fine
when I had my boys. I have been told that 200mcg is the most that I can take, is
this true? Please help as I dont want to have to go through this again. Sandie
Dear Sandie, I am sorry to
hear that you had a miscarriage. It is probable that you have thyroid
antibodies (antithyroid peroxidase antibodies) because you have been
diagnosed as having hypothyroidism. These antibodies are associated with
miscarriage, although this would be expected to be less if you have on the
thyroxine treatment. It is not true that 200 mcgs is the most that you can
take. The dose is dependent on what your TSH level is, if you need more to
get your TSH level to the normal range that is fine. Another point is that
if you do become pregnant you should increase the T4 dosage by 50 mcgs in
the first instance. This is because most pregnant women on thyroxine need
more when they are pregnant. Best of luck. PROFESSOR JH
LAZARUS
>>> <Heartofgold002@aol.com> 05/12/2006 16:47:44 >>>
I am currently taking 100MG of Levothroxine due to the fact that I had a
thyroidectomy in August of 2000. Here in the past two months I have gain 26lbs
and my eating habits are no different than before. Is there any kind of
medicine that I can take to help me lose weight? I am currently walking for and hour
in the morning and an hour in the evening but this doesn't seem to be
helping me control my weight. I am not used to being the size in which I am at and
it's killing me to weigh this much. Please help me if at all possible.Debbie
Dear Debbie,
I understand you had a thyroidectomy and you are now on 100 micrograms (not milligrams) of levothyroxine and you are concerned about significant weight gain. It would help if we knew what your thyroid function was while taking the 100 mcgs of thryoxine. There may be room in the results of the thyroid function tests for you to increase the thyroxine and this is the first thing I would go for if this is possible. In this regard the serum thyroxine level could be above the normal reference range quite satisfactorily and safely in somebody taking thyroxine. As long as the serum T3 is within the normal reference range you are entitled to an increase in T4 dosage.PROFESSOR JH LAZARUS
"Kate Walker" <kwalker@dgatpa.com> 04/12/2006 19:12:37 >>>
I was diagnosed with Grave's Disease in 2001. At the time the only symptoms
I had were shaky hands and fatigue. I took Tapazole for a short period of
time. The shaky hands stopped and instead of fatigue, I had sleeplessness.
All this time my T3, T4 and TSH levels were elevated but I felt fine. I
stopped the Tapazole and for 3 years never had another external symptom
although the blood tests were still high. Recently, I started having the shaky hands and heart racing. I went on PTU.
The shakiness is gone, my heart is fine but I have a terrible time
controlling my body temperature. Approximately every 10 days, I get severe
chills (it is cold where I work) and once I am chilled to the bone I can't
get warm or stop shivering. Not long after this I will get a fever with the
chills and I have to leave and go lay down. It takes a couple hours and
then I feel fine.
I thought it was a storm but several people on-line said I am having a
reaction to the PTU. I asked my doctor about switching to methimazole but
she believes it is a storm and not the PTU. In order to experiment, I went
off the PTU for a week, I took one pill and had an episode. I stayed off
for 10 more days and tried again and had another episode. I abstained for
10 more days, took a pill this morning and I am not doing well right now.
Do you think it could be the PTU or a thyroid storm?
I live in a small town and there are only 2 endocrinologists in the
neighborhood. The one I went to just moved to the city and the one left
doesn't have an appt till March. Kate Walker walker111@comcast.net
Dear Ms Walker,
Overall I think the reactions you are describing may well be due to the PTU. PTU can produce an immune reaction. You should have your anti-nuclear cytoplasmic antibody (ANCA) measured. I doubt whether this is a thyroid storm.
I do not think you should be untreated if your thyroid hormone levels are high. However you indicated that at one time your T3, T4 AND TSH LEVELS were elevated. If this is the case it is quite possible that you never had thyrotoxicosis. You should carefully check these levels again, because the TSH level should be low or suppressed in somebody with hyperthyroidism associated with a high T4 and T3. If this is not the case the diagnosis is not secure.PROFESSOR JH LAZARUS
>>> <tom51@tiscali.co.uk> 03/12/2006 13:58:32 >>>I am writing to you in the hope that you can point me in the right direction with my thyroid. July 05 I was diagnosed with an over active thyroid - My treatment was firstly on MRI scan (for peturity gland) then raido iodine for a growing thyroid.Consequently I was put on 75 mcg of thyroxine for an under active thyroid and told by my doctors that the levels are right and I am on the correct dose. This is where I part ways with my doctor, I am sure he is doing everything within the recognised box but I know my body and it still feels like it did before I underwent any treatment. My symtons are Nearly two stone weight gain.Swollen feet Palpitations Swollen all over feeling and this is hard to explain but a flu like feeling all over my body. My Doctor says I am on the correct dose of thyroxine so where do I go from here.? Any advice or comments would be very much appreciated.Mrs Lesley Smith (Age 53)
Dear Mrs
Smith, I understand
you have had radioiodine for hyperthyroidism and this caused under activity
of the thyroid and you are now on thyroxine replacement therapy. The
question is how much therapy you should be on and what are the exact levels
of thyroid hormone, while you are on 75 mcgs of thyroxine. My own
recommendation is that the TSH level can be low or even suppressed in some
patients on thyroxine. The T4 level can be above the upper limit of the
quoted normal reference range, but the T3 level should be within the normal
range. There is an issue with suppressed TSH in that theoretically there
may be a risk of cardiac irregularities and it may affect the rate of bone
loss (and this is especially important in a post menopausal woman).
However, I would imagine that increasing your dose to 100 mcgs a day would
probably not be a major problem, but I cannot firmly recommend this as I do
not have sight of the blood levels.
It is true
you gain weight after radioiodine; this is because when you were thyrotoxic
your weight was probably less than it would otherwise have been. Some of
your symptoms are clinically suggestive of an inadequate thyroxine
replacement. I hope these
comments are of help.PROFESSOR JH
LAZARUS
>>> "The Metauro's" <wollastonlakers@sympatico.ca> 28/11/2006 21:09 >>>Hello Doctor looking for your opinion on the following results from my thyroid scan.(the following is the report as given to me) "Describing a complex left thyroid nodule and a small solid nodule centrally in the submental region.The thyroid scan demonstrates patchy uptake bilaterally. There is inhomogeneous uptake on the right lobe , with a large area of decreased activity laterally. There is a well defined focal area of no activity in the lower pole on the left, which is likely due to the underlying nodule In addition, there is decreased uptake in the upper pole, but in a less foacl fashion. The uptake in the midpole is relatvely increased. There is no uptake specifically in the submental region to indicate ectopic thyroid tissue."All my blood results have come back normal and I also have a cyst in the lymph node under my chin.This was the reason I originally went to the doctor.Angela, Canada
Dear Angela, Your thyroid scan suggests that firstly your thyroid gland is not normal, secondly it suggests you have multiple lumps or nodules in the thyroid, some of which take up the radioisotope and some of which do not. Although your blood tests of thyroid function have come back normal, the main question is whether any of these nodules have serious disease (i.e. malignancy in them). Overall this is unlikely, but you should consult an appropriate endocrinologist who could do a needle test on one or more of these nodules if necessary.I am not sure about the significance of the lymph node under your chin.PROFESSOR JH LAZARUS
>>> Maree
Jaeger <mcm@unite.com.au> 28/11/2006
09:32 >>>I am female-
just turned 37 I was
diagnosed in 2002 (I
think..who can keep track of these things!) I had NO
symptoms whatsoever just woke up one morning and my throat
was swollen like a football!! Having a really high
allergy rate I thought it was an allergy. I went to the
dr who sent me to a specialist who ordered
tests- which confirmed Graves. i did have heart
palpitations but only a couple of days after my throat
swelled up. My specialist didn;t believe that I had no
symptoms prior to my throat swelling up that was how it
was.I had my
first child when 35-I had a flare up again 18 months (usually
apparently its sooner than this) after my daughter was born. He put me on
6 tabs (carbimozle) then my results improved and he reduced it to
two tabs- he said the latest test was slightly up so he put me on 3
tabs.He is talking
surgery- but I am really wanting another baby as time is ticking.Should I
delay surgery and ttc or have the surgery (NOT WHAT I WANT IN THE BEST
OF ALL POSSIBLE WORLDS OBVIOUSLY) then try to ttc number 2?Regards,
Maree
Dear Maree, You had two episodes of hyperthyroidism due to Graves' disease, which suggest to me that the tablets are not a suitable option in the long term. If you are wanting another child you could easily have surgery and recover relatively quickly from this. You would then almost certainly require to take thyroxine. If you became pregnant the thyroxine dose would need to be increased during the pregnancy.If you stay on tablets I would suggest you switch from Carbimazole to Propylthiouracil because the latter are a little safer during pregnancy.If your thyroid is as swollen as you say, I think it suggests that surgery is a reasonable option and it will not delay you particularly in becoming pregnant after the thyroid has been removed. PROFESSOR JH LAZARUS
>>> "PATTI
WEBER" <fennimore4@msn.com>
26/11/2006 14:46 >>>my wife is
taking levoxyl for the rest of her life because she had her thyroid removed
last year are there any natural remedies to take instead of the drug
levoxyl? sincerely her husband jim
Dear Jim, The normal
therapy for thyroid replacement is a commercially manufactured pure
preparation of the hormone thyroxine, that is what levoxyl is. The thyroid
community consider that these preparations are the most satisfactory as they
are carefully manufactured to precise limits and standardised.There are
thyroid preparations known as thyroid extract which are made from animal
thyroids and, although made to strict specifications, they are not as
standardised as the synthetic variety. Hence they are not recommended for
routine use by thyroid physicians in the world. It is true that originally
in 1896 thyroid extract was used for the first treatment of an underactive
thyroid, but as you can imagine this preparation was crude and for the last
50 years or so commercial synthetic thyroxine has been the mainstay of
treatment.In summary I
would not recommend any other treatment other than levoxyl and would confirm
that there are really no useful natural remedies to take instead of the
drug.PROFESSOR JH
LAZARUS
>>> "Diana Mak" <dmak@headplay.com> 22/11/2006 19:51 >>>
I had a partial thyroidectomy (left lobe) in 2004 due to a growth in the
thyroid. The test result of the removed thyroid tissue was benign. There
was another question on the website titled HYPOTHYROIDISM AFTER REMOVAL OF
HALF THE THYROID (24AUG 06). The writer described the exact same symptoms
that I experienced as well after the surgery. I was not given any
medication because I was told that the other half of the thyroid will
compensate. However, about 6 weeks after the surgery, I was experienced
mood swings and felt tired all the time. I thought it would go away but it
didn't so I went on Synthroid. (My family physician had previously
prescribed Synthroid before I had decided on the surgery. When I took this
before surgery, I had too much energy and with the physician advice, I did
not take it anymore.) I felt better after taking the medication. However,
on a follow-up appointment at the surgeon's office, I was told off for
taking the medication because my TSH and T4 results were in the normal
range. I was even told I probably have other mental conditions such
depression and that I should go see my family physician. With the family
physician's consent, I ignored the surgeon's advice and continued with the
Synthroid medication for about 6 months. I felt better during that time.
After the 6 months, I decide to stop the medication and see if there may be
changes. Towards the end of the 1st month after I had taken the medication,
I was experiencing the same symptoms. By the 4th month, I could not handle
being tired after 10 hours of sleep and not being in the 'right state of
mind' and continued with the Synthroid. I'm feeling better now but still do
not have the
same energy as before the surgery.
My question
is : All medical professionals indicate that the other half of
the thyroid will compensate for the lost of the other part. Is this really
true? Are the TSH and T4 tests accurate at providing information on the
health of a
patient?
Dear Ms Mak,You had a
partial thyroidectomy and the question is what is the function of the
remaining lobe? If the remaining lobe is normal (which in your case it
probably is), then you will have a normal TSH and T4 and will not require
any thyroxine replacement therapy. However, it
is true that some surgeons routinely ask their patients to take thyroxine
after surgery, although in my opinion there is no definite evidence that
this is required. It would be useful to know whether you have any thyroid
antibodies present in the serum, as this may indicate the progression of
thyroid disease in the remaining lobe. The answer to your question is that
the remaining thyroid can function quite normally after thyroidectomy and
will indeed compensate. The best tests of thyroid function we have at
present are indeed TSH and T4 and they are normally accurate at providing
information on the health of a patient.Professor JH
Lazarus
DIAGNOSTIC DOSE OF 131-I
21 Nov 2006
QUESTION-Can you please answer my questions regarding RAI dose of *111MBQ
for a 30ys old male*
How many days should the person stay separate from others ?(especially from
pregnant person)
As per our doctor this is a diagnostic dose to check for the spread of
cancer. One year back the same dose was given and it was found that there
is no spread of cancer in the body. So is there a possibility that there
will be spread after one year? Is this a high dose? Thanks Elizabeth.
RESPONSE-This is not a high dose. It is a diagnostic dose that will not
cause significant exposure to other people including pregnant women.
Regarding the possibility of subsequent spread after a negative
diagnostic WBS, it depends from the original TNM stage, the age of the
patient and the type of initial treatment. However, the diagnostic WBS is
poorly sensitive in detecting local or distant recurrence. The best method
of follow-p is measurement of serum stimulated thyroglobulin (that must be
undetectable) ands neck ultrasound (that must exclude regional disease).
Sincerely, F. Pacini MD
HYPOTHYROIDISM,
THYROXIN DOSAGE, PREGNANCY
17 OCT 2006
QUESTION-I am 29 years old female (weight: 143lbs (pretty constant for the
last 5 years; height: 5’-3”) currently residing in India. I have been
diagnosed with hypothyroidism since 2001, and I have been on thyronorm
(thyroxine sodium) on and off. I had 0.25mcg thyronorm continuously for one
year in 2004. Recently, when I got my blood profile done, my TSH value was
8.5, and was put on 50mcg Thyronorm. 2 months later my TSH levels dropped to
0.02. Suspecting that there was some problem with the results, doctor
suggested a retest. But now the TSH levels have dropped to 0.01.At this
time, my doctor asked me to do a TPO antibodies test, which showed the
result as >1300 (range <34). He is asking me to continue the Thyronorm for
next 3 months (50mcg). Other than the abnormalities in the blood test, I do
not have any major symptoms of either hypo or hyper thyroidism other than
difficulty in losing weight. I have no lethargy/ tirdness/ fatigue etc. I am
attaching my historical TSH values for your reference. We are trying to get
pregnant, and the doctor has asked us to wait for 2-3 months.Is there
anything else that I need to recheck? Should I ask for a second
opinion?Myself and my husband are really concerned about this issue, and we
would be very grateful if you could please advise us on this issue. Shilpa
|
|
T3 (ng/dl) |
T4 (ug/dl) |
TSH (UIU/ml) |
TPO ANTIBODIES |
|
|
|
|
|
|
|
10-Oct-06 |
167 |
12.1 |
0.01 |
>1300 IU/ml |
|
Range |
70-204 |
5.2-12.5 |
0.35-5.5 |
<34 |
|
|
|
|
|
|
|
07-Oct-06 |
215 |
12 |
0.02 |
|
|
Range |
60-200 |
4.2-12 |
0.3-5.5 |
|
|
|
|
|
|
|
|
26-Jul-06 |
136.4 |
8.7 |
8.52 |
|
|
Range |
70-204 |
5.2-12.5 |
0.3-5.5 |
|
|
|
|
|
|
|
|
09-Jul-04 |
90 |
|
9.54 |
|
|
Range |
80-180 |
|
0.4-5.5 |
|
|
|
|
|
|
|
|
28-May-04 |
110 |
|
8.63 |
|
|
Range |
80-180 |
|
0.4-5.5 |
|
|
|
|
|
|
|
|
04-Jun-01 |
83 |
5.99 |
8.54 |
|
|
Range |
70-200 |
4-13 |
0.3-0.6 |
|
|
|
|
|
|
|
|
06-Apr-01 |
160 |
11.94 |
0.02 |
|
|
Range |
70-200 |
4-13 |
0.3-7.0 |
|
|
|
|
|
|
|
|
03-Jan-01 |
123 |
9.91 |
5.65 |
|
|
Range |
70-200 |
4-13 |
0.5-0.6 |
|
|
|
|
|
|
|
RESPONSE-Dear madam, the only reliable parameter to monitor appropriate thyroid hormone substitution is the TSH value. T4 and T3 parameters are insensitive to this end. Your TSH should be between .04 and 2.0. This means that you are using a little too much thyroid hormone. I suggest to take alternatively 25 and 50 microgr per day. There is no problem to try to get pregnant already now, even if your dose is a little too high. This does not hurt. Be aware that during pregnancy many women need about 30% more thyroid hormone. I suggest that as soon as you have conceived to increase the dose by 30% of what you are using. Have your TSH tested 3 weeks after this increase and subsequently every 6 weeks during pregnancy. After delivery most women can go back to the pre-pregnancy dose. Georg Hennemann, Md
POSSIBLE HYPERTHYROIDISM
10 CT 2006
QUESTION-I'm a 34 year old
female. On a routine blood test, my doctor discovered a slight case of
hyperthyroidism. My TSH is below .01, and my T4 and T3 are elevated ( as are
FT4 and FT3), both slightly, but the T4 is elevated more, relatively
speaking. My doctor says my ratio of these factors points towards it not
being Graves.
After a patient history, physical exam, and an EKG to check for any
arrythmia ( it was normal), my doctor decided it was likely to related to an
excess of dietary iodine ( a supplement with 150 mcg and excessive amounts
of dairy), and too much caffeine ( I am, or was, until this happened, as he
termed it, a caffeine abuser). I was told to watch the iodine and
caffeine for 8 weeks and return for repeat testing. The only other
significant factor in my history is that after 11 years of being either
pregnant or nursing continuously, I stopped in May of this year ( but my
child is older than a year).
I asked my doctor about Graves, and he is unconcerned about it. I had a late
term pregnancy loss ten years ago, and underwent extensive testing at that
time, and have continued the testing at future pregnancies. I have had four
negative thyroid antibody tests, and he declined to do another one at this
time . My only finding from all of my repeated autoimmune testing is a one
time low positive anticardiolipin antibody, but it was later attributed to a
case of CMV, and never occurred again.
I have no family history of Graves or autoimmune disorders. I have
absolutely no symptoms at all. No weight loss, no palps, no skin or hair
changes. Nothing. I feel just fine, and can exercise and complete my daily
work with no trouble at all.Is my doctor right to advise this course? Watch
and wait? Jessica
RESPONSE- Your thyroid
hormone data point to hyperthyroidism. It is not possible to judge from
these data if it is caused by Graves’ disease or some other condition, such
as nodular goiter or thyroiditis. The fact that you have no family history
of Graves is a weak argument against Graves, but more significant be it not
conclusive, is that you have no thyroid auto antibodies. If you have no
serious complaints and no anatomical thyroid abnormalities, such as goiter,
the option “to wait and see” is a good one. If you happen to have the
painless type of thyroiditis, this resolves spontaneously in 70% of cases.
