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Topical Patient Questions 2008

Last Updated: · Patients
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Questions answered by Dr John Lazarus


1 Antithyroid drugs, Carbimazole

I would like to ask a question for the thryoid disease manager web site. I 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. Last test results l.4 TSH : 11 T4: 4.4 T3. I have tried coming off twice but symptoms return and will continually try to reduce or come of this drug if blood test results allow.If this is not possible what are the long 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.I understand the risk of a sore throat and the need to have a immediate test but would like to know what other risks are involved in long term use of this drug..Does diet and stress reduction play any part if reducing symptoms?

Many thanks.

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.


2 Goitre

Dear Sir/ Madam,

I have a Retrosternal goitre, diagnosed approximately 6 yrs ago, and asymptomatic of this.A Fine needle biopsy showed a benign multinodular goitre with a tracheal deviation to the left. All TFT’s were within normal range, and was advised to monitor the growth regularly, and check TFT’s.14 months ago I suddenly began to experience pain bilaterally in the Achilles tendon area. This would start first thing in the morning after being in bed overnight. I had to adopt this shuffling gait until I.’Warmed up’ approximately 2 – 3 hrs, now the stiffness never actually never leaves me. I now find that if I sit for a period of time ( 15 – mins. ), I am as bad as I am first thing in the mornings. ( My husband affectionately calls me the ‘Penguin’ in the mornings.) Plus, my gait pattern, even at the end of the day is ..a conscious effort to walk as normal as the people I am passing by. I have NO history of Back Pain or any other soft tissue trauma.’Overall, It’s getting worse, ( which is why I am writing to this website) I am now experiencing a type of Laryngeal Stridor ,this occurs if I tuck my chin down into my chest.to apply jwellrey, style hair etc. etc and if I do any moderate physical activity…such as going for a brisk walk or climbing stairs…surely not too much to expect from an otherwise healthy, 175 cm tall / 69kg 50 yr old !!The size of the goitre appears not have grown to much, but the Achilles Tendon / shuffling gait / stiffening up after only a short period of sitting has me totally confused. My GP perceives it as an ‘Injury’ that I do not remember doing.but bilaterally ??? plus I have not done any moderate or extreme exercise to cause this type of injury,(I walk our dog, but not on uneven surfaces or the beach, and tentatively, trying to present a ‘Normal gait Pattern’ to the public at the same time…) however, my GP did admit that to injure the Achilles Tendon’s bilaterally did not quite fit the picture. Incidentally, a recent TFT was abnormal.raised I believe, but only slightly..Some other symptoms may include..anxiety, weight gain..or am I going mad ??

Response

Dear Ms

I do not think that your bilateral achilles tendon pain is related to anything to do with your thyroid. It sounds like a rheumatological problem or clearly connective tissue disorder.As far as your thyroid is concerned, it sounds as if your retrosternal goitre has indeed enlarged a bit and, most importantly, because of your abnormal thyroid function you are mildly thyrotoxic. Because of the enlargement and because of the overactivity, it would seem to me that you need to have surgery to this goitre. You should not have surgery if your thyroid tests are high. You should start on antithyroid drugs until the tests are normal and then have the surgery.


3 Thyroidectomy

Dear Dr. Lazarus,

Hope you are doing well. I have a thyroid related question for you. In Aug 2006 I had a partial thyroidectomy. I had this procedure because after I had my second child I developed a goiter and my endocrinologist attempted to shrink or stop its growth by having me take synthroid. That never worked, so after a year of that I decided on surgery. At that time and now my blood tests for thryoid levels have always come back NORMAL. However, I have been taking 50mcg of Synthroid ever since my surgery. My questions for you are:

1) My doctor says I will need to take synthroid forever. Is this true? (I don’t have thyroid disease, but she thinks I should continue synthroid to prevent another goiter).

2) Would having another child affect my thyroid? Would it make me get thyroid disease or possibly another goiter where I might have to have a total thyroidectomy?

3) What are the long term effects of taking synthroid at the dosage I’m taking? Do those who have had a partial thyroidectomy eventually develop thyroid disease?

Thanks so much for your time. I appreciate your feedback.