However in these patients hypothyroidism may develop in later life. Your
doctor could measure thyroid uptake of radio active iodine that is low or
absent in thyroiditis but normal or elevated in Graves and nodular goiter.
If iodine would be the cause of your hyperthyroidism, then it might resolve
after reducing intake. This implies that you might risk hyperthyroidism at
some time later, even without excessive iodine intake. Georg Hennemann, MD
MEANING
OF POSITIVE ANTIBODY TEST 10OCT 2006
QUESTION-I had hyperthyroidism about a year ago and it was very severe, I
lost about 30 pounds weighing about 100 and could not do anything without
almost fainting but I ate like a horse. My thyroid got very low after some
time on tapazole and I finally got off of it. Once my thyroid levels became
normal I have had elevated antibodies. This scares me and makes me think
there could be something else raising my antibody levels, but my doctor
seems nconcerned. My thyroid gland is enlarged and I have had several ultra
sounds on it and there is nothing showing up. The doctor said normal
antibodies are at 35 and mine have been 165. This seems abnormally high.
Could this mean I have some other unrelated problem in my body like cancer
or an immune problem? –sciple l m
RESPONSE-I agree with your doctor that this is
hardy anything to worry about. In the first place your antibody level is
only mildly elevated. Strongly elevated levels are in de many hundreds or
may be thousands. The presence of these antibodies is only a risk factor
that at any time in your life you may develop ether hyper- or
hypothyroidism. A yearly check of your TSH is there fore mandatory. Georg
Hennemann, MD
THYROXIN TREATMENT AND URTICARIA
QUESTION-I am a patient who has underactive thyroid and have been on
medication for a long time. I just develped uticaria out of the blue.
Never heard of such a thing. went to the dr. He put me on Prednizone,
Zantac and Zyartec which are all antihistamines. Can this be due to my
throid changing. All of a sudden.
Are there any diets you can go on. I appareciate your answer. My dr. took
all blood tests. He thinks it is a virus that hit the immune system. Is
that possible. joankjoank@msn.com
RESPONSE-
Very rarely patients become allergic to the thyroid
medication. Not so much because of the thyroid hormone it contains, but to
the other material in the tablet. In such case changing to an other thyroid
hormone preparation is usually sufficient. Again this situation is really
verry rare. It can certainly not be due to a change in thyroid function. Of
course there are many other more frequent causes of urticaria. Georg
Hennemann, MD
THYROXIN
DOSAGE AFTER PREGNANCY 26 Sep 2006
QUESTION-I
have been taking synthroid 50mcg for years. I then became pregnant and my
dose was upped to 75 mcg. after having my baby and nursing for 4 months i
was feeling extremely awful and all my hypo signs returned. My tsh was
tested and came back 14.78. The doctor ordered and additional TSH and it
came back 17.48 in one week it went up from 14 to 17. My goiter has also
become enlarged. My doctor upped my Synthroid to 150 mcg and ordered
additional blood work in 6 weeks. I am afraid she doubled it and that may
be too much.Do you think 150 is too much of a jump from the 75?
RESPONSE-You may be right. However you are most probably suffering from post
partum thyroiditis. This condition may occur in women who have thyroid
antibodies (anti-TPO) in the circulation. It usually develops in the first
year after delivery. It can cause either hyper- or hypothyroididm. You
apparently were already partially hypothyroid before pregnancy. This has now
aggravated after delivery. The following process may occur. Either the
severity of your present hypothyroidism remains permanent and may become
even worse, or resolves to the pre-pregnancy level. The increase in dose,
considering your TSH level may certainly be too high for the present time. A
jump in dose of 50 would probably have been better. However if your thyroid
is going to be damaged even more the dose may have to be again increased
further. Note that for appropriate dose finding only the TSH level, and not
the T4 and or T3 levels, is important. The TSH should be in the range of 0.4
and 2.0.
Can
breastfeeding cause the TSH levels to rise so high?
No
How
quickly do you feel side effects from synthroid?
If
appropriatly dosed there are no side effects. If the dose is too high, side
effects, in the sense of hyperthyroidism, may ensue after 1 to 3 weeks.
How soon
do you feel improvement after taking higher dosage?
This may
start between a few days and 1 week. G Hennemann, MD
HASHIMOTO’S
THYROIDITIS AND MANY PROBLEMS 26 SEP 2006
QUESTION-I am a 34 year old mother of 2. About one year after my first
child was born I was at a health seminar were I had a health screening.
Being a Physical Education teacher and avid fitness buff, I thought they had
sent me incorrect results from my cholesterol test. It came back high and
with a warning to see a Doctor. I ignored the test and the next year became
pregnant with my second child. I had a much more difficult pregnancy with
my second. I had severe fatigue, a strange skin condition around my mouth,
my eyes and my ears and gestational diabetes (which is not prevelant in my
family at all, and my pregnancy weight was totally normal). My OB chalked
it up to being a mother of one and hormones. (I have a wonderful
OB). Approximately 6 months after the birth of my second child I experience
major weight gain, severe fatige, dry skin, scruffy voice and hives. I was
immediately sent to an endocronologist after my TSH levels came back high at
my yearly OB visit. Too make a long story short (TOO LATE) I was diagnosed
with hashimoto's. I am taking Synthroid .111. I feel much better then last
year, but I still have some conditions that are interfering with day to day
activity. First of all the strange dryness around my eyes and ears are
gone, but is still around my mouth all the time. Every 2 to 3 weeks I have
these episodes where I become completely irritable and unable to control my
temper and emotions, my vision gets blury, I become forgetful, bloated and
my periods are out of control. My mother who also has thyroid issues (not
as severe as mine) often says give the medicine another year. I don't think
I can. I call my endo. regularly, but his nurses seem to blow me off and on
the rare occasion I do talk to him I don't feel like I get any answers. He
has sent me for lab work, all of which comes back fine. My question is
this. Are there answers out there to get or am I losing my mind. I feel
crazy and am beginning to wonder if I am ever going to feel normal again.
Just curious if I should pursue a different route or stay the course. I
hear wonderful things about my endo. from other people and I certainly don't
want to complain about him, however, I really need to get back on track and
even if one person could tell me that I will be back to normal one day soon
it would make me feel so much better. I greatly appreciate any response
you might have time to give me. I can tell by reading the thyroid disease
manager website you are very busy, but I am very impressed with all the
responses. Thank you for your time. Katie
RESPONSE-
Dear
Katie, in the first place the question is if you are appropriately treated
with thyroid hormone. The only correct way to dose this is on the basis of
the TSH value that should be between 0.4 and 2.0. T4 and T3 are unnecessary
and even sometimes misleading. Check with your endo if this is really the
case. You should know that all! abnormalities and symptoms, caused by
Hashimoto, revert to normal after correct treatment, This may sometimes, in
long term severe cases, even take a year indeed. However in that year there
has to be a continues improvement, So, if complaints remain, one have to
think about other causes. As Hashimoto is an auto-immune diseases, one has
in the first place to think of other auto-immune conditions that may play a
role, For instance dry mouth and eye problems may occur in Sjögren’s
disease. Psychological problems can certainly exist in inappropriate thyroid
hormone substitution and generally in people who feel awful for any
reason.Talk to your doctor! Georg Hennemann, MD
TREATMENT
OF PAPILLARY THYROID CANCER 26 SEP
2006
QUESTION-My son is 23 yo who was diagnosed with papillary carcinoma of the
thyroid in 1995. He had a total thyroidectomy and a right radical neck
dissection. He was treated with 83.2 mCi of I131 post surgical ablation. In
1996 he was again treated with another 29.5 mCi of I131 for an elevated TG
of 450. TSH was 51.1. Post therapy scan revealed a single small uptake of
iodine in the right upper lung. Six
months later 1997, he was treated again with 29.4 mCi of I131 for an
elevated TG of 2200. TSH was 144.2. Post therapy scan revealed that the
single area of uptake in the right upper lung has resolved. However, there
was diffuse uptake seen throughout both lungs, which was interpreted as
microscopic metasatic papillary carcinoma. Six
months later in 1998, he was treated again with 178.13 mCi of I131 for
elevated TG of 1300. TSH was 217.6. Post therapy scan showed no
significant change from the prior whole body scan six months ago. Six
months later in 1998 he was again treated with 161.77 mCi of I131 for an
elevated TG of 1121. TSH was 185.9. Post therapy scan again showed no
significant change from the previous.
Chest
X-Rays were all normal and Chest CT's showed diffuse lesions mainly in both
lower lobes largest being 10x11mm. Most of the lesions are 7x6mm or
smaller. CT findings have been relatively the same as well as the I131
whole body scans. A recent PET CT fusion scan revealed the same findings.
In 1998 it
was the opinion of the attending Nuc Med physician that we stop and watch
the disease due to the accumulative I131 dose of over 500 mCi and my sons
age of 15 yo. Since then we have followed the disease by TSH suppression
and TG. Results have be shown to have a slight increase from 85 in 1999 to
141 in 2006.
Currently, his physician has recommending another I131 therapy treatment
utilizing dosemitry for the maximum dosage which is scheduled for Oct 18,
2006. Last year when the question was raised of therapy a Nuc Med
physician suggested banking bone marrow. This time, on multiple occasions
his endocrinologist has been calling him and informing him of the high risks
on sterility and complete destruction of his salivary glands. I have been
in the Radiology field for 30 years and through all the lititure I can not
find anything to support the extent of these risks. I do find the risks to
be classified as "suppressed" rather than complete destruction. Other
concerns are leukemia and pulmonary fibrosis. My son is raising questions
of quality of life.Few
physicians when asked why do therapy if it is stable? Most jump to the guns
and say treat with I131 despite knowing he has had 5 therapeutic doses of
I131 for a total over 520 mCi. Some after learning the history of my son
say that being conservative is also an option. Some have talked about
future medical advances which may cure this disease.
We again are having mixed feelings about this therapy. Getting a good
experienced second opinion is very hard to come by. We are in search for an
unbiased good experienced second opinion. I have read some of your
publication and feel you are the most experienced that I have found in the
11 years of searching. Could you please give us your thoughts, suggestions,
and recommendations. George Miladinovich
RESPONSE-
I have reviewed the facts in your son's case carefully. Although it is
difficult to comment on the decisions made by others in retrospect, it does
seem that the administration of radioactive iodine was done with reason and
for contemporary indications. Generally your son would be considered to have
a good prognosis as he was diagnosed at a young age. Individual progression
is difficult to predict but there is some indication that his thyroglobulin
is rising despite TSH suppressive therapy. It is likely, given the diffuse
nature of the apparent disease in his lungs that surgery is not a viable
option. As such his physicians may be balancing the risk of progression of
the thyroid cancer versus the down side of additional 131-I treatments which
do include the risk of salivary gland damage, and higher risk of secondary
malignancy such as leukemia. The comments about transient bone marrow and
testicular suppression are valid and indeed some patients have experienced
bone marrow failure (risk is likely greatly lessened with dosimetry) and
infertility. The banking of sperm has been recommended for those undergoing
higher dose 131-I therapy and I would think that bone marrow banking might
seem reasonable as a measure to utilize in the case of marrow failure or the
development of leukemia. I do not believe that marrow banking is generally
recommended in current guidelines.
So what to do? If there is evidence of anatomic progression, further
treatment with 131-I would seem reasonable if the post (or pre for that
matter) treatment scans indicate that the 131-I was taken up into the
tissue. If the post-treatment scans show no uptake however, consideration of
chemotherapeutic protocols currently under investigation would be reasonable
if there is evidence for progression of disease. James Hennessey, MD
FLUID RETENTION, ? CUSHING’S, ESTROGEN TREATMENT, EXCESS WEIGHT 23
Sep 2006
QUESTION-I`ve been to several endocrinologist in the UK over the last 20+
years, who don`t seem to be up to speed. I initially had increased prolatin
some 20+ years ago I was prescribed T3 which helped with fluid retention.
However after 3 months it stopped working. I found out many years later that
after 2 to 3 months T3 causes a rebound reaction..I was then prescribed a
narcotic the name evades me at the moment.. It made my blood pressure drop
like stone.Then about 10 years ago I had 2X 24 hour urine samples and I
appeared to have 11 Hydroxycortisol missing along with one or two other
elements.The endocrinologist I saw were I am very much afraid out of their
depth... They were only concerned I might have Cushings.They did not want
to entertain I might have adrenal hypoplasia.I did get some dexamethose for
a private GP and natural path which seem to help.and some saline
solution. But since then I got myself off the dexamethsone.I`ve been
borderline diabetic for many years, but the endocrinologist did not want to
know..I`ve gone into early menopause at about 37.. I was found on a private
test some 3 or so years later my oestrogen level had dropped below so called
normal menopausal levels.I think it was 8%..I`ve been on oestrogen of
various kinds for the last 8 years or so.So I still have periods... But my
weight keeps increasing.. I am about 20 stone and don`t eat much.Is there
any help you could suggest? Like experts in the UK who know what their
doing. Carol J. R. Rae
RESPONSE-If
you do not have Cushing’s disease or thyroid malfunction, the increase in
bodyweight can only be due to an imbalance between energy intake (food) and
energy expenditure (exercise etc). The only solution is to decrease the
first and increase the second.Regards. Georg Hennemann MD
HYPOTHYROIDISM AFTER OPERATION
23 Sep 2006
QUESTIONS-I'm a 51 year old regularly menstruating female.I recently had a
total thyroidectomy for possible Hurthle cell ca found on biopsy of one
dominant nodule (multinodular goiter with previously normal free T4 and
TSH). The final path report was thankfully negative, and I began my
exogenous hormone replacement at 75mcg four days postop, not feeling
particularly fatigued. At 4 weeks (9/8), my Free T4 was 1 and my TSH was
24.5, and the fatigue has set in I'm now on a 150mcg dose daily, but
feeling significantly more fatigued each day. This increasing fatigue made
me suspect that my "homemade" supply has been exhausted and I'm now solely
relying on my Rx My questions are--
(1) How long does the body "hold on" to its T4 and T3 post total
thyroidectomy, and how long does it take for the Rx to "take hold?"
If a “total” thyroidectomy is really total, usually a minimal remnant stays,
thyroid hormone levels disappear from the blood in about 6 weeks.
(2)How often do you recommend TSH monitoring before a euthyroid state is
achieved? Thank you for your expertise and your time!
Erica B
That depends on the time periods that the dose is increased until the
desired amount. I suggest that after each increase in dose, the TSH should
be checked about 4 weeks later. Note that for optimal dose finding and
maintenance the best test is that of the TSH. In patients on thyroid hormone
treatment it should be between 0.4 an 2.0. The values of FT4 and T3 are
irrelevant in this respect. George Hennemann, MD
MANAGING
A THYROID CYST 23 Sep 2006
QUESTION-I read on your site that cystic growths may not be visible on MRI.
If draining of the cyst is a treatment option, then (a) How do you
ascertain the location of the cyst (and where to drain it from)
(b) Is draining sufficient for a total cure (if it is fully liquid)?
Thank you
ggopal@mba04.rsm.nl
RESPONSE-Cyst are best visualized by ultrasound. Draining is done under
ultrasound control by needle puncture. The best results, about 30% complete
and in 60% partial disappearance, are obtained, when after draining the cyst
is rinsed with ethanol. George Hennemann, MD
HASHIMOTO’S THYROIDITIS
AND MANY SYMPTOMS (5 Sep 2006)
QUESTION-I am a 39-year old white female who was diagnosed as having
Hashimoto's
thyroiditis 7 years ago. At the time I was hyperthyroid and received
medication to treat that for 1 month, but have since then be euthyroid. My
latest TSH levels were 1.7 in January and 1.3 in June. My thyroid is
enlarged and has been since prior to diagnosis. I have had a series of
thyroid sonograms that do show several small insignificant nodules that are
not changing in size. I have also had an uptake scan done which is normal.
My problem is the body aches and fatigue that have accompanied the initial
thyroid symptoms have not dissipated. I have had an endocrinologist and an
ear nose and throat specialist tell me that "you have an autoimmune
disease--deal with it". My general practitioner frequently runs all types
of blood work and has no answers. Because I am currently euthyroid, I am
told that I do not require treatment, but I am very frustrated with the
fatigue and body aches. The endocrinologist that I was seeing has since
retired and there is at least a 6 month wait in my area to get an
appointment with one. I am currently being treated for high blood pressure,
endometroisis, anxiety and TMJ. Any suggestions?
lscrawley@verizon.net
RESPONSE-In Hashimoto’s thyroiditis, we usually use thyroxine tablets when
patients have decreased thyroid function, and we call this is the
replacement therapy. Sometimes drug is used to suppress TSH in order to
decrease the thyroid size or to inhibit the growth of thyroid nodules. In
latter case, some patients complain heart palpitation, hand tremor etc.,
just like you, due to slightly increased serum thyroid hormones. Initially
you might have this condition. It seems unlikely that there is functional
difference among different brand tablets. Hashimoto’s thyroiditis gradually
develops into hypothyroid condition and your current treatment with 0.1mg of
Levoxyl is appropriate since your TSH 1.47. Anti-thyroid peroxidase
antibodies (TPO -Ab) keep their high titers for life long and are not
disappear and just show continuation of thyroid autoimmunity. However, TPO-Abs
have no biological activities. Liver function tests are influenced by
abnormal thyroid function but slightly increased ALT in your case may not be
related to thyroid problem since your thyroid function seems to be normal
due to suitable replacement therapy. Your feeling of fatigability may not
relate to thyroid problem since your thyroid function is normal.
N Amino, MD
THYROXINE DOSAGE FOR CONGENITAL HYPOTHYROIDISM 1Sep 2006
QUESTION-My daughter, who is nine months old, was born with congenital hypothyroidism. It was caught because of the heel prick test and she began taking Synthroid in her second week. She has been on a dose of 25mcg pills of which she takes 1.5 pills per day. We have been to several dr appointments and her med levels have not changed. She went to another appointment this week and they want to adjust her to 1.5 pills one day and 1 pill the next, alternating. Her TSH level was 1.65 and her T4 level was 0.05. The doctor said the the T4 level was a bit low but the TSH level was good and that she wanted to decrease the dosage just a bit. I have seen the normal levels on your site but wonder are these levels the same for infants. She is developing normally and the doctor says there are no problems. She did ask me if she was restless sleeper. What would this mean and how do I know what restless is. She has been sleeping through the night since she was 1 month old and very rarely wakes up. Is restlessness an indicator of something? Also what sort of signs should I look for that may indicate that there is a problem with the dosage of medication. She only goes to the dr every three months currently. Thank you for your help.Janice McKinstry .
RESPONSE-A dosage of 37.5 mcg (i.e., 1 ½ 25 mcg tabs) is a common dosage for babies with congenital hypothyroidism. Visits every 3 months are OK. One of the signs of thyroid hormone overdosage is difficulty sleeping which your baby definitely does not have if she sleeps through the night.Are you sure that it is not the free T4 that is 1.65 ng/dL and the TSH 0.05 mcU/mL? If so, then decreasing the dosage would be reasonable.Sincerely,Rosalind Brown MD,
? RAI TREATMENT IN A 14 YR OLD WITH MINIMAL CANCER (25 AUG 06)
QUESTION-My name is Sheila( from UK) and my 14 year old daughter underwent hemithyroidectomy in April 06 to remove 3.5cm tumour, which was found to be microinvasive follicular carcinoma.She subsequently had the second half of her thyroid removed in July 06, and this was found to contain a tumour <1cm in size. Now her surgeon is considering RAI ablation, but says he is not keen on this type of treatment, and that my daughter and I have to decide whether or not she should have it.My questions are - what are the risks of radioactive iodine for a girl this age, and could measuring her thyroglobulin levels indicate whether or not the cancer may have spread? Sheila.
RESPONSE-Although the prognosis in this situation is very favorable, the usual response would be to ablate the residual thyroid tissue with RAI. There is probably no detectable risk with this treatment. Alternative but less satisfactory approaches would be to 1) follow the situation with imaging and blood tests, or 2) delay RAI until age 18. But I doubt that either is quite as satisfactory as to treat now. L De Groot,.MD
TREATMENT OF RAI INDUCED HYPOTHYROIDISM (25 Aug 06)
QUESTION-I had been diognised with
Hyperthyroidism -- Graves Disease for
years with Tapozle. Then my endocrinologist suggest me to take RAI. After
RAI, I still hyper, so continue to take Tapozle. After 1 year of RAI, right
now I am
Hypothyroidism -- after RAI treatment
. And I am on Synthroid 0.088mg for 3 months, then my doc change to
Eltroxin 0.05mg now. I am searching for the better treatment for myself
because I don't think these chemical medicine is good for the body. I regret
that I took RAI without knowing the serious side effect for my rest of my
life. :( -------------from what I had experienced I will NOT sugguest
people to take RAI !!-------------
I suffer lots of symtoms after got Hypo. after RAI. Not sleep
well, no energy, hair loss, dry skin, feel cold..and I am only 23 years
old! I feel helpless...but I believe the natural herbal may be can help
me..I found a site
http://www.greenlife-herbal.com/ and want you comments. What
do you think I should do?? What do think about the western medicine and
tradiational herbal treatment? Waiting for you answer....Thank you a lot!!
Kelly RESPONSE-RAI treatment
is the best treatment for Graves’ disease. Appropriate treatment with
thyroid hormone is easy and people feel 100%.For dose finding the only
important thing is to check serum TSH that should be between 0.4 and 2.0.
Both Eltroxin and Synthroid are perfect medications for hypothyroidism.
Alternative treatments do not work and life is not possible without the
availability of thyroid hormone!! Georg Hennemann MD
STAPLES IN THE NECK AFTER THYROID SURGERY ( 24 AUG 06)
QUESTION-At least ten years ago, I had a goiter removed, surgery went well, no complications. About five years after that, I had to have xrays taken on my neck, and found out by the technician that I have staples where my goiter surgery was, actually it is more to the left up the side of my throat! Is this common, or did the Doctor just want to do a "quick" job to get done, or did he forget to remove these? I have since relocated from the area that this surgery was performed, but many times this has been an unanswered question in my head. Can you enlighten me on this matter? Thank you. Lynn
RESPONSE- It is normal to have staples present in the area of prior thyroid surgery, and harmless. L De Groot,MD
HYPOTHYROIDISM
AFTER REMOVAL OF HALF THE THYROID (24AUG 06)
QUESTION-I am a 40 year old female. My doctor discovered a tumor on my
right thyroid lobe in 2002. I immediately underwent surgery due to results
of the ultrasound, uptake and scan. When the surgeon removed the gland
tests indicated the tumor was benign, so he left the left lobe in tact.Since
this time I have been taking 100 mcg of synthroid daily. I’m not sure how I
feel. I have not felt like myself since prior to the surgery. I do know
that I feel better when I take the Synthroid than when I’m not because I
stopped taking the meds before.I began seeing a new doctor 3 weeks ago. I
had not taken the synthroid for approximately 3 weeks so she ordered blood
work at that time. I went back today and she told me that my blood work
confused her because my TSH was 7.4 and my T4 was 5. and the T3 was 2.4.
She wants to repeat my blood work again in two weeks 24 hours after I have
taken my synthroid. I don’t understand any of this and I have never asked
about my blood work results in the past. I just let them draw the blood and
took the meds the Doctor prescribed. I do know that I feel fatigued and
catch every virus and cold that I’m around. I also believe that something
is affecting my mental health. Can thyroid disease effect all of this and
do you have any answers based on the small amount of information I can
provide? Sandia
RESPONSE-If one lobe has been removed by surgery, the other lobe usually
compensates for the whole thyroid function. In other words, there is usually
no additional thyroid hormone substitution needed. It may be that, because
you used thyroid hormone that you recently stopped, your thyroid is resuming
function that was suppressed by the thyroid medication. I therefore think
that is too early to conclude that you need permanent thyroid hormone
medication because your TSH is elevated at the moment. I would suggest to
wait at least another 8 to 12 weeks before taking a decision about
treatment with thyroid hormone for permanent thyroid failure.Georg Hennemann
MD
QUESTIONING THE DIAGNOSIS OF GRAVES' DISEASE (24AUG 2006)
QUESTION- I am a 40 year-old female who has been diagnosed with Grave's disease, but I am questioning this diagnosis for the following reasons. I have been hypothyroid for 10 years and taking thyroid medication. When I switched to this Dr. she had my blood tested for antibodies, which came back positive. These were my results in 12/04. FT4 was normal at 1.0, TSH was abnormal at 11.584, anti-thyroglobulin AB was 125 (<40 IU/ML) and antithyroid peroxidase was 553 (<35 IU/ML). She put me on thyroid replacement (Synthroid) at that time and told me that I had Grave's disease because I tested positive for antibodies. I came home and read all that I could find on Grave's disease, but could not find anything that supported treating GD with thyroid hormone replacement. The next test I had she only tested me for TSH, which was 9.473 in 7/05. Then just recently, she only tested for TSH again, which was 8.023. She has increased the dosage of my medication.
Can you please tell me if this is a correct diagnosis? Most of what I have read would point me towards Hashimoto's Thyroiditis as opposed to Grave's disease. However, as far as I can tell I do not have a goiter. Is it possible to have autoimmune thyroid disease without having Hash. or Grave's, or is that for sure what the antibodies are predicting?
I would appreciate it so much if you could help me with this. Each time I told my Dr. that I couldn't find any literature to help back up what she has diagnosed me with, according to my labwork, she tells me that I had hyperthyroidism at one time, but that my thyroid burned out and doesn't work any more and that is why I am taking thyroid replacement. Is this possible? I have always been very cold, low temp., suffer from bouts of depression, and very tired. I'm just questioning this diagnosis.Thank you for any help you can give. Anita
RESPONSE-You do not have Graves’disease, but auto-immune hypothyroidism. The misunderstanding however is that Graves’ disease and auto-immune hypothyroidism are from the basic causal point of view not very different. Graves’ disease is caused by thyroid auto-antibodies that stimulate the thyroid to hyper function. These antibodies are called Thyroid Stimulating Immunoglobulins (TSI). However in Graves’ disease, also thyroid damaging auto-antibodies are being produced, i.e. anti-TPO and anti-Tg. It depends on the ratio of the present stimulating and damaging anti bodies what the clinical picture will be, hyper- or hypothyroidism. If stimulating antibodies prevail hyperthyroidism will ensue, but at the long run the thyroid will be damaged by the concomitantly present damaging antibodies, resulting ultimately in auto-immune hypothyroididsm. If the damaging anti-bodies are initially dominantly present the primary picture is that of auto-immune hypothyroidism.Thus both diseases are caused by the same basic process, but differ in clinical picture.Your doctor has to increase the thyroid medication on the basis of the TSH level that should be between 0.4 and 2.0.
HYPERTHYROIDISM AND WEIGHT GAIN 19
AUG 06
QUESTION- I have gained 10 pounds in the last year and haven’t felt
myself. Went to Dr. and they tested my thyroid – much to my surprise-they
are telling me I am hyperthyroid even though I have a lot of hypothyroid
symptoms – My bloodwork and RAI uptake test all came back – over an 8 month
period, my TSH has continually been 0.01 and now my Free T3 is high – my
endo is recommending that I have a treatment of Iodine Therapy and then take
PTU 48 hours after the treatment. Is this the correct approach? I am very
nervous. I don’t know what to do.Tracy
RESPONSE-It
is exceptionally rare to have weight gain during hyperthyroidism, but it
happens indeed! Only if your thyroid is not or only slightly enlarged it is
worthwhile trying to treat you for at least one year with an anti-thyroid
drug. However relapse occurs in the majority op patients. More and more the
first line of treatment is administration of radio-active iodine. It is
harmless except for the thyroid that is intentionally being damaged.
Hypothyroidism will ensue in due time, frequently already in the first year.
But treatment with thyroid hormone is easy. In fact even after (successful)
treatment with ant-thyroid drugs, hypothyroidism develops ultimately in many
patients, but over a longer period of time. .Georg Hennemann MD
THYROGLOSSAL CYST (16 AUG 2006)
QUESTION-Hi, my name is Dianna and my son has a thryo glossal cyst. He is only 2 years old and I was told that it needs to be removed along with the hyoid bone. Will this cause him any danger getting the hyoid bone removed? Will he still be able to talk normal and be a normal 2 year old. Please help me because he is due to have the surgery soon. Thank you for taking time to read this. Thank you, Dianna
RESPONSE-The suggested operation is the correct procedure for this boy. There should be no significant difficulties with swallowing or speech after surgery. The central part (Sistrunk) of the hyoid is removed. If it is not removed, recurrence can occur. If the patient does not have surgery, there is the possibility of a recurrence.If I can be of further assistance, please let me know.Edwin Kaplan, MD
HYPOTHYROIDISM
AND HIVES
QUESTION-I am scratching myself crazy. I am getting hives several times a
day and it's pushing me over the edge. The hives are coming more often and
spreads to a larger area with a burning and crawling sensation. At the end
of last year my doctor put me on Synthroid I started out at 100 and elevated
to 150 mcg. I stopped taking it @ January after only being on it a cpl of
months due to a lost of insurance. In the past several months the hives are
back Big Time, I have went from 180 to 255 in 6 months ( I barely eat and my
fiancee and daughter are constantly on me to eat----but I'm getting scared
to because of the incredible weight gain;I am 6' tall so 165-180 is my
normal weight - I am 43 yrs old), I am losing hair like there is no
tomorrow, my blood pressure is extremely low always, I have absolutely no
energy, my periods are extremely irregular and very heavy ( I go through 2-3
boxes of tampons & 2 bottles of Pamprin Max each period- passing ALOT of
clots), my face is puffy and at times it is a bit sore, and as weird as it
may sound when the hives come my tongue gets fat and it seems with each
episode it stays fatter, headaches are constant at this point and it seems
to effect my vision alot, and unless I take something - I am constant
constipated...am I going crazy? Menopause from hell? or is my thyroid
wacked out? My mother died @ 25 years ago, however, I know she had major
issues w/her thyroid and even at one point had goiter surgery. My daughter
has borderline TSH levels and I have several nieces w/thyroid issues and are
on constant medication. Can this be dangerous or just extremely annoying
and uncomfortable....I do not have insurance and know retesting and meds are
extremely high. My doctor moved to FL at the time I ran out of meds and
insurance so I would have to find a new one.....Guess I just want to make
sure this isn't dangerous, as well as, is there anything I can do that isn't
going to put me into financial hell. Donna Gillstrap
RESPONSE-Your complaints and symptoms sound very serious and are quite
compatible with severe hypothyroidism! I am compelled to say that going on
like this may be life threatening! You may even be in a situation that
immediate full replacement with Synthroid may be dangerous too and that
substitution has to be done carefully in a graded manner, for instance every
for week an increase in dose of only 25 microgram and starting with this
dose as well. Appropriate treatment should aim at a TSH level between 0.4
and 2.0. T4 and T3 levels are absolutely unnecessary and cost only money. It
is only the TSH that matters.I am really sorry about your financial
situation but this is life priority!I can’t exactly explain your hives
problem but there may be a connection with your present state of
hypothyroidism. Georg Hennemann, MD
HYPOTHYROIDISM AND HIVES -20 JUL 2006
QUESTION-I am a 37 year old female who is experiencing urticaria x 3-4
years. My hives have been progressively getting worse. I recently went to
an allergist to be tested, hopefully to receive immunology injections to
alleviate this problem. He ordered a series of blood work to determine if
my thyroid was normal. My lab results came back with my TSH High at 5.37,
my Anti-thyroid ABS--TPO AB is High at 1335,Antithyroglobulin AB High at
77. My IGE, total and Immunoglobs A/G/M QN were all in the normal range.
After researching hypothyroidism I have almost every symptom there is--low
body temperature, dry/breaking hair/dry eyes/fatigue/weight gain/low
bp/irregular periods/increased snoring and unexplained anemia, etc. My
other concern is my mother to my knowledge has not had any thyroid problems
but she had multiple sclerosis which is another autoimmune disease. Could
this autoimmune disease be related to MS? Thanks Pam
RESPONSE-Although rare, thyoid auto-immunity (positive for TPO- and Tg
antibodies) maybe related to hives. Your thyroid is starting to fail and
that will certainly worsen looking at the high level of your TPO antibodies.
There is no doubt in my mind that you should start with thyroid hormone
(levothyroxine) treatment. Georg Hennemann, MD
CONCEPTION AND
HYPOTHYROIDISM - 20 JUL 2006
QUESTION-I had missed two cycles on menses, was advised a TSH which turned
out to be high. Have got T3 and T4 done. My question is does this affect
the chances of me getting pregnant ? how much time would the drugs to get
TSH normal and me to start ovulating ? Thanks Fatema Bangalore
RESPONSE-
It may take several months before you start ovulating again,
at least if this symptom is not due to anything else other than your thyroid
problem. Patients on thyroid hormone substitution should have a TSH that
varies between 0.4 and 2. T4 and T3 levels are not important for dose
finding! When you have conceived be aware that you may need about 30% more
thyroid hormone during your pregnancy. This is very important for optimal
development of your child, in particular the nNervous system. I would advise
to start immediately with this increased dose after conception and adjust
the dose after 4 weeks to the required TSH interval I indicated. Regular
check of your TSH during pregnancy is advised. A TSH during pregnancy no
higher than 1.0 is even better. After pregnancy you can reduce the dose to
the pre-pregnancy amount. Georg Hennemann, MD
POSITIVE
THYROGLOBULIN ANTIBODIES AND NORMAL TSH
QUESTION--Hi - I'm so glad I found your site! I'm 41 and feel like I've been
struggling with fatique for a very long time. I'm a medical technologist so
have the ability to run most routine blood work at will. Nothing came to
light. Then 2 years ago I learned of estrogen dominance and determined that
was part of my problem so I started using natural progesterone cream with
great relief(P:E ratio improved too). Now, however, the fatigue has returned
somewhat but the bigger battle is with constipation! My TSH has pretty
muchrun above 2.5 for the last six years with the exception of one 2.33
value in 2/2005. My highest reading to date was in May at 3.47. I stumbled
across something that said kelp could help decrease fibrocystic breasts (it
hasn't!) so about 4 weeks ago I added 225 mcg to my supplements. I ran my
TSH last week and it was lower than usual at 2.42...which I attibuted to the
kelp. I finally sent my thyroid antibodies off and low and behold my TPO is
negative but my Thyroglobulin antibody is high at 91 (lab ref range <20).
Is this a common findiing? From what I've read it's usually the opposite.
So, could there be a chance that the kelp is causing the high
anti-thyroglobulin antibody? If so, please explain b/c I can't put reason to
that. I've since stopped the kelp b/c I didn't realize there is 1mg in my
multi-vitamin. I guess there's always the theory that the 1mg of kelp in my
multi-vitamin has been keeping my TSH lower all this time. I feel I'm
hypothyroid based on my symptoms and TSH tending to run above 2.5 plus the
antibody. My mother is also hypothryoid but not sure if she's ever had
antibodies tested. I'd be curious to hear your thoughts before I head off to
an endocrinologist to tell me I'm nuts! I'm a very healthy, active, health
conscious person who used to be an energizer bunny. I know age slows one
down but geez! Thanks for all you do! Tracey
RESPONSE-- Your TSH has always been in the normal range. The variation in
values is also quiet normal. It is mostly that when thyroid antibodies are
present, it is the TPO that is elevated and not the TG antibody. Having anti
TPO increases the risk of future development of hypothyroidism. Your value
of 3.47 tends into that direction but not quite. It has been shown that
iodide may induce hypothyroidism indeed in susceptible subjects. As your
mother had hypothyroidism, and most probably also thyroid antibodies, you
probably have that susceptibility , What is your FT4? If that is not
lowered, there is no reason to start with thyroid hormone, considering your
values. Do not take kelp anymore and test your TSH and FT4 every half year.
Georg Hennemann, MD
NORMAL TSH IN AN INFANT- 2 Jul 2006
QUESTION- Is the normal reference range of TSH in an infant the same
as that for an adult? If not, what is the normal range?
Background:- 5 month old girl TSH .473 and I'm getting conflicting
information on whether
that's normal but a little low, or something to be concerned about.
(And in case you wonder why I don't ask my doctor: he thought low
TSH meant hyPOthyroidism.) -Ariel Shkedi
RESPONSE- the normal TSH value is higher particularly in the first
few days of life ; <25 mcU/mL on the first day; <20 mcU/mL 2nd day,
<10 mcU/mL after the first week. After the first week a value up to
9.1 mcU/mL is normal up to 20 weeks according to the Quest normative
data. As you know, it is hard to get one's hands on good norms.
Quest reports the normal TSH from 21 wks to 20 yrs as being 0.7- 6.4
mcU/mL. Another reference gives a range of 0.8-6.3 mcU/mL in the
first year of life (progressively lower thereafter), so, at least
for a 5 month old, I think that there appears to be good agreement.
More information can be found in Chapter 15 of Thyroid Manager.
Rosalind Brown MD
POST-PARTUM HYPERTHYROIDISM
QUESTION-I am a 40 year old female, who gave birth to my third child
in January of 2006. Following my pregnancy, I have developed a
thyroid problem. Slowly of time, it continues to get slightly
worse...my T3 is now 277 and my TSH is <0.01. I was referred to an
endocrinologist, who put me on 5mg of Tapazole, but I developed bad
hives from it. So, I have since stopped the medication. I also
have a "lump" on the right side of my thryoid, that seems to move
when I swallow. My doctor seems to have the lets wait and see
mode...I have also lost a bit a weight. He says if I loose four
more pounds to call him. Am I wrong to tell him that I want an
ultrasound to be on the safe side? Cheryl.
RESPONSE-, it is unfortunately not
uncommon, that women develop thyroid problems within one year after
delivery. This condition is called “post partum thyroiditis”. It is
caused by antibodies that circulate in your blood that are directed
against your thyroid.