Response

Dear Ms

After your partial thyroidectomy you have been taking Synthroid without affect. It is not clear what the diagnosis is and what the histology of the thyroid was when it was removed. The answers to your questions are:

(1) Synthroid is probably not necessary to take for ever, it does not always prevent the recurrence of goitre, but your thyroid levels should be checked regularly.

(2) Having a child can affect the thyroid but it is not clear whether it would affect yours. If you have thyroid antibodies then there is a possibility that it could be affected but it would be unlikely that you would require a further operation on the neck.

(3) The long term effects of taking Synthroid at the dosage you are taking are nil or minimal. It is unlikely that you would develop further thyroid disease having had a thyroidectomy for what is called a non-toxic goitre. However one cannot absolutely guarantee that recurrence of a goitre would not occur even when one is on Synthroid.


4 Hypothyroidism

Dear Doctor,

I am a girl of 17 suffering with hypothoridism.my problem started from 1 yr. I have severe pain in my throat, My hands & legs are swollen My symptoms: 1.hairfall 2.poor memory 3.swollen limbs 4.pulffy skin 5.pain in throat & hands

thankyou,

Response

Dear Ms

If you are definitely suffering from hypothyroidism then you require a full replacement dose of thyroid hormone. The amount to take depends on the blood test and how you are feeling. If you take the correct dose the symptoms you are complaining of should disappear. Sometimes it takes more than two months. I also do not have an explanation for the pain in throat and hands, and it may be that after you have taken treatment for three months or so you should have another examination if there are still things wrong. There may be another condition from which you are suffering.


5 Adrenal and Thyroid

Is there any link between Hypothyroidism and adrenal adenomas? I had an MRI recently that incidentially found the adenomas and I didn’t know if some how this was linked to my Hypothyroidism. I currently take 125MG daily of generic brand synthroid. My weight over the past 3 years has ballooned from 130lbs to 190lbs. Is there any link to these issues?

Thanks for all your assistance.

Response

Dear Ms There is no definite link between hypothyroidism and adrenal adenoma. Often an adrenal adenoma is a so-called incidentaloma, not related to any other condition. In addition to the TSH level while you take 125 mgs of Synthroid, you need to also check your T4 level and make sure it is at the top end of the normal range. This may help your weight.


6 Thyroidectomy

My sister had a Thyroidectomy last year due to a goiter. She has had many health issues since. Panic attacks ( which have subsided untilnow), depression, low levels of calcium . Her most recent problem is her tongue is swollen . She has been on blood pressure medication since she was in her 20″s (she is in her 30″s now) She has been in the ER 2 times in the last 2 weeks due to this swelling and SOB. They told her is was allergic reaction to her BP medication (Lisinopril). They now have her on Diavan. They are treating her with prednisone and benadryl and have adjusted it since this last episode. Her thyroid levels are okay at this time but she has been lax in taking her calcium. She is starting to have the panic attacks again . She is going to see a ENT . Do you have recomendations?

Help please.

Response

Dear Ms

Your sister’s panic attacks are almost certainly not related to her thyroid. However if she has been lax in taking her calcium the calcium levels may be low and this may give her odd behavioural episodes. She needs to have her calcium level checked regularly and be absolutely sure that it is normal. The tongue swelling is probably an allergic reaction, but not related to her thyroid.


7 Pregnancy and Thyroid

I am 28 years old mother of 3. I just found out that I am pregnant with #4, I called my Dr. and got a appt that same day. The day after I found out I started spotting and I has allot of gas also. I have been spotting for 10 days with mild cramps some small blood clots but no fecal tissue, I’m not shur if it’s a miscarriage or something caused by my thyroid. I did let my Dr. know and i am waiting to see him. I’m not soaking a pad or anything like that. I ad surgery on my thyroid this past December because I had like 4 nodules. I had a tumor growing on the rite side of my thyroid. They removed that side only. I was told the left side was healthy. My thyroid was still functioning fine it was just the tumor. I am on a low dose of levothroxine as a precaution to make shur it will be fine. So my question is Is it possible to have spotting for all these days and it not be a miscarriage? Does my thyroid have anything to do with this? I have never had amiscarriage and all my children are healthy.

Response

Dear Ms

I do not think your thyroid has anything to do with your spotting. You