They can cause both hyperthyroidism (increased thyroid function),
but also hypofunction of the thyroid (hypothyroidism) or
alternatively both conditions. In your case apparently
hyperthyroidism. This condition may disappear spontaneously in weeks
or months. If you are allergic to tapazole, your doctor has the
following options for treatment. Treat with PTU, that also inhibits
thyroid function but in 50% of cases that are allergic to Tapazole
also induce allergic symptoms. You can try it and if it also is
allergic to you, propranol is the best alternative. It does not
affect thyroid function but suppresses the symptoms of hyper
function. If your hyperthyroidism does not subside over a few
months, I would advise treatment with radio-active iodine. If your
hyperthyroidism does resolve spontaneously then regular thyroid
function tests, throughout your whole life, are obligatory as you
have a risk of ultimately developing hypothyroidism any time in your
life.
If spontaneous resolution occurs, the risk of developing hyper- or
hypothyroidism during or after a next pregnancy is increased and
regular thyroid testing should be performed during that time. Ultra
sound of your thyroid will be of little help in this problem.
However a lump may point to a hyperactive nodule. If this is the
case than your hyperthyroidism is caused by this node and this
condition is not related to your pregnancy. It may have developed
coincidentally. To investigate this, a radio-active scan would
appropriate to establish the diagnosis. In that case it should be
treated by operation, ethanol injection or laser therapy. Treatment
with drugs is useless.I hope this answer is of some help to you.
Regards, Georg Hennemann, MD
THYROID MEDICATION AND HAIR LOSS
QUESTION-I am trying to understand my current condition of
HYPOTHYROID. My biggest concern is excessively falling hair. The
situation is quite bad. I have tried everything from homeopathy to
chinese medicine but no success. I list below my blood test of date
1. What is your blood test result most recently?Results
Feb
24-06 June 06-06
FT3 3.7 2.9
FT4 18.6 14.0
TSH 0.11 1.10
AntiThyroglobulin Abs 3.7 2.6
Anti ThyroperoxidaseAbs 61.4 424.4
Iron 7umol/L 15
Folic
Acid 51.5
Red Cell Folic
Acid 885
Between Feb -06 to June06 my dosage has changed. Till Feb-06 I was
taking 125mcg per day. From June and now, I take Mon, Wednesday,
Friday, Sunday take 100mcg. On Tuesday, Thursday and Saturday I take
150 mcg. My Iron was low, so I take natural snowdonia water to help
get over my iron deficiency. I have just started to take KELP as you
will notice that my AntiTHyroperoxidase Abs is very high which means
I am seriously Iodine deficient. I also take Multivitamin with
minerals, Vit A 7mg and Betacarotene -1 a day. and VIT D + Calcium
1250mg - each tablet - taking 2 tablets a day.If there is anything
you can suggest to improve my hair falling problem woudl appreciate
it. I have: no fatigue, no constipation (never did), good sleep,
good energy. Sometimes less concentration, falling hair - handfuls ,
cold hands and feet, swelling on top of my eye lids in the morning
and swelling under my eyes - more on the right hand side.I am going
to a homeopath also but it has not helped at all.Please let me know
if there is anything that can help me reduce my hair loss. Kind
regards, Gohar
RESPONSE-You were overdosed indeed with 125 ug, but on 100 ug T4 you
are OK. I can see this from the TSH values. My advise is that your
TSH should be kept between 0,4 and 2. If your falling hair were to
be due to variations in T4 dosing then it will surely recover if
your present TSH stays between the range that I indicate here. This
may take some time even a few months. If it does not normalize then
there must be another reason, for instance varying iron levels
sometimes dropping below 10. What is the reason for this low iron
level. Do you suffer from heavy menstrual blood loss? If not, you
may discuss this with your doctor. The thyroid antibodies will not
hurt you and there is no reason to take extra iodine. You are now
taking thyroid hormone and you are not anymore dependent on iodine.
I can hardly believe that iodine deficiency would still occur in the
US. Extra iodine may however affect your thyroid if there is still
some functioning left. It may aggravate the hypothyroidism but also
induce hyperthyroidism.A last advise. Why don’t you use iron
tablets? It is probably cheaper and contains a constant amount of
iron. Georg Hennemann, MD
Thyroglossal cyst
RESPONSE-Removal of a thyroglossal cyst and twice operated for, is such a rare event, that I think that nobody has any experience such to tell you if your complaints are ‘common’ for this surgery. It seems to me that your complaints are directly caused by the cold, for which they are certainly ‘normal’, rather then anything else. However your second operation was certainly relatively extensive and may aggravate these symptoms.Georg Hennemann, MD
THYROID ANTIBODIES
AND QUESTIONABLE HYPOTHYROIDISM- 6 June 2006
QUESTION-Hi, I am a 50 year old woman. Since age 12, I’ve experienced
repeated bouts of over activity followed by under activity, the duration and
recovery of each bout has also increased over the years. I’ve been unable to
return to work since 1993. I heard about Hashimoto’s and requested tests in
March 1996, TSH 2.3 and T4 80 (previously 1.1 and 94 respectively in Jan
94).
|
|
April 96 |
October 1996 |
|
Antithyroglobulin |
Neg |
1:100 |
|
Antimicrosomal |
1:400 |
1:25600 |
I started on 25 mcg Thyroxin, increasing over 15 months to 100mcg, but could not find a dose that returned me to ‘normal’, my TSH also fluctuated - 1.4/0.2/1.5/0.2/1.2. I was concerned about taking replacement T4 when antibodies can also increase T4, but both my GP and Endo said not to worry. I settled on 75mcg for the next 3 years, even though I still experienced fluctuating symptoms I felt overall much better with a clearer mind and sleep down to 8-10 hrs. I was still not able to work but was able to start an OU physics degree course.
|
|
T4 |
TSH |
|
|
T4 |
TSH |
Dose |
|
|
T4 |
TSH |
T3 |
|
20-1-99 |
|
1.8 |
|
22-5-02 |
31.6 |
0.1 |
75mcg |
|
9-5-03 |
18.6 |
<0.1 |
2.1 |
|
29-3-99 |
22.1 |
0.3 |
|
30-8-02 |
22.3 |
<0.1 |
50mcg |
|
2-6-03 |
17.4 |
<0.1 |
1.8 |
|
6-4-00 |
30.7 |
0.1 |
|
9-12-02 |
24.9 |
<0.1 |
25mcg |
|
23-9-03 |
|
1.0 |
|
|
24-8-00 |
|
1.9 |
|
18-3-03 |
24.4 |
0.1 |
0mcg |
|
23-1-04 |
|
1.2 |
|
|
9-3-01 |
28.5 |
|
|
|
|
|
|
|
10-8-04 |
|
1.22 |
|
By May ‘02 I felt so
hyper that I started to decrease my dose of Thyroxine and have had none
since March ‘03. In May 2003 Anti-TPO was 1212 u/ml. I believe the low TSH
was due to the antibodies but GP thinks it was over-replacement - What is
your opinion? I have continually deteriorated since and now am unable to
concentrate on my coursework and sleep 12-16 hrs a day (as well as other
symptoms). GP won’t put me back on replacement but has referred me to Endo.
I’ve been reading about T4/T3 combo for people who continue to have symptoms
on replacement T4 only. What is your opinion and what tests should I expect
the Endo to do? My latest TSH was 2.65 in Dec ‘05.
I am not sure if you reply by e-mail or only on your site. It would
therefore be appreciated if you would e-mail me as to whether you are able
to respond to my questions or not. Thank you in anticipation. AJ McGowan
RESPONSE--It
strikes me, if correctly understood, that you started on thyroxin while you
were not hypothyroid? I agree that you have high titers of thyroid
antibodies, but that does not automatically imply underactivity of the
thyroid! Or did you have an elevated TSH at that time? At any rate, your
present situation shows that your thyroid is normally functioning without
medication! Consequently meaning, that the antibodies have not damaged your
thyroid to the extent that it can not function normally.
A point of note is the fact that even a low dose of thyroxin. i.e. 25
microgram suppresses your TSH which does not occur in subjects without
thyroid affection. In normal subjects the TSH stays in the normal range with
this dose. In your case this is probably explained by the fact that you have
also an other thyroid antibody circulating named TSI which stands for
Thyroid Stimulating Immunoglobulin. This antibody contrary to the other ones
does not damage, but stimulates the thyroid and can not be suppressed by
thyroxin. Hence the lowering effect on your TSH.
My suggestion is that you keep discontinuing thyroxin usage, but keep a
close watch on your TSH. My guess is that ultimately you really will develop
Hashimoto and then it is time to start with thyroxin. Be aware, and not all
doctors realize this, is that when on thyroxin, you have to keep your TSH
between 0.4 and 2. The values of T4 and T3 are not important in the dosing
of thyroxin in those situations. Georg Hennemann, MD
RAI TREATMENT, FERTILITY, AND EYE PROBLEMS- 3
May 2006
QUESTION-I am a patient I have been fighting Graves disease for almost 4
years I have almost gone into remission 2 times using tapazole. This last
time I came closer then ever and was put on synthroid because my thyroid
level was low. They took me off the synthroid for 6 weeks and when my
thyroid levels didn't normalize they did an ultrasound and uptake and
discovered the graves had come back and now my doctor wants to do RAI and I
am very worried about the side effects Namely thyroid eye disease and
difficulty getting pregnant as well as the possibility for the disease
coming back. I have detached retinas in both eyes that have been operated
on and I am legally blind I am worried if I do the RAI my eyes will get
worse. I have also had Cerebral palsy since birth and I am worried how
these conditions may be effected. My doctor says RAI doesn't effect
fertility is this true. How will my other conditions be effected by the RAI
and can it come back after the RAI? I want to go back on the tapazole
because RAI terrifies me? Please respond if you can do so thanks
Eidwriter@aol.com
RESPONSE-, I think that I understand your problem fully.
1.RAJ does not affect fertility
2.There is no side effect of RAJ treatment established so far in the many
million patients treated as such, despite scrutinized follow up over more
than 50 years, but for one exception and that concerns you in particular.
That is that in a minority of patients eye problems may be induced. In
essence these signs involve an increase in volume of the tissue behind the
eyeball causing bulging of the eye outwards. This process may consequently
lead to increased intra-occular pressure that probably may increase the risk
for a 3rd retinal ablation. It is possible to prevent this
complication by administration of prednisone before treatment and for
several weeks thereafter. However this scenario seems to be equally risky
for you as prednisone may raise intra-occular pressure as well.
My conclusion is that there are 2 remaining options for you.
1.Start again with tapazole. However this treatment does not always prevent
eye problems, especially if it is not performed with a full inhibiting dose
of tapazole on thyroid function in combination with a dose of thyroid
hormone that keeps the TSH in the low-normal range. Even then eye signs,
though rarely, can not always be prevented
2.So my final advice to you is to have your thyroid (near) totally removed
by a very experienced surgeon. The less thyroid tissue remains, the lower
risk of developing eye problems in the future. I suggest that this operation
should be done by a thyroid surgeon experienced in operating patients with
thyroid cancer as they are used to perform total thyroidectomies.
Georg Henneman, MD
THYROID TUMOR WITH NEGATIVE IMAGING AND POSITIVE TG 18 MAY 06
QUESTION-I'm a 30 year old male who has PTC and has had: A partial thyroidectomy (right side tumor ~10cm and attached to all surrounding structures, with lymph node metastis which were removed), Surgery to remove the remainder of the thyroid (no tumor, but left lymph node metastis which were removed), I-131 treatment on two occassions with 150 mCu on each occassion, Numerous I-131 WBS with negative results, Numerous US with negative results, Numerous chest and neck CT's with negative results, One whole body PET scan with negative results. However, my Tg is significantly elevated (not sure of the exact level).
My questions are: Given that no tumor can be found through imaging, what are my options for next steps? Where could the residual tissue be located? Will further I-131 treatments are required? Would a neck dissection be required?Thanks.Any help would be appreciated as this has been a two year ordeal and I see no end in sight. BWoodford.RESPONSE- Your problem is, unfortunately, not rare, and causes both the patient and physician a great deal of distress. There is no perfect answer. To begin, I assume that your antibody test is negative, so that the TG assay is meaningful. If so, to some extent the answer depends on how high the TG is with TSH suppressed, and with TSH stimulation, and whether the TG level is rising, stable, or even falling, over time. Another question is whether the post therapy scan with that 150mCi treatment was negative, or not? So long as there is no identifiable tumor lesion on any modality, and in view of your prior therapy, there is probably little to do except for continued follow-up with TG, US, and sometimes 131-I scan and PET scan. More specific answers to your questions should come via discussion with your own MD, who knows you, your exam, and your treatment history. L De Groot, MD.
RAI TREATMENT AND PREGNANCY (10 MAY 2006)
QUESTION(S)--My husband who is 30 years now was diagnosed with Papillary carcinoma of thyroid two years back(2004). In Sep 2004 a total thyoidactomy was done and he was adivsed to have 300mcg of Eltroxin. In Nov 2004 he had RAI.While this iodine treatment was going on i was 20 weeks pregnent and 4 weeks later i had to go in for an MTP due to the child having TOF(Tetrollogy of Fallots). Since the doctor advised us to wait for one year after the radiation for another child, i didn't conceive for one year. In Aug 2005, he started getting giddiness and the doctor found that Eltroxin intake was high and reduced the dose to 200mcg. After two months in October 2005 again he had RAI and found that no spread of cancer in the body.The Eltroxin tablet was increased to 250mcg subsequently. The doctor again advised us to wait for one year after the second radiation to conceive.My questions are the following:1. Can i conceive after one year (by September 2006).Is it safe?2. If i conceive will the child have any defects since he had two RAI?3. Will there be any infertility problem for my husband ? or do we need to go in for a sperm test before conceiving to check the whether radiation is still present in the body.4. I am assuming that my first child had ToF because when my husband had RAI i had accompanied him to hospital and also during the time of his surgery (Sep 2004) i was with him in the hospital in my 8th week of pregnency for a week after the surgery.5. If i conceive and in case ny husband has to undergo another RAI what steps do i need to take.6.Do i need to check my husbands T3,T4 and TSH levels before conceiving. Thanks, ElizabethRESPONSES- 1-Yes. Generally it is advised for males to wait 6 months after RAI before starting a pregnancy, but there is no hard data to support this suggested time period.2-There is a 4 percent chance of a fetal abnormality is all pregnancies. The added risk related to prior 131-I treatment is very low, and is usually ignored. However the occurrence of a previous abnormality raises a concern that you should discuss with your Obstetrician. I do not think the occurrence of the Tetrology could be related to your husband's treatment when you were in the 20th week of pregnancy.3. Fertility could be reduced. There can be no RAI left at this point. I do not think there is any practical test that can be done to answer the question you raise.4. See above.5. You must discuss this carefully with the therapist. Mainly you need to avoid close contact for about a week.
6. The dose of medication that he is on probably makes him mildly hyperthyroid. While not dangerous, it might be reduced toward a more normal level. L De Groot, MD
T3 FOR WEIGHT LOSS
QUESTION-For yearS I have tried to loose weight. I have a small goider but
nothing serious with no changes. My T3.T4. TSH, Free T3, etc. always come
back within normal range. My hair is falling out, I am always cold, plus
other symptoms that point to thryoid issues. I am close to putting myself on
a trial of a T3 thyroid medication. What are your thoughts. Thank you for
your time and attention, TPerk1211@aol.com
RESPONSE-Using T3 to loose weight is
dangerous. It mainly decreases your body protein meaning that your
organs like muscle, heart, liver etc are being damaged, while your body fat
is hardly affected.G Hennemann, MD
EYE PROBLEMS, ON
STEROIDS
QUESTION-I have been on prednisone for over 4 months. I was put on it for my
eye lid swelling and bulging with severe pain. A CT showed the muscle in the
back of the eye and right side of the eye not working correctly.Every time
we try to get off the prednisone, it swells again. I had T3,T4, and TSH done
and all came back normal.I went to a new Dr and he did thyroid antibodies
and it came back none. I had another CT done today. Can you give me any clue
has to what this can be? Kathy
Westtxkc101@aol.com
RESPONSE- Usually eye signs are decreasing spontaneously over time, what may
take years. Mild and moderate eye signs are at present not routinely
irradiated by X ray. However if eye signs are more severe irradiation
should be considered seriously. Also when eye muscles are not
functioning well in the sense that they do not move precisely
simultaneously, they may be infiltrated by fibrous tissue, which stays
there more or less permanently. This may lead to squinting. In this
situation I advise orbital irradiation under supervision of an
experienced endocrinologist and radiologist. Good luck! Georg Hennemann, MD
CONCERNS ABOUT THYROID DAMAGE 3 Apr 2006
QUESTIONS- and ANSWERS---Do
you know of any medications that can cause your Thyroid to be over active?
Iodine in susceptible
people
Also do you know if a person has had surgery in that area C 5 C 6 Fusion.
Could there be signs of scar tissue that could shoot off the Thyroid
hormones into the Blood stream?
Highly improbable
If so could this cause the T3 T4 levels to change?
See above
Why would you need an Biopsy of the area with aspiration of small needle of
the gland?because a small
needle is much simpler and less damaging than a thru cut biopsy
Can this also cause voice problems?not
if properly done.
Thanks.
Carolgammon1@aol.com G Hennemann,
MD
THYROID CYSTS AND THYROXIN TREATMENT 13 March
2006
QUESTION- Good day to you Doctor. I’m Juvy C. Garcia here in Guam,
USA, 42 years old. Two years ago (March 09, 2004 to be exact), I underwent
a Thyroid Ultrasound Test. The findings was “There are two focal lesions.
In the superior pole of the right lobe, there is an entirely anechoic lesion
measuring 7 x 4 x 5mm. There is quite hypoechoic sharply demarcated 4 x 2 x
3 mm lesion in the extreme interior aspect of the right lower pole. The
background thyroid stromal echotexture is normal. There are no other focal
hepatic abnormalities. There are no areas of abnormal stromal
echotexture.IMPRESSION: THIS IS A NEAR NORMAL EXAMINATION. THE TWO LESIONS
IN THE RIGHT LOBE OF THE THYROID GLAND HAVE EXTREMELY BENIGN
CHARACTERISTICS.
My questions are as follows:
1.
When I had vacation in the Philippines, I had it biopsied and Thank GOD, it
turned out to be negative for malignant cells. Doctor my question is, if it
was diagnosed non-malignant the first time, will it turned out to be
malignant after two years?
2.
Sometimes, I feel pain but not too much? It’s like feel
that it has grown or it’s just in my mind. What is this Doctor?
3. My
Doctor prescribed me Eltroxin? Is this a good medicine? And what are the
side effects of this medicine?
4.
Will it be good to just continue taking it
because I stopped it for awhile.
Thank you so much. Juvy
RESPONSE-I get the impression that the focal lesions are cysts. A cyst is
defined as an entirely an- or hypoechoic lesion with a sharp demarcation all
around. You do not mention anything about the demarcation of the lesion in
the upper part of the right lobe. But as this lesion is anechoic I presume
that this is a cyst as well. Thus probably you have 2 cysts in your thyroid.
Cysts are by definition non-malignant, because they have no cellular lining
on the inside and if there are no cells, then there is obviously no
malignancy present. There is usually little effect of thyroid hormone
treatment on cysts. Cysts usually do not cause pain, so it may be in your
mind. If they cause pressure feelings in the neck and or are disfiguring the
first line of treatment is aspiration of the fluid and subsequent rinsing of
the cyst with alcohol. This procedure can be repeated say 3 times in a
period of 3 months. They may disappear completely or partially that may be
often considered as sufficient. If there is no effect at all, operation is
the only remaining option. There is little chance that thyroid hormone
treatment will have a sufficient effect, but there is noting against it to
try this. To do this optimally the dosage of thyroid hormone should be
chosen such that your TSH comes down just above the lower normal level oh
the assay. If after half a year there is no effect. You may discontinue
thyroid hormone gradually in a 2 week period. However if there is an effect
you should not be surprised if the cysts relapse.
Georg Hennemann, MD
MAXIMUM DOSE OF THYROXIN --10
MARCH 2006
QUESTION-My query is what is the maximum dose per day of l- thyroxin in
adults? .khanhasinkhan@hotmail.com
RESPONSE-There is no specific ‘maximum dose’. You have reached the proper
maximum dose when the TSH of the patient stabilizes between 0.4 and
maximally 2.0 uU/ml. Georg Hennemann, MD
THYROXIN DOSE AFTER PREGNANCY- 8 MARCH 2006
QUESTION-Not a physician but in need of assistance. I was diagnosed as
having Graves disease in '97. I chose radio active iodine as my solution. I
went off to college and had a horrible 1st year not being able to get back
in touch with my Endo who did not inform me and my parents of the need for
continued meds. In early 2005 I finally got pregnant. I had been going
steady on 88mg for about 2 yrs and got increased from 125mg to 112mg during
the pregnancy. I gave birth in Oct. and my dose was decreased to 100mg in
December. in mid Jan my TSH was @ .43. Now in early March my TSH is .088 and
my T4-Free is 1.98. My Dr. advises to decrease back to 88mg. My question is
will this be a sufficient decrease? Can this affect my child in any way in
regards to affecting the quality and amount of breast milk? I originally
thought the dose needed to be increased as I seem to be having the same
symptoms as when I did the radioactive iodine e.g.. significant hair loss,
weight gain despite working out three days a week(I have always been
skinny), lethargic, depressed etc. I read an earlier response also about
cold medicines not affecting properly managed individuals. I have found that
I get palpitations and shortness of breath when taking them. I've just
settled for OJ and water as my cures. Any other suggestions? Coleen Jackson
RESPONSE- Probably you will need to
go back to the same dose you took before pregnancy, if your weight is about
back to normal. The tiny excess hormone (if present) certainly will have no
adverse effect on your infant. Mild hyperthyroidism could relate to
palpitations, but I hesitate to relate it to your other symptoms. L De
Groot,MD
HAIR LOSS AND NORMAL THYROID TESTS 21 Feb
2006
QUESTION-What do you know about Wilson’s Thyroid Syndrome and T3 & T4
treatments? In July, 2005, I had my thyroid levels tested. Everything was
considered “in range”, except Antithyroid Peroxidase which was 46 when
range should be <35 Iu/ml. As a result, I was diagnosed as Hypothyroid and
began the Wilson’s Thyroid Syndrome regiment (T3/T4 compounds) in July, 2005
(for about 7 months now) where I take my temperature every morning,
evening. Starting with 7.5 mg, If my temperature is below 98.6, I would
escalate up another 7.5 mg etc. up to 37.5 mg. My temperature is steadily
around 97.9 – 98.1.
I have felt an increase in my energy level and able to sleep much
better at night, plus my night sweats were eliminated. However, I am
experiencing an abnormally severe hair loss. I am 50 years old, and have
always had issues with hair breakage---but they were short pieces, spurts of
growth and then slight breakage (due dry hair and possibly peri-menopause).
Now I am losing full, long strands with white bulbs on the tips to a point
of bald patches in the back and sides of my head. Additionally, I am
experiencing severe thinning in the top ---you can see clear through my hair
to see my scalp. I do not have a perm or use chemicals on my hair. I do
use hair coloring, but brands with no peroxide.
It’s winter where I live, but my skin is dry and is very itchy and
stings. I am frantically scratching---but there is no rash. I have not
lost any weight as I was expecting. My metabolism seems to still be slow.
In August, 2005, a sonogram indicated a large mixed nodule on the
left side w/ no abnormality---2.0cm x 2.7cm in diameter. A biopsy showed it
was not malignant. I am not experiencing any pain---so I have not made a
decision to have removed at this time.
What do you recommend my next steps should be? I have made the
decision to stop the T3/T4 regiment as I only experienced this drastic hair
loss since being on the medication. My dermatologist is baffled. My
thyroid surgeon recommended I see a Doctor of Internal Medicine---I’m
confused. Do I need to see an Endocrinologist or Hormone specialist? Is
there something else I should be taking for my hypothyroidism, or to
generate hair growth? I want so much to solve my hair loss problem and am
not sure what’s causing the loss. Will it grow back? Can you give me some
general direction where to begin? T3, Total – in
range at 1.2 Reference 0.6 – 1.8 ng/ml
T3 Uptake – in range 29.53 Reference 24.4 – 39.1%
TriiodoThyronine Free 2.6 Reference 2.3-4.2 pg/ml
T4, Total – in range 7.2 Reference 6.5-10.5 mcg/dl
Free Thyroxine Index 7.1 Reference 6.0-11.4
Free Thyroxine (FT4) 1.0 Reference 0.8 – 1.8 ng/dl
TSH (3rd Generation) 1.620 Reference 0.35-5.50 mciu/ml
Anti-thyroglobulin AB <20 Reference <40 iu/ml
Thyroglobulin 23.7 Reference <=55.0 ng/ml
AntiThyroid Peroxidase Out of Range 46 Reference <35 iu/ml
Even though I was primarily “in range”, my symptoms were low energy, low sex
drive, wintery skin, restless nights, irritability, inability to lose
weight, night sweats, stiffness, hot/cold intolerance. My doctor felt it
was better to treat the symptoms. There has been some improvement as noted
below. But no weight loss (not 1 lb), low sex drive, wintery skin, hot/cold
intolerance is still a factor Diane Peoples.
RESPONSE-You had a thorough set of thyroid tests, and they are all
normal. Thus it is not possible to attribute your symptoms to a lack of
thyroid hormone, no matter what your arm-pit temperature is. The predicament
you have is similar to that bothering many middle aged women. There are
many causes for hair loss, so you need a careful medical evaluation, which
unfortunately often ends up "negative". Hair loss is certainly associated
with alterations in thyroid hormone levels, especially when changing from
hyper- to hypo- and back again. Hair loss is common with aging, serious
illness, psychological stress, excess androgens, and can be due to
autoimmunity. You apparently have low levels of anti-thyroid antibodies, so
to some extent, Hashimoto's thyroiditis. This could possibly be related to
hair loss, but in view of normal thyroid function, does not offer an
approach for treatment. So probably the best advice is to have a thorough
medical exam to rule out other illness, consult your dermatologist about
possible treatments, but not expect miracles to recover the hair. L De
Groot, MD
PAINFUL HASHIMOTO’S THYROIDITIS
10 FEB 2006
QUESTION-I am not a doctor, but am in need of advice. If you cannot reply,
I understand. I am a 40 year old female that was diagnosed with
hypothyroidism six years ago. I was placed on levothyroxine and up until
one year ago, was doing fine. In January of 2005, I started losing weight.
Then in June of 2005, my thyroid became enlarged, with significant pain. My
doctor sent me to an endocrinologist, who diagnosed subacute painful
thyroiditis. At this time, my TSH was low, and FT4 was high and my T3 number
was so high that it did not register. I had all of the symptoms of
hyperthyroidism. I was placed on a beta blocker and was taken off of my
levothyroxine. The enlarged thyroid and pain persisted, and in July I was
placed on 40 mg of prednisone per day. At this time, I also went back on
the levothyroxine, at 125 mcg. After a month of prednisone, they tapered my
dosage, but as soon as I got down to 10 mg, the inflammation and pain would
come back. I was then sent to the University of Michigan Health Center,
where they diagnosed me with Hashimoto’s thyroiditis. After one month, I
was to again told to taper my dosage of prednisone and again when I got down
to 10 mg, the inflammation and pain would come back. We tried to taper the
dosage eight times, with no success. I went back to the University of
Michigan in January 2006. The ultrasound confirmed the Hashimoto’s and the
thyroid is still enlarged. At this time, I was taking 5 mg of prednisone
per day and I was instructed to stop taking the prednisone on 1/27/06. Two
days off of the prednisone, I had severe prednisone withdrawal symptoms
along with a very enlarged thyroid, and extreme pain. I am back on 5 mg of
prednisone. They have also placed me back on a beta blocker, as I have
episodes of heart pounding and tremors. I am currently having weekly flare
ups and the thyroid is still quite enlarged. There are days that you can
see it from across the room and it has been extremely tender. During these
flare ups, I have difficulty swallowing, and the pain radiates up into the
ears. U of M told me that I have two options. One is to stay on the
prednisone for another 6 months to a year or the other is to have a
thyroidectomy. The side effects from the prednisone have been horrible. I
have a history of ulcers, and take Prevacid daily. My bones are becoming
brittle. I broke a rib from coughing. I have bad leg cramps and weakness.
I am told that because of the enlarged thyroid, and because it has been
enlarged for so long, surgery risks are increased. Is this true? My
question is, are these my only two options, or should I get another
opinion? I am afraid about the risks of surgery, but am desperate to get my
quality of living back to what it should be. Any insight that you can
provide would be greatly appreciated. Julie Lofgren
RESPONSE- Assuming everything you say
is "as is", and that the diagnosis is really painful Hashimoto's thyroiditis
(and not subacute thyroiditis), thyroidectomy sounds like a conservative
answer to your struggle. We have reported this problem, treated with
surgery, and sometimes RAI in addition.(Go to PUBMED on your browser and
search for "degroot lj AND painful thyroiditis") L De Groot,MD
FLUORIDE
AND THYROID FUNCTION- 6 Feb 06
Does fluoride indeed
affect the thyroid levels? I have Hypothyroidism and take Levothyroxine.137
1x daily. I am a Dental Hygienist and I would like to know for myself and
for my patients. I use a fluoride toothpaste and I recommend it to my
patients. I also give every patient a fluoride treatment after a cleaning.
So any information would be very helpful. Thank You. Robin Carney RDH
RESPONSE- I have never heard that the concentrations used in toothpaste
en the tablets given to children affect the thyroid in any way.Below you
find a report of a study in workers contaminated with fluoride because of
their work that do not affect thyroid hormone blood levels. I do not know
what amount you use after teeth cleaning. Is that really necessary when you
use fluoride also in toothpaste? You may know that fluoride in toxic doses
may cause bone abnormalities. See also abstract below Georg Hennemann, MD
Epidemiologic assessment of
worker serum perfluorooctanesulfonate (PFOS) and perfluorooctanoate (PFOA)
concentrations and medical surveillance examinations.
Olsen GW,
Burris JM,
Burlew MM,
Mandel JH.
J Occup Environ Med. 2003 Mar;45(3):260-70.
Perfluorooctanesulfonyl fluoride (POSF, C8F17SO2F) is used to create
applications for surfactants and paper, packaging, and surface (e.g.,
carpets, textiles) protectants. Such POSF-based products or their residuals
may degrade or metabolize to PFOS (C8F17SO3-). PFOS concentrates in liver
and serum and results in hypolipidemia as an early effect of cumulative
dosages. Male and female employees of two perfluorooctanyl-manufacturing
locations (Antwerp, Belgium and Decatur, Alabama) participated in a periodic
medical surveillance program that included hematology, clinical chemistry,
thyroid hormone, and urinalysis testing. Serum concentrations of PFOS and
perfluorooctanoate (PFOA, C7F15CO2-, used as a fluoropolymer emulsifier)
were measured via mass spectrometry methods. The mean serum PFOS and PFOA
concentrations for 263 Decatur employees were 1.32 parts per million (ppm;
geometric mean 0.91, range 0.06-10.06 ppm) and 1.78 ppm (geometric mean
1.13, range 0.04-12.70 ppm), respectively. Mean concentrations were
approximately 50% lower among 255 Antwerp workers. Adjusting for potential
confounding factors, there were no substantial changes in hematological,
lipid, hepatic, thyroid, or urinary parameters consistent with the known
toxicological effects of PFOS or PFOA in cross-sectional or longitudinal
analyses of the workers' measured serum fluorochemical concentrations.
HYPOTHYROID AFTER TREATMENT FOR TOXIC MULTINODULAR GOITER
QUESTION- I am writing you for help. I have been a thyroid patient in some
form for the last 8 years. The reason I am stating in some form is that I
have had several thyroid related issues in the last 8 years. My first
abnormal TSH test came back in August of 1998 with a level of 0.32. After a
couple of other blood work ups I was sent for an uptake and scan. At that
time my scan showed a large hot nodule and an increased uptake. My PCP at
that time thought I had subclinical thyroiditis. They placed me on a high
dose of prednisone to be tapered off with in four weeks. After two weeks I
went in for a follow up and my doc decided to taper me off quickly as I had
gained 12 pounds in that two weeks and my symptoms showed no change. At
that time I began having more symptoms of hyperthyroidism with the rapid
heart rate, hot flashes, insomnia, and inability to concentrate. Unlike
most hyperthyroid patients I had an increased weight. It took me until
April of 1999 to began being taken seriously for my symptoms as my doctor
noticed that the right lobe which had the hot nodule was becoming larger.
At that point I had an ultrasound done and another uptake and scan. The
ultrasound showed a cold nodule with no blood flow. The uptake and scan
again showed increased uptake and a hot nodule that was slightly larger than
the original scan. I do not know the exact levels of the uptake. I then
was referred to a general surgeon as my symptoms had increased. I had neck
pain, difficulty swallowing, rapid heart rate, hot flashes, insomnia,mood
swings, muscle weakness, and severe fatigue. At that time my surgeon
diagnosed me with Plummer's Disease (Toxic Nodular Goiter). I was scheduled
for surgery two weeks later. Surgery took longer than expected due to the
size of the nodule once the surgery was under way. My doctor told me it was
golf ball size so that I would be able to understand opposed to
millimeters. I began to notice a remarkable difference almost immediately.
I lost all of the 40 pounds I gained in total and felt great.
About a year and a half later I began to feel bad again. I had
problems again with weight gain, muscle weakness, mood swings, heart
palpitations. I had them run my labs and the only abnormal result was my T3
which at that time came back as 291. Since I had already had the right lobe
of my thyroid removed they thought that maybe I was beginning thyroid
decline which I had been warned might happen. At that time they put me on
.25 synthroid. My symptoms worsened, I began sleeping all the time and had
no energy. They changed it to 25 of cytomel to see if maybe there was a
conversion issue. I felt better and had a little more energy. I stayed
this way for close to another year. As I continued to gain weight and feel
worse, I just thought it was me and this is how I was supposed to feel. I
went to the doctor in May of 2003 and had labs drawn. Again my TSH and T4
were normal. My T3 again was 246 still way above normal. My doc at the
time refused to do anything stating they weren't abnormal enough to worry
about even with my history. I began to see another doctor who was a little
more progressive. He suggested a new uptake and scan. The scan showed
increased uptake on the left side that remained and some residual growth on
the right side. At that time my TSH was back into the hyperthyroid stage
again. I was sent to a endocrinologist who did a physical examination, and
review of labs and the uptake and scan, as well as new blood work. My TSH
at that point measured 0.17. I was diagnosed at that time with Grave's
Disease and due to increased risk due to scar tissue it was suggested that I
have RAI. I went in two days later for the RAI of 17 microcurions (sp?).
Within 2 days I began to have symptoms of radiation thyroiditis. My
endocrinologist considered it the worst case he had ever seen and that I was
lucky at that point to only have half of my thyroid as it was severly
swollen. Within 6 weeks I had a TSH of 79. I began levoxyl at that time.
I began at 127 then moved down to 112 back up to 127 then 137 to 150 and
finally to 175. At that time I was asked to come back in 6 months. I did
not have insurance 6 months later and my doctor would not refill my levoxyl
without new labs. I ran out of levoxyl and was off of it for a month. I
ended up in the emergency room where my TSH was over 300 the point where the
lab stopped measuring. They gave me a prescription for 150 levoxyl. I was
able to get insurance and see a doctor in August. She ran new labs at which
time my TSH was still high I believe it was close to 12 and she wanted to
see if it came down in a month due to my being off of it for so long. When
I ran new labs my TSH was up to 17 but my T4 and T3 were normal. She
thougth this was indicative of possible pituitary problems so she had the
office endocrinologist see me the following week. He said he did not think
that there was an issue with my pituitary and ran a full panel of pituitary
tests. Again they raised my levoxyl this time to 150 one day and 175 the
next alternating. Well I went in a couple of weeks ago and had my TSH and
T4 drawn again. My T4 came back at 1.10 which is mid-range. My TSH however
went up again to 20.9.
After going through all of this for so many years I have gotten
to a point where I do some of my own research. I know most docs don't like
this, but you can only feel bad for so long before you start to look for
answers. Right now I have a variety of symptoms besided feeling awful. I
am have gained 30 pounds again. I am have severe dry skin, fatigue,
headaches, difficulty concentrating, muscle weakness, and visual problems (I
have had since grave's diagnosis). My question is am I losing my mind? I
have no thyroid function and I thought that as long as my T4 and T3 were
normal my TSH should be too. The only thing I can find that fits what my
labs are showing and I am feeling is a TSH Secreting Pituitary Adenoma. My
doctor doesn't want to run an MRI or CT. Is it within my rights to demand
one? Do my symptoms truly match those of someone with a TSH pituitary
adenoma? I am looking for help, any advice is appreciated and words are
never a diagnosis I am aware. So any thing you can offer me is
appreciated. Stephanie L. Jackson
RESPONSE-On the basis of the supposition that your story is exactly how all
happened (I have not heard the standpoint from your doctors), the least that
I can say is that I am not impressed by some aspects of the medical
expertise that you were confronted with.
I
feel no urge to go into detail
about this comment. I just like to say that you are now (most probably)
permanently hypothyroid. It is far from true that the TSH value is not
important as long as the T4 and T3 is normal. In contrast, the reverse is
true, i.e. as long as the TSH is in the range that is the best when treated
with thyroid hormone, which is between 0.4 and maximally 2.0, the value of
T4 and T3 are of little importance. The TSH is by far the most sensitive
measure to monitor optimal thyroid hormone substitution. I am almost
convinced that if you guard your own lab results and fulfill this criterion,
no matter what your doctors say, you will ultimately (this may take some
time) feel normal again. I agree that that is no reason for a MRI or CT of
your pituitary, because your thyroid hormone values are ‘normal’ for a
person who is still under substituted with thyroid hormone. Georg Hennemann,
MD
HYPOTHYROIDISM
TREATMENT, SOY, AND PREGNANCY - 12 JAN 2006
QUESTION(S)-I have been looking at your site and hope that one of the
experts has time to consider the below and provide some answers.
I was diagnosed with
hashimoto's earlier this year (July) following a positive test for
antibodies and an ultrasound of my neck (which showed a number of small
nodule). I have had a noticeable goiter (about twice the normal size) for
about 15 years (it was first noticed when I had glandular fever as a
child) and my TSH level has been regularly checked (and always been within
the 'normal' range), this year I was tested for antibodies for the first
time. Since diagnosis I have been on 'oroxine' (600mcg / week). My TSH
levels have dropped (from 3.3 in July to 0.68 in November), my FT4 has
increased slightly (16 to 19) and my FT3 is pretty stable (4.7 to 4.6).
Following my diagnosis my Mother has also been diagnosed with hashimotos
(she has no symptoms) and I know that my Grandfather (on the other side of
my family) had thyroid problems and had his thyroid removed in the early
1940s.
Two months before the hashimotos diagnosis I had a miscarriage at ten weeks
(the baby was only 6w2d - my TSH levels were 'normal' during pregnancy). We
have been trying to conceive again since August (last time we got pregnant
on the first cycle). Since I started on the 'oroxine' my periods have been
getting longer (from having always been 27-8 days now up to 32 days last
cycle) and I am worried that the hashimotos or the oroxine is interfering
with ovulation. Is my lengthening cycle just coincidence or could it be a
result of the hashimotos or oroxine and if so, what does that mean in terms
of trying to conceive? The ‘normal’ levels
of TSH of people using thyroxine, is different from that in the normal
population, in that it is between 02-04 and maximally 2. The FT4 under these
circumstances is in the high normal range. In fact as long as the TSH is OK,
the values of FT4 and T3 are not important. Under these conditions there is
no influence on the ovulation, cycle, or conception
What levels should my TSH, FT3 and FT4 be
to allow conception and maintain pregnancy?
See above
When we do conceive, other than regular
TSH tests, are there any tests or treatments that I should request?
NO
I've never had any thyroid symptoms (other
than the goiter and indigestion problems) but have read that I should be
avoiding salt and soy products (I am intolerant to lactose and fat so I have
a lot of soy products), is this true? there
is no specific reason to avoid salt. Soy however is an other story. Soy
interferes with absorption of thyroxine from the gut. To avoid this you
should take your thyroxine on an empty stomac. It is not known how long you
should wait before taking soy to avoid this problem. I would guess at least
3 hours, if complete avoidance is possible at all!
I have recently moved countries and feel very much in the dark as I don't
have a specialist or Doctor here yet to consult with and would really
appreciate any advice you might have on managing hashimotos, particularly in
relation to conception.
In almost all women the dose of thyroxine
has to be increased during pregnancy. This is very important for optimal
brain development for the child. As soon as you have conceived you have to
increase the dose you are using at that moment, by 30%. Then have your TSH
checked every month during pregnancy to keep it around 1. After delivery you
may go back to the original dose.
Georg Hennemann, MD
Thank you for your consideration. Kind Regards, Gemma.
CONFLICTING OPINIONS ON A NODULAR GOITER
12 JAN 2006
QUESTION-Glad to come across your ad so I'd be learning more about my
thyroid condition. I'm Ryanna,female,34, from the Philippines.I've been
under medication for nodular goiter for 2 years. I started with eltroxin
100mg for about three months but when I went to a new a new doc, my
medication was changed to euthyrox. T3 =1.62 nmol/1, T4= 92.90 nmol/1,
TSH= .75 uIU/mL as of June 2004 result. My first ultrasound was done
6-1-04: Right thyroid gland enlargement with a cystic nodule.R thyroid gland
is enlarged measuring 4.9x2.5x3.0cm with a cystic structure measuring
1.8x1.0x1.8cm with a volume of 3.8cm. Euthyrox dosage started from started
from .25mg and gradually raised to .50, .75 and now to 100mg. Ultrasound as
of 6-14-05 shows Right Thyromegaly stable in size with progression of the
cystic nodules. A new cystic stucture was noted inferior to the previously
noted nodule. FNAB as of June 2005 = Negative for Malignant Cells. My
ultrasound as of 10/24/05 shows a .56x.42x.23cm(LWH) with a volume of .03ml
hypoechoic solid mass in the superior aspect of the isthmus, solid mass with
cystic changes in the right lobe of the thyroid gland measuring
4.19x2.7x2.42cm(LWH) with a volume of 14.21ml. The cystic structures
measures 1.82x1.5x1.19cm(LWH) with a volume of 1.7ml and
1.27x1.03x.51cm(LWH) with a volume of .35ml. I was then advised for an
operation.I sought for a second opinion then,.The new doc asked for another
FNAB and the result shows cells suspiscious for malignancy, of papillary
origin, and was also advised for an ops. I was then alarmed so I thought of
taking another opinion. TSH result = less than 0.05 uUI/ml as of January
2006. I'm still watiting for the ultra sound result as of this moment.My
concern here is that if I could get well through medication and not undergo
an operation,then the better...Do you think it's ok that I change doc for
the third time?Aftyer all, it's a patient's prerrogative , right?
I'd be very glad to hear from you so I could better decide whether i should
really submit myself to the operation as the doctors here suggested. Have a
great day(*?*) -- RYANNA
RESPONSE-This is not an easy problem! If I understand the situation
correctly then you have partly solid and partly cystic lesions in the right
lobe and the isthmus. They are progressive despite treatment with thyroid
hormone. You have one FNA negative and one positive for malignancy. If the
pathologist is experienced then I think operation should follow. If he is
not that experienced in FNA’s, I suggest to have both FNA’s evaluated by a
third pathologist with a nationwide experience in FNA’s. I am sure that my
good friend Dr Mazzefari, who is a world known specialist in thyroid
carcinoma, can help you further. I send him a copy of this e-mail.He will
certainly advise you too what to do and if his advise goes against mine, do
follow his! Regards, Georg Hennemann
ANTITHYROID DRUGS VS
RAI OR SURGERY 6 Jan 06
QUESTION-Dear Sir/ Madam- I'm not a physician, only a 28 year-old lady
aspiring to study graduate medicine. I was previously a consultant in audit
risk management. In October 2004, I was diagnosed with Graves' Disease:
T3 >12.0 (1.57- 2.59 NMOL/L);T4 >90 (9.6- 19.1 PMOL/L);TSH <0.006 (0.36-
3.24 MU/L); andTSH Receptor Antibody >40.0 (0.0- 1.5 IU/L).
I was given Lugol's iodine mix for a week and started on antithyroid drug of
20mg. Currently, my daily Cabimazole dosage of 10mg has controlled my T4 at
12.42 (10.00- 20.00 pmol/L). TSH is 0.014 Low (0.290- 3.770 mU/L). I still
have a goiter which occassionally becomes painful in the evening.The
problem arose 6 months after medication, when my doctor recommended me for
RAI. My parents felt that it wasn't the best option for me and we switched
physician, hoping to find a dedicated doctor who cares for patients more
than the number readings. Nevertheless, my current doctor also seems to be
getting impatient on me and has been pursuading me into RAI, otherwise
surgery, for the past 3 months (or 1 year since the onset of Graves'
disease). Although my T4 of 12.42's within the lower normal range, I'm
already experiencing the hypothyriod symptoms such as muscle aches in my
body, retardedness, decreased concentration and weight gain. Comparing the
hyper and hypo stages, I definitely function better in a slightly
hyperthyriod one. No way would I trade my body for a life-time hypo plus
hormone replacement. My doctor claimed that "it would be much easier to
taking only 1 pill after RAI" but I could foresee the difficulty of
adjusting to the right amount of thyroid hormone after the body enters the
permanent hypo stage. The body will be fighting against the hypo symptoms at
one point or another as the thyroxine hormone can never be accurately
prescribed. It will not be me when I cannot push myself to perform to my
full potential and concentrate in my studies, muscle pains, lethargy and
weight gain. The outward physical ills are secondary, the body has to cope
with life-long hypo symptoms which decrease the quality and momentum of
life. For an older woman entering menopause, the body would not adjust as
well with fluctuating hormonal changes and slower metabolism. How many
patients actually thank their doctors after gulping down mouthful of RAI?
Why wasn't proper informed consent presented to the younger patients about
the after-years effects of RAI? Why are doctors rushing patients into
irrevocable options when 1- 2 years of antithyroid drug trials are not up?
Wouldn't a patient on medication be given a higher chance of remission of
illness? This can be easily achieved by doctors without having to adjust the
standing antithyroid dosage much.
If my physician bugs me in March again, I am prepared to sack
him for another doctor. Is this the practise at your side too and for what
reason, or is this only happening in Singapore? I am thankful that
antithyroid medication at least gives me hope for a miraculous recovery-- to
be free of medication one day. This would not be possible with RAI. The
option of surgery, on the other hand, has its shared amount of risk. What
do you reckon is the best option in the patient's interest? Yours Sincerely,
Celeste Yeo
RESPONSE- The vast majority of patients seem to do well after RAI therapy,
or surgery, but of course some have problems. Often it is difficult for
the physician to know whether the problems are due to the thyroxin
replacement, or another situation in the patient's life. Life is
complicated, and everything interacts with how a person "feels". You can
continue to take antithyroid drugs for years, and unless you have a reaction
there is no absolute reason to stop. MDs typically suggest RAI or surgery
after one or two years of pills, if there has been no sign of remission.
This is because usually life is simpler on replacement therapy than on
antithyroid meds, and because, as I note, most patients feel well and normal
on the pills. I suspect that if you discuss this with your MD, he/she will
agree to follow you on the pills until you remit, or grow tired of the
process. L De Groot,MD
THYROID AND WEIGHT GAIN, REDUX !
QUESTION-hi my name is louise i have had under active thyroid for about 13
yrs now i feel ok most of the time but sometimes i feel i cannot eat
anything because i gain weight so fast and very easy.I cannot eat fruit or
veg or i would is there anything i can eat that won't give me a bloated
stomach every other day thanx louise
RESPONSE-You have to be treated with thyroid hormone, if this is not already
the case. Your doctor has to see, in order that you get the appropriate
amount of thyroid hormone, that your TSH blood level is between 0.4 and
2.00If the latter is the case, any weight gain is not caused by your thyroid
problem.Regards,
Georg Hennemann, MD
BULIMIA AND EXCESS THYROXIN
QUESTION- I am sorry to bother you with this question, but I have researched
my
question on the internet and cannot seem to find an answer. I am bulimic,
and in addition to purging and laxatives I take 10 x 100mcg Oroxine tablets
a day. I know that this is a bad habit, and I am working
out my problems with a therapist, but I would just like to know the exact
repercussions that I may face if I continue taking this kind of dose. At
the moment I am continually restless, my legs ache and I get some pretty
bad pains in my chest... Can you tell me exactly what might be happening?
Kind Regard, Jean
RESPONSE- Oroxine is the Australian brand of thyroxin, and if you actually
absorb all
of 10 X 100ug of thyroxin each day, you will become dangerously
hyperthyroid. ("thyrotoxic "). That is 6 to 10 times the usual dose, and
could cause heart failure and death. I hope I have been clear about the
danger. L De Groot, MD
SPONTANEOUS VARIATION
IN TSH LEVELS
QUESTION-I am not a physician. I am 45 and started suffering from severe
menstrual irregularities about 4 years ago. After an abalation, I switched
to another GYN closer to me who happened to be a reproductive
endocrinologist. She couldn’t understand why tissue taken during the
ablation was from both before and after ovulation and apparently neither
could the pathologist. That and the fact that my sister has Grave’s and my
mother has Addison’s and a hypoactive thyroid prompted her to do a TSH. My
TSH history is below.Ablation May2003
Jan05 TSH=3.087
July05 TSH=0.67
July05 TSH=0.61, t4=9
Aug05 TSH=4.255, 1.198
Dec05 TSH=2.77
Lab normals for TSH =0.3-5.5
Any ideas on the reasons for the TSH fluctuations? In addition to periodic
sweating and palpitations and a dizzy spell or two, which are resolved now,
my menstrual cycles are all over the place (20-54 days) and the GYN says
this is not due to perimenopause based on other tests she’s done. My GYN
said to come back in another couple of months for a repeat TSH. Thanks much!
Michelle
RESPONSE- Certainly your genetic
heritage suggests you are prone to multiple endocrine autoimmune diseases. I
would guess that, assuming the TSH levels are accurate, you have Hashimoto's
thyroiditis, and that your thyroid produces variable amounts of hormone from
time to time. Another explanation might be related to adrenal autoimmunity
(much less common), which could affect the thyroid. I suggest that you MD
check anti-thyroid antibodies, and adrenal function. On the other hand, all
of the TSH levels, save one, are
in the normal range, so there does not seem to be any acute problem. Leslie
J De Groot, MD
TSH REMAINS ELEVATED-20 Dec 2005
QUESTION--Hi, I have been experiencing elevated TSH levels on my last 2
checkups, even though I never miss a dose of the Synthroid. I had been
having normal levels but 6 months ago my first TSH was 22.0. I attributed
this to having taken the medication approximately 2 hours before having the
labs drawn. A follow up was much lower. A few weeks ago, the first level
was 12.0 and it was 9.0 when re-done. I am not having considerable fatigue.
My doctor does not want to adjust the dose as of yet but I am just
wondering what would cause this elevation regardless of the fact I'm taking
the meds correctly.:
Wrosebush@wmconnect.com
RESPONSE- There could be many reasons. Have you gained weight? Are you
pregnant? Do you have Hashimoto’s thyroiditis? Did you change brands of
thyroxin? Are you on another medication, iron, or other material that might
alter your dosage? Maybe you just do not have quite a big enough dose. If
none of these factors are present, and your TSH remains elevated, you most
likely need more hormone. L De Groot, MD
THYROID HORMONE DOSE
AND WEIGHT GAIN 11Oct 2005
QUESTION- I HAVE BEEN DIAGNOSED WITH THE ABOVE ABOUT 2 YEARS AGO. I
HAVE A QUESTION ABOUT TRIGGER FOODS.
ARE THERE FOODS THAT TRIGGER THE MY PROBLEM
TO MAKE THE WEIGHT GAIN COME ON? WHEN I AM FUNCTIONING FINE
I CAN TAKE THE WEIGHT OFF PRETTY EASY. I HAVE HAD A CONTINUALLY FLARE UP
SINCE THE SECOND WEEK OF AUGUST. ALL THE WEIGHT I TOOK OFF HAS CAME
BACK.. IT IS A UNUSUAL FEELING OF EXTRA WEIGHT. (SQUISHY FAT AND IT IS
ALL IN THE MIDDLE) IT IS VERY HARD TO EXPLAIN. ONE OF THE THINGS THAT MADE
ME MAKE MY DOCTOR PERSUE THIS WAS I WENT FROM A 7/8 SIZE TO A 12/14 IN THREE
TO FOUR MONTHS. PLEASE HELP.
PAHARRIS@MANDTBANK.COM
RESPONSE, as long as you are being treated with the proper thyroid hormone
dose and consequently your TSH is normal (not higher than 2.0) the thyroid
hormone dose can not cause increase your bodyweight. There is one exception
and that is that if you still have a partially functioning thyroid, excess
iodine can further suppress its function. However if you are on a full dose
of thyroid hormone iodine can not hurt you either.Discuss this with your
doctor. Georg Hennemann, MD
PROPER DOSE OF THYROXIN-23 Sep 2005
Question-I am a 34 year old female. In late May this year, the doctors
discoverered my T4 level to be low. I was placed on 25 mg of Synthroid. In
July, the dosage was raised to 50 mg, because the T4 level was still low. I
have recently startted to gain weight rapidly-12 pounds in 2 months and I am
very active. I am wondering when or if this will stop. I want to stop
taking the Synthroid, but it is working for my other symptoms. What shall I
look for? Dawn
Response-The only way to check if substitution with thyroid hormone is OK is
to measure blood TSH. This should have a value no higher than 2.0,
preferably 1.5. The level of FT4 is of secondary value.
Georg Hennemann, MD
VERY ELEVATED TSH LEVEL
24 Sep 2005
QUESTION-March my TSH level was checked and was in the
approx 780. My doctor wanted to recheck before putting me on medicine..so
in April my level was 895. The doctor, before putting me on medication,
wanted to have the ultrasound and subsequent radioactive iodine scan. Which
came back normal. So I started Synthroid at .25mcg with the doctor noting
that the medicine would most definitely need to be increased, but wanted to
wait a few months to see the effects. So I just did my bloodwork and the
doctors office called that the TSH level is 1200. I know this is way out of
range and will be going in to see the doctor, but am very curious at why
with medicine my TSH has increased. To
note, my symptoms that persisted prior to medication are gone (constant
menstruation, inability to tolerate cold, etc....) The only symptom I seem
to have developed recently are dizzy spells and muscle cramps. Any help
would be greatly appreciated.Thank you ~Sherri
Response-Your TSH results are almost certainly an artifact in that these
values are most probably caused by circulating anti-bodies against TSH in
your blood, interfering with the test.This can be easily sorted out by the
laboratory chemist. He should perform so called “dilution curves” of your
blood TSH and of the standard TSH of the test and compare parallelism of
these curves. This phenomenon has no health consequences for you. There is
no reason to continue using thyroid hormone. This assumption is based on the
presence of a normal FT4. If this value is also elevated then it is
theoretically possible that your pituitary produces too much TSH. To
investigate this, a MRI of the pituitary can give the answer.
Georg Hennemann, MD, PhD, FRCP
REACTION TO ANTITHYROID DRUG
Question-I hope that you will find a time to answer my question although
I am not a physician. I am a pharmacist and recently I have been
diagnosed with hyperthyroidism, precisely with Grave’s disease. I live on a
small tropical island and I would have asked my physician what to do but the
problem is he is out of the island and there is nobody else available. I
started taking Methimasole 20 mg 2 times a day on 25th of May
2005, and I started feeling much better (my hair stopped falling, my pulse
became normal, excessive sweating and shaking has been decreased) but
yesterday when I got my blood results I noticed that liver enzymes have
increased which left me in doubt what should I do next-decrease the
dosage of the medicine or discontinue it because of possible hepatotoxicity?
Grave’s disease was diagnosed based on the following results: 20 may 2005
FreeT4.......4,12 ng /dl (0,9-1,9),TSH...........0,007microUI/ml
(0,18-3,4)
TRAK (antibodies for tsh receptor)......4,4 (n<1,5 IU/L)
Dimensions of the gland were normal and without any nodules, ultrasound
results pointed possibility of Hashimotos.I had almost all the symptoms
except that instead of losing I gained weight and there was no goiter. My
eyes are not bulging, but sometimes I feel discomfort and redness.
After one month of therapy with Methimasole 20 mg two times a day, I got the
following results: Free T4.....2,3 ng/dl,Free T3.....5,0 ng/ml
(1,40-4,40), TSH...........0,005microUI/ml
GOT(AST).........42 U/L (0-40),
GPT(ALT).........89 U/L (0-38)
Alkaline Pho......80 U/L (37-137)
Bilirubin –di.......0,0 mg/dl (0-0.8)
Bilirubin-to.........0,4 mg/dl (0,2-1,6)
GGT....................29 U/L (0-60)
Bilirubin ind........0,40ml/dl (0,10-1,0)
CBC with film was normal except LYM%......50,8% (13-50)
I would very much appreciate your advice, because there is nobody else that
I can ask at the moment, I am 29 years old and haven’t had any major health
problems in the past, in my family there are 2 cases of hypothyroidism as I
know, and I have to mention that I had some major stressful events in the
past years (including death in the family).Vesna Nastovska,Pharmacist
RESPONSE-Methimazole
can certainly cause liver function abnormalities on the basis of allergy
and/or of toxicity. These abnormalities are very rarely serious and then
especially of the cholestatic type. In your case only ALAT is mildly
elevated. Apart from allergy or toxicity these abnormalities may also be due
to the hyperthyroidism itself. The high normal count of lymphocytes is due
to the Graves’ disease per se. A toxic reaction is likely less probable
because the cumulative dose used is so far very low. Most probably the
abnormal tests are due to the hyperthyroidism itself. As your
hyperthyroidism has been successfully (partially) blocked by methimazole, I
would suggest to decrease the dose to 20 mg daily. Check your liver function
tests for the time being twice a week and stop the methimazole if they do
not normalize in a few weeks and if they increase stop immediately. If you
have to stop, I would not advice to try propylthiouracil as there is
considerable overlap in side effects, but start with propranolol, 40 mg 3 or
4 times per day and have yourself treated with radio-active iodine
eventually abroad. You can even use prednisone in addition if necessary.Kind
regards, Georg Hennemann
HYPOTHYROIDISM AND JOINT ACHES
QUESTION-Is
there a relationship between inflammation of muscles/ligaments and thyroid
problems.
I had total thyroidectomy 1 year ago (actually 2 partials) for follicular cancer.
Lately I have had pain in the achillies tendon which passed. This week
it is in my knee, I do exercise but I have done nothing for a few days
and suddenly this afternoon pain in my knee. I can harldly lift my leg
but there is no radiating pain of visible inflammation. I took 600mg of
Motrin which has given me some relief. Someone told me that ligamament
inflammation can be related to the thyroid. Is this true?
kfrebo@comcast.net>
RESPONSE-
If you are properly treated with thyroid hormone to suppress your TSH,
your complaints are most probably not related to your thyroid condition.
G Hennemann, MD
ESTROGEN AND HIGH T3 LEVEL (24 MAY 05)
QUESTION-I have now been taking Diane35 (estrogen) for 6 months
following the doctor's advice for treatment of PCO (poliquistic
ovaries). Now I have the results of a recent blood analysis showing
high levels of T3, while
T4 and TSH remain normal. Values are as follows:
Triyodotironina (T3): 3.58 (ref. values 0.90-2.79)
Tiroxina (T4): 150.3 (ref. values 24.5-171.6)
Tirotropina (TSH): 1.94 (ref. values 0.35-5.50)
I am wondering if the high T3 levels are caused by the estrogen pills,
and what effect this might have.
I am supposed to stop taking those pills in September to control PCO.
Thanks! Victòria Mengual
RESPONSE-Estrogen raises TBG, which raises bound hormone, but not active
free hormone. This appears to be the situation since your TSH is normal. The
test should normalize when the estrogen is stopped, but it is not a problem
anyway. L De Groot, MD
HYPERTHYROIDISM AND
PREGNANCY (27Apr2005)
QUESTION-Hi I am in my 29th week of pregnancy. I have my thyroid
levels checked once a month and am on PTU's I currently am taking
150mg a day. My question is this every time have my thyroid levels
checked my TSH is less than .001 and my t4 is highly elevated. I
think around mid 20's. My question is this. What affect will
these levels have on my unborn child and what affect will the meds that I
am taking have on my son. I have had one ultrasound at 14 weeks and they
said it was a boy and everything looked good, and he is growing like he
should but I am not sure if anything could be happening to him because of
how long my hormones have been so messed up while I am pregnant
and the doctors dont seem to have an answer. I really would like to
know if there are complications or
possible birth defects that I could expect so that I can prepare myself
for these.> Michelle Rhodes
RESPONSE- Your thyroid overactivity should be controlled to the normal range
as soon
as possible. Hyperthyroidism can definitely cause difficulties in
maintaining a normal pregnancy. PTU is the usual treatment, and is not
anticipated to cause trouble with the fetus unless relatively high does are
required. It is best that you discuss all of these issues with your MD.
Regards, L De Groot,MD
ARMOUR DESSICATED THYROID AND SYMPTOMS (24Apr05)
QUESTION- Does Armour thyroid medicine, or the condition of hypothyroidism
cause a fast heart rate? I have been diagnosed with hypothyroidism about 3
months ago and am now on 90 mg of Armour. I check my heart rate during the
day and after resting for 15 minutes my heart rate is usually around 90-100
but sometimes it is higher. My doctor seems to think it is NOT from the
medicine but it sounds like the logical explanation to me. Thank you, Alica
RutherfordRESPONSE-
Dear Madam, I have personally no experience with Armour but can tell you
that as long as your TSH blood level is within normal range you are not
using an overdose. In overdose situations TSH is below normal or even
totally suppressed. Regards, Georg Hennemann
THYROTOXICOSIS AND PREGNANCY (21 APR
2005)
QUESTION-Hi. My husband who is 27 was diagnosed with 'grave's disease'
in February of 2004. He is currently on PTU and Propranolol, and his
endocrinologist has recommended he has the iodine therapy done, as the
medication is not working successfully. We are trying to fall pregnant, and
I am concerned about the affect (of any) of the iodine on a males sperm and
reproductive system. Should my husband consider freezing some sperm before
he has this done? Also, There seems to be lots of information regarding
women's fertility but not mens! Does having an overactive thyroid cause
infertility? If so, why? If infertility happens when your thyroid is
overactive, when the levels settle down, will fertility 'come back?' We
would really appreciate any advice you can give us. Thank you for your time.
RESPONSE- Thyrotoxicosis can reduce fertility, and it should return to
normal after treatment. RAI can damage sperm formation. Freezing sperm is
possible. Often males are advised to wait several months after RAI treatment
before planning pregnancy. L De Groot,MD
HYPOTHYROIDISM
AND PCO
QUESTION-I am 28 years old hypothyroid patient, married 4 years back.
We are trying to conceive from the last 3 years and 2 years back we found
that I am hypothyroid and have polycystic ovary also. From the last 2 years
I am having 100mgm Thyroxine sodium ( Electroxin from Glaxo) and ovary
ruptured ( one year back) by laparoscopy as per infertility specialist
direction to reduce PCO. But I am not yet conceived and the doctor says my
LH level remains too high during the initial period of my cycle and hence
the eggs are not growing or producing. Recently I tested my blood, blood
sample collected on 3rd day of my period, the LH value was 19,(
Reference range is 1.1-11.6) and the FSH is within the reference range.
Doctor please advise me on the following :-
a. Is there any relation between Hypothyroid and Poly Cystic Ovary ?
b. Is there any relation between Hypothyroid and LH surge on the initial days of period ?
c.
What are the probable cause of LH surge, other than hypothyroidism,
and treatments for a successful conceive.?
.Thanking you. Rachel.
RESP0NSE-As
far as I know, there is no relationship between polycystic ovaries and
thyroid diseases including hypothyroidism. Neither, certainly when
substituted adequately with thyroid hormone, between hypothyroidism and the
LH surge, as you indicate. The elevated LH levels in polycystic ovaries are
a characteristic feature of this syndrome but not fully explained. Other
causes of elevated LH are the post-menopause state and a benign tumor of the
pituitary gland. Georg Hennemann, MD
FACTORS ALTERING
THYROID BLOOD TESTS
Perhaps you could have the following questions answered in "the
patient
asks" section of
www.thyroidmanager.org. Thank you. Idlle Port. 4/2/05
1. For a patient who's hypothyroid because of autoimmune
thyroiditis and
taking thyroid meds, what effect could transdermal estradiol have
on
total T3, free T3, and TSH?.
RESPONSE- It will probably cause some increase in total T3
and temporary decrease in free T3, but in time the latter
should return
to the pre treatment level.
2. What effect might SHBG below normal (e.g. .5 (range
1-3)...hyperandrogenism) have on metabolism of thyroid meds and
thyroid
blood tests?
RESPONSE-Should not influence it.
3. Is atrophic autoimmune thyroiditis (nongoitrous) resulting in
hypothyroidism a distinct entity compared to goitrous Hashimoto's
disease?
RESPONSE- There must be some difference in the pathogenesis
(immunology) of the
conditions, but at the practical level treatment is the same.
4. What effect could the presence of anti-TG antibodies in the
absence of
anti-TPO antibodies have on thyroid blood tests for someone who's
hypothyroid?
RESPONSE- Unless the TG antibodies included the rare anti T4
antibodies, it should not make any difference. L De Groot,MD
CONTINUED HYPERTHYROIDISM AFTER SURGERY
QUESTION-I don't know if it's proper
for me to show my case here, but I'm in argent need 4 help. My name
is Salar Hesen Omer Berwari, I'm 28 years 28 years, male, single & I
work as a constructions engineer. I live in Duhok- northern Iraq, in
my city we don't have expert in thyroid diseases so I was going 2
another city 2 have treatment, but under the bad situation of
security in that city I couldn't meet physician any more, & it seems
that I'll not be able 2 go there till a long time.
I got Hyperthyroidism in 1997 & used 2 have carbimazole in deferent
doses starting from 12 tablets of 5mg/ day. But the size of the
gland still increased & the excretion of T3 & T4 was on, there I did
a surgery in Oct. 2002 & removed the great % of the gland (270 g). &
all features of Hyperthyroidism disappeared, & tests didn't show any
kind of cancer in the removed gland.
I was going on taking carbimazole after the surgery for about a
month, & after 3 months features of Hypothyroidism appeared, but I
didn't take anything against that, after about 5-6 months features
of Hyperthyroidism appeared again 7 the test of T3 & T4 show that
there was a great increasing. I started taking carbimazole again,
12tab.s for about 2 months, 9 tabs for 45 days, 6tabs for a month &
then 4 tabs till now, that with inderal & Predizolon according 2 the
physicians recommendations. But after that the size of the gland
started increasing under unknown reasons ( I was taking 4 tabs that
time) & after that features of Hyperthyroidism started again (pulse
increasing, high temp.) & now I don't know what 2 do. Can u plz help
me & show me what can I do till I meet my physician again?? Why I
was back 2 Hyperthyroidism after the surgery?? & why going on taking
carbimazole can't stop increasing the gland & the hormones?? For
information I don't have any family history of thyroid disease
and/or diabetes. Thank u so much.
Salar Barwari
RESPONSE-From
what I understand is that you have relapsing hyperthyroidism despite
thyroid surgery and continuation of carbimazole.
You also had an increase in thyroid size for unknown reason.
My general impression is that the dose of
carbimazole that you are using are higher than usually
necessary. We know that high doses can lead to goiter formation.
However if at the same time or soon after an
increase in goiter size during
carbimazole hyperthyroidism relapses, the
increased volume is probably related to the persistence of the
hyperthyroidism.
I think that it is very important to establish if you still
have hyperthyroidism. If that is the case the best treatment is
administration of radioactive iodine. Would that be possible in your
circumstances? If that is not the case you have to continue with
carbimazole in a dose that normalizes
your thyroid function properly until you can get permanent
treatment. I would strongly advise you not have a second operation
as in that case complications causing paralysis of your vocal
cord(s) and or inadvertent removal of your parathyroid glands are
possible.
If you can have your TSH and T4 being
measured periodically, I am quite happy to advise about the dose of
carbimazole that you have to take until
you can consult your doctor again. I am not very happy about the
fact that you use prednisolone.
Inderal is OK for the time being. Georg
Hennemann, MD
QUESTION-I have had a multinodular goiter for at
least 5 years, although I suspect its been more like 10 years.. I am
30ish female with multiple symptoms on NO meds, cause my doctor
likes voodoo medicine. The body canheal itself, etc.....I have
ultrasound once a year. Fine needle biopsy ,have lost up to sixty
pounds in a two month peroid, massive hair loss, periods have
dissapeared,6 months no period. dizzyness...singular
pvcs,tremors.heat intolarance cold intolerance,memory loss with
personality changes, TSH is .48...t4,9.8 my question is my dr says
labs are fine perfect do you think I need meds?
jlshearer <kwittenrkwitty88@sbcglobal.net>
RESPONSE-Voodoo medicine is potentially dangerous for any patient. My advice to patients is to turn away from doctors who practice this kind of quackery.
The complaints that you have are typical for someone who’s thyroid functions too rapid. It may be so that your lab results are (just) within the normal range. However this does not mean that they are normal for any subject, as the normal ranges of TSH and T4 are rather wide.
Your doctor apparently has not determined your blood T3 concentration. T3 is another thyroid hormone that is much more active than T4 and I would not be surprised, considering your symptoms, if this would be elevated. But even if this is not the case than I still think that your thyroid is (borderline?) overactive. This expectation is on the basis of the combination (1) of your typical complaints, (2) the fact that you have a longstanding multinodular goiter that very often develops into hyperfunction and (3) the combination of a low normal TSH and high normalT4.
Even if hyperfunction is borderline it can produce substantial symptoms on the long run, which is possibly the case with you.
My advice is to consult an endocrinologist who practices regular medicine.
Kind regards,Georg Hennemann
ELEVATED T3 LEVEL AND ESTROGEN
QUESTION-I am not a doctor but I have a medical question (I am going to
a doctor. soon) I had a thyroid profile II because i was having problems
with
anxiety (the doctor checked for graves because my sister has it) my
test results were the following: TSH 1.217, T4 12.9, T3 uptake 21,Free
Thyroxine Index 2.7, T3 241. My doctor is concerned about the T3
results and told me to go see my regular Dr (the first Dr is a Dr at my
school) I did some research and found that a high Estrogen level can
cause an elevated T3 level (I have been telling my doctors for years
that I thought I was producing to much estrogen) my question is can
High Estrogen cause an elevated T3 level or am I in early stages of
Graves and if it is the estrogen how do i get my doctor to test for
that I have been trying for years to get my hormone levels tested and
not just by one doctor. Erika
RESPONSE-
The normal TSH gives a strong indication that you do not have thyroid
hormone excess. Estrogen does increase the TOTAL levels of T3 and T4,
but estimates of the free level are normal when there is no thyroid
disorder. You do not give the units or reference ranges for T3 and T4,
but the T3 concentration, if high, will correct to normal when the low
T3 uptake is taken into account. If you are taking an OCP it would
explain these tests.
Hope this is helpful. Jim Stockigt, MD
THYROXIN DOSE AFTER THYROID CANCER
SURGERY
QUESTION--Hi I am a 46year
old female being treated for papillary carcinoma. In 1997 I had a
partial thyroidectomy and was told that my biopsy revealed follicular
neoplasm. I was told everything was okay. In April 2003 I was not
feeling to well and visited my doctor. I have an existing B12
deficiency and thought that might be my problem but I also stopped
sweating(I usually sweat alot) and was just not feeling to well.
My T4 was checked and my levels were to low according to my doctor.
I went from 75mcg to 100mcg and started feeling better. But in
August I started noticing changes in my voice and a lump in my neck.
My voice started to sound shaky and the lump was preventing me from
swallowing properly.. I went to my doctor and he ordered a
ultrasound of the thyroid. There appeared to be a mass in the left
side of the thyroid. The right having been removed in 1997.
I went for a FNA to biopsy the mass. The biopsy revealed
changes of either a follicular variant of a papillary neoplasm or
a follicular neoplasm. I had surgery in February of 2004.
The report reads as follows. The specimen was
sectioned in its entirety. The sections show multiple nodules of
varying sizes and the nodules contain follicles of varying sizes some of
which are very large. Some small nodules are composeds of very
small follicules. The largest nodule, witha nearby long black
suture, is also mainly composed of follicles but show a fairly large
component of papillae fomations.These papillae are arborizing in areas
and have a fibrous and fibrocascular stalk. The lining
epithelium is composed of columnar cells which are medium to large in
height. A few show nuclear grooving and a rare cell shows
internuclear vacuolization and some cells show clearing the nuclei.
The findings are those of a papillar carcinoma. This focus
occupies approximately .7cm in the center of this nodule which is
approximately 1.5cm in dimension. This case represents
papillary carcinoma.. I was told 6 weeks later of this
finding. I was also told by the surgeon not to worry it was no
problem because it was all removed. On seeing my
endocrinologist he informed that I would be needing treatment and this
was not to be taken lightly.. I was put on a low iodine diet
and taken off my levothyroxine. I was without my thyroid meds. for
11 weeks and was treated with I-131 and then given a body scan 2 weeks
later. My body scan showed 3 foci's. Two in the area of the
jaw and one in the lower left region of my clavicle. Four
months later my TSH levels and other blood work was done. My TSH
levels were to high and I was put on 150 mcg of levothyroxine as
the Endocrinologist informed me that cancer could come back. I
wanted to know if the 3 foci's were of concern and my doctor just
shrugged his shoulders and told me he would be keeping an eye on it.
Now it has been 5 weeks since my dosage was increased. I am
experiencing blurred vision, heart palpitations I am urinating about
every 1/2 hour I also feel agitated, numbness in the hands and feet and
excessive sweating. I also feel like my mind is racing and I am
more irritable than normal. I am 5'1" and weigh 114 lbs. I do not
know if the amount of levothyroxine is to much for someone of my size.
I do not see the endocrinologist until Feb 2005. Should I be
concerned with the amount of levothyroxine I am
taking?"Lilliane Dubois" <lamd1@mts.net>
ANSWER- In brief, yes. You need enough thyroxin to keep TSH near
0.1 when you are on the med, but for you that dose is probably near
125ug . The exact amount can only be determined by trial. Get a blood
test now. L De Groot,MD
HIGH TSH AND THYROXIN TREATMENT
QUESTION-After years of vague symptoms attributed to menopause (I am F
52yr.), my G.P. did yet another TSH (previous thyroid panels were all
negative) and it was 187. Because it was so high, should I be concerned
about the pituitary gland having a problem? And, is it OK to treat
hypothyroidism by just monitoring TSH levels? Should Free T4 and T3 also be
drawn? I have been on Synthroid 75 for 7 months now, and my TSH is down to
4.3.
Cindy
RESPONSE-
History of controlled hypothyroidism--now with hives
QUESTION-I have had hypothyroidism for ~ 18 years now. I also have a history of ebstein-barr virus in 1988 which manifested itself with (L) sided weakness and burning- neurlogical symptoms that still remain. I have been on Synthroid 150 mcg po qd and my T3, T4 in Feb 04 was normal. I am 41 years of age. I had a child in October 03. For the last 5 months I have had to deal with hives. Initially, they were on my most dense on my abdomen & back, and some on my legs, arms, lips. My family Dr suggested Benadryl. No help. After they worsened, I went to see a Dermatologist who put me on Zyrtec 10 mg po qd. That did help for about 3 1/2 months. I would have intermittant hives but they were tolerable. For the last 3 weeks, they have been horrible again. Raised, red, itching and burning relentlessly. They are most dense on my legs this time, but also appear on arms, lips, hands, back and abdomen. Dermatologist doubled my zyrtec to 20 mg daily with no improvement. I saw him and he gave me 60 mg of kenalog IM and added allegra 180 mg qd as well. He did bloodwork as follows:
T4 - free, direct tryroxine 1.14 nl(.61-1.76)I have to wait a week to see my family Dr. I am not established with an endocrinologist as I had been stable. Please help me understand what is going on and what the next steps should be.
Thank you,
Dee
RESPONSE-I understand how difficult your problem is. It appears that you have been appropriately treated. Generally a search is made for any possible environmental factor that might cause an allergy, for certain genetic traits, for other diseases associated with hives, and for "collagen-vascular" disease, but this is often fruitless. You do have autoimmune thyroid disease , and that is definitely associated with the hives that you have. However to my knowledge that does not offer any recognized different approach to treatment. Typically over time the process subsides, often to recur to some extent at a later time.
Sorry I cant be of more help,
L De Groot,MD
WHAT IS THE PROPER DOSE OF
THYROXINE?
Hello,I know you are mainly for professionals but I really need some
advice. I am sure your comments would not take
long on this if you could please just take a few
moments to read this. I am a 34 yr old male with auto immune thyroid
(Hypothyroidism). My blood tests (04.12.2003): Glucose, Lactate,
Leucocyte count, Erythrocyte count, Hemoglobin,
Hematocrit, Mean Corpuscular Volume, Mean
Corpuscular Hemoglobin, Mean Corpuscular Hemoglobin Concentration,
Trombocyte count, Potassium, Creatinine, Sodium, Alanine
Aminotransferase, Amylase, Aspartate
Aminotransferase, Calcium, Billirubin, Billirubin
conjugate were normal; but TSH was 51.80 mU/l (norm here is 0.6-4.2). Two
weeks later my blood test was (19.12.2003): FT4 - 7.2 pmol/l (norm
here is 9-20), TyglAb - negative, TymsAb - 6400
(norm here is <400), TSH - 61.50 mU/l.
My blood pressure based on averaged measurements made per hour one
week was: (a) after waking up, but before standing
up: systolic - 99.4+-2.3, diastolic54.9+-2.4, pulse, (b) during the day:
systolic - 114+-5.5, diastolic - 67.7+-4.2, pulse
- 56.9+-4.3. I have not any symptoms of
hypothyroidism. But I have headaches (often).
My questions: (1) What is the optimal
dosage of thyroxine therapy for me, considering my
blood tests and the absence of symptoms. My weight is 63-64 kg (stable over
20 years)? (2) Should I take it all my
life, or I can stop when the blood tests will
normalized? (3) What is the mechanism for
decreasing antithyroid antibodies by thyroxine
therapy? Thank you for your time,
Alexander.alexander.fingelkurts@bm-science.com
RESPONSE-The common dose needed is around 1
microgram /pound of lean body mass, but your MD must determine the
exact dose by trial until TSH is in the proper range. Usually
you need to take the med all your life. The antibodies commonly
stay positive for years or forever even on treatment. L
De Groot,MD
CANCER IN THYROGLOSSAL DUCT
My 40 year old son has recently had a Thyroglossal Ductal Cyst removed and
the pathology report was Thyroid Papillary Carcinoma. He was told that
it is very rare to find cancer in these Cysts. His head MRI and Chest
CAT scan show no evidence of any caner remaining. He will see a
radiologist and endocranologist next week to determine what if any followup
he needs.Are there other test that should be taken to determine if the
cancer has spread to the Thyroid or other tisue? Would you recommend I
131 or followup surgery to remove the Thyroid? I
can't seem to find any information about this type of caner within a Cyst.
Could you provide some information? Thank you in advance,
Daryl McRoberts,mailto:darylm@rogershsa.com
RESPONSE-Whether to remove the thyroid and look
for nodes, or not, is a matter of debate. There is some chance that the
tumor involves the thyroid. If the physical exam is negative, the thyroid
ultrasound is absolutely negative, and the serum TG is normal,
I believed it would be safe to wait and follow
with periodic exams, ultrasounds and TGs. If these tests are abnormal, it
probably would be best to operate and do a near-total resection of the
thyroid. Leslie J De Groot,MD
Question: Can I take antithyroid meds for Graves
Disease for a long time?
Good Afternoon. I have Graves Disease diagnosed in 1996. In
1998 try to leave the antithyroid tablets but my thyroid became over active
again. I started the tablets again.
Since then I have been taking methimazole tablets 5mg daily and every
second.
day 10mg (5mg in the morning and 5mg in the evening). I am now
normal/stabilized for nearly 4 years, but want to know why I cannot continue
with the tablets for life?
hank you, Kind Regards, Charlotte Dreyer,
cdreyer@safaricom.co.ke
Response-There is no specific prohibition to taking antithyroid drugs
over a long period, but there is always the small possibility of an allergic
reaction. Generally patients and their MDs give up after a year or two or
three, because of the inconvenience, and resort to RAI or surgery. L
De Groot,MD
TWIN PREGNANCY AND RAISED TSH LEVEL
I have had my thyroid levels tested twice now with my TSH raising both
times. We have found out we are expecting twins. I am 8 1/2 weeks
pregnant. My levels were: TSH is 8.66, T3 is 150, T4 is 7.7. I am
going to see a thyroid doctor next Thursday. We lost a child last
year at 12 weeks. Are a little nervous and wondering if this is a
problem we should be worried about. My Ob said not to worry because
my T3 and T4 are normal but it is the TSH that is high. RESPONSE
No matter that your T3 and T4 are normal. When your TSH is raised
it means that you, and especially your BABIES!!, need thyroid
hormone. You have to be treated with L-Thyroxine such that your TSH
drops to below 2,0 mU/L. Good luck Georg Hennemann, MD
PAXIL AND ELEVATED TSH
I have been taking Paxil or Paxil CR for nearly 3 years now. I have been
slowly gaining weight and increasingly feeling tired/unmotivated. I started
working out, then ordered some Royal Jelly (Bee product) for energy - then
decided before I start self medicating I really should have a physical. My
results included TSH at 2X normal levels (per Internist) and an enlarged
multinodular goiter per ultrasound of Thyroid. So... I just read a science
article from the U of Georgia where they state that they believe fluoxitine
inhibits thyroid and so they'll be looking at that in an upcoming toxicology
study re: wastewater and wildlife. I guess the body's internal pathway of
using and recycling hormones is complex and the SSRI's may inhibit
'something' in that pathway. I know only 1 in 1000 of Paxil takers can get
hypothyroidism from Paxil. So it's 'possible' that MY Paxil created my
Thyroid problem. (I prefer not to be diagnosed and treated based on
'probabilities' if specifics can be found!!!)
I guess the REAL question clinically is - how would you differentiate what
caused my hypothyroidism? Did those 'rare' ones who lost their thyroid
function from taking Paxil have returned function after ceasing taking
Paxil? Is it reversible - do we KNOW?
If you believe you can get to the real 'root' of this issue better than I've
tried to parse it here- please feel free to answer as you see best. Thank
you for your time! Cheryl.
RESPONSE
Paxil activates enzymes in the liver that metabolise thyroid hormone, thus
increasing the requirement. In people who are"normal" this presents no
problem. However in, people with a diseased thyroid, it may produce
hypothyroidism, and the same in people who take their hormone from a bottle.
If you stop the Paxil you may not need hormone, but at this point if you
continue the Paxil you need to take thyroid hormone supplementation. I will
wager that if your MD does tests for anti-thyroid antibodies, the test will
be positive, and that you actuallya have Hashimoto's Thyroiditis. Best
regards, L De Groot,MD
HASHIMOTO'S ANTIBODIES
Does Hashimotos thyroiditis reduce or in anyway influence iodine uptake by thyroid gland? I have extremely high levels of TPOAb and I am wondering that since TPO is very essential for iodination of thyroglobulin, wont TPOAb reduce levels available for the iodination? Are there statistics on how Hashimotos patients with DTC respond to RAI ablation compared to DTC patients without Hashimotos? Thanks, Anita
RESPONSE
Dear Madam,
TPOAb does not enter intact thyroid cells, hence can not inhibit TPO-activty. TPOAb however kills thyroid cells and thereby reduces the iodine uptake of the whole thyroid gland. A goiter that has developed because of Hashimoto's disease is hardly that big that reduction is necessary and if so RAI does don't work because cells are not viable anymore and do not or only minimally take up RAI. I do not know of such statistics that you ask for.
Georg Hennemann, MD, PhD, FRCP, FRCP(E)
HASHIMOTO’S THYROIDITIS WITH VARIABLE THYROID FUNCTION
I have a question about
Hashimoto's?>
> I was diagnosed a year ago. My TSH was JUST above normal, and then I was
> tested for antibodies which were high. So I have hashimoto's (my mother
has
> it as well and has been on Synthroid for years). I also have a couple of
> small nodules. I must have had Hashimotos for about 2 years, which
> explained the weight gain (about 15 pounds), aches and pains, dizziness,
> muscle cramps. At the next test, a few months later, my TSH and all the
> hormones were normal, so my endo 'monitored' me and I was tested again in
> six months. I know that for some people, small fluctuations in the
hormones
> can cause a lot of changes in how you feel. At my last test, while the
> antibodies were still present (this was in may) my hormones were at normal
> levels and my endo said my thyroid shows normal function. SO I am not on
> meds. And I seem to have lost weight and don't feel as bad as I did a
> couple of years ago.>
> Does this happen a lot, that you have antibodies but normal function? Can
> things turn around like that? I have no idea what caused the change.
And
> can you be treated with synthroid or whatever in a case like this,
if you
> have high antibodies but normal hormone levels?
> Marlene, Journalist
RESPONSE
Thyroid function can fluctuate between normal and high or low in some individuals with Hashimoto's thyroiditis. Generally if the hormone supply is normal, treatment is not given. However sometimes thyroxine is given in an attempt to decrease the size of the thyroid, and treatment may reduce the antibody levels. Except for their action on the thyroid, the antibodies in Hashimoto's are thought usually to cause no trouble. Leslie J De Groot,MD
Thyroid and Hair Loss - I recently stared taking synthroid. I am experiencing fairly severe hair loss. I have been on it for almost 3 months. It has helped me tremendously! I have lost 25 pounds, have more energy, much more interested in sex and basically feel better than I have in 2 years. I am afraid to stop taking it because I feel so much better. What can I do about the hair loss and will it grow back? It has gotten very thin. Thank you! C B
Hair loss is common in people who are either hypothyroid or hyperthyroid. Hair loss is also common when one changes the metabolic state. Presumably you were hypothyroid, and hopefully you now are "normal", and not over-treated. If this is the situation, there generally will be a return to normal hair density over months. However remember that there are many other causes of hair loss, including many serious illnesses, excess androgens, autoimmune problems, and the aging process. Hopefully your problem will straighten out spontaneously in time. L De Groot,MD
PAINFUL HASHIMOTO’S
THYROIDITIS
QUESTION-I know you are only for Doctors but I really need some advice i
am sure your comments would not take long on this if you could please
just take a few moments to read this. I am a 23 yr old women with auto
immune thyroid,Hypothyroism & A Goiter. My last blood work done was--TSH
- 6.54, Free t3 – 123, Free t4 - 1.4, and antibodies
at 135. I have been suffering from Goiter pain and have told my Endo
this several times. It was the whole reason I had been referred to him.
anyway I called him today to ask for a recommendation on what I could
take other then Aleve for the pain as it was not helping and his reply
was that it wasn't my thyroid he thinks I have a sore throat. ok I think
after having this problem for 15 years I know the difference but that is
what he insists on he told me to go to my reg DR to have it looked at
and I plan to go tomorrow just to be sure But I am not sure what to do
if my GP says there is nothing wrong with my throat.I mean should this
DR,giving my thyroid problems,have blown me off so easily without even
looking at things?Should I see about getting a different Endo?or do my
test tell him that things are fine and that is how he knows it isn't my
thyroid? as he never even seen me it was a phone conversation in which
he told me to take Aspirin that I am allergic to and he knows that I
am.I am currently taking Synthroid .175 for the past 3 weeks up'd from
.150. Thank you for any response you can give, Kyra Tuesday, June 10,
2003
RESPONSE- You seem to have Hashimoto's thyroiditis, and according to the TSH you were a bit under-replaced with hormone at the time the test was taken. Pain in the thyroid is unusual in Hashimoto's, but does occur, and sometimes people even have to have the thyroid removed surgically to get rid of the pain. Your MD might check out an article published in the last issue of Journal of Clinical Endocrinology and Metabolism, entitled "Painful Hashimoto's thyroiditis". Good luck. L De Groot,MD
MEDICATIONS WHILE HYPOTHYROID-
Question-I have been searching for cold medicines that are okay for
patients with hypothyroidism. Everything I've seen over the counter to
date includes a notation that one should check with a doctor if one has
thyroid disease. I've talked with three doctors, and none have any
suggestions. Do you know of anything that will dry sinuses or suppress
coughs without containing pseudophedrine products? Or suggestions on who
to contact next?
Laurie 10 Jun 2003
Response
After your hypothyroidism is treated and your tests are normal, those restrictions on medications no longer apply to you. You are effectively normal, at least in regard to the thyroid.. L De Groot,MD
NURSING MOTHER AND PTU TREATMENT
> Dear Physician,> I am a 32 year old female who is nursing my 2 month old
second baby. I have
> graves disease. I have been on PTU for the last 2-3 years.
Before my
> pregnancies in was on carbimazole. My first pregnancy was
uneventful though
> the delivery was by c-section. The first pregnancy my
endocrinologist
> recommended that I be on PTU during delivery as well as during nursing.
The
> second pregnancy my endocrinologist (different from the first one)
> recommended that I stop taking PTU (which I was taking 100 mg three
times a
> day) at the 34th weeks of pregnancy. Once I delivered the baby and
now at
> 10 weeks after delivery the TSH, T3 and Free T4 levels are marginally
> increased. My questions are;
>> 1. Can I not take PTU during lactation? What are the
complications for the
> baby?
> 2. Do I have to stop nursing if my levels go too high and take
medication?
>> Please advice. Radhisha Peiris,: 23/2, Flower Road, Colombo 07,
Sri Lanka
> Telephone: 34-1-689125
harim@lanka.ccom.lk
The best evidence is that the amount of PTU crossing into the milk is
generally not enough to affect the baby's thyroid function. I suppose
that if you needed very high doses- such as 800 mg/day or higher- it
might be an issue and one would need to check the baby's hormone level
and TSH. The baby could also become allergic to PTU, although this must
be very, rare since so far as I know it has not been reported.. Thus you
may take the PTU if needed and nurse the baby. L De Groot, MD
1/21/03 -Hello,I just found your website and I am hoping you can
provide some insight on my situation. I am a 36 years old female and
began to notice hair loss in May 2002. The hair loss is diffuse thinning
- more in some areas than others - not alopecia areata. I have seen two
dermatologists. The dermatologists do not believe that the problem is
male/female pattern baldness. They were unable to state the cause.I
realize that hair loss can be caused by many things. My question is
related to my TSH levels. Here is a history of my TSH:
10/97 = 0.73 (0.3 - 5.1 uIU/mL)
4/99 = 0.99 (0.3 - 5.1 uIU/mL)
8/01 = 2.35 (0.49 - 4.67 uIU/mL) T4 = 13.9 (4.5 - 12.0 ug/dL)
2/02 = 2.53 (0.49 - 4.67 uIU/mL) free T4 = 1.55 (0.6 - 1.85 ng/dL)
4/02 = 3.69 - (noticed hair loss late April early May) (0.4 - 5.5 uIU/mL)
7/02 = 4.09 ((0.4 - 5.5 uIU/mL)
12/02 = 1.90 (0.50 - 5.00 uIU/mL)
I showed these results to the dermatologists but they did not mention the
changes in my TSH. Are these changes significant enough to cause hair
loss? What could cause these levels to change like this? I was on
Serzone (350 mg/day) since August 2001 and began tapering off 25 mg/week
in March 2002. Could this affect my TSH directly or indirectly? I am
completely off of the Serzone.If the hair loss is related to my thyroid,
will the hair grow back? How long (approximately) will it take?Any
insight would be much appreciated.Thank you,Valarie
RESPONSE-My answer is "maybe". The drugs such as Prozac and Paxil, and
Serzone, cause increased metabolism of thyroid hormone, which fits with
your increase and then decrease in TSH. However the TSH never got out of
the normal range. I am unsure that this is enough of a variation to
cause hair loss, but it might be. If so, the hair should regrow when you
are now back on the regular dose and your TSH is back close to its
former level. L De Groot,MD
13 Jan 03- Two years ago when I found I had Hashimoto's, My
dr. also told me I had autoimmune hepatitis, due to elevated liver
enzymes and the ANA was positive. Is it possible that these
two disorders could be closely related, i. e. the thyroid
has "caused" the liver autoimmune response? Thanks for
your answer! ~carol~
Response-Other autoimmune diseases are sometimes associated with
Hashimoto's, and both the ANA and liver disease could be connected in
that way. However it is generally believed that these are independent
diseases, and not that Hashimoto's "causes" the other problem. The cause
is probably one step farther back for both, some dysfunction in the
immune system. L De Groot,MD
11 Jan 03 Hi,I found your names in the internet and decided to try asking you a couple of questions regarding my wife's thyroid disease. She is scheduled to take the "radio-active iodine" pill next week and we are a little concern about the effects of it. We have two girls and we lost a baby last year. We would like to have another baby, but we were told that after taking the pill, we have to wait at least 6 months. My wife is 31 and we are a little scared about "this pill". She needs to be away from the children and from me for 3 days, she can not use any metalic silverware, her clothes and the sheets she will sleep in during the first three days after taking the pill need to be laundered separately from the rest of the clothes, etc. etc.. So here are my questions:
The consequence of the treatment with radio-active iodine is indeed that the risk is high that your wife has to take tablets containing thyroid hormone for the rest of her life, because the treatment very often results in permanent thyroid failure and its function has to be replaced by using these tablets. However this also occurs frequently after operation, while long term treatment with tablets to suppress hyperthyroidism is usually inadequate as relapses frequently occur. Furthermore, if your wife has Graves' disease, then the natural course of the disease is often that after many years thyroid failure will develop anyway. Last but not least, although it is unpleasant to have to take tablets every day, treatment with thyroid hormone to substitute for thyroid failure is easy and does not affect health in any way. The only important thing to remember is that during pregnancy about 50% of women have to take more thyroid hormone for adequate supply to the unborn child. This has to be checked during pregnancy. Georg Hennemann, MD.
This site complies with the HONcode standard for trustworthy health information:
verify here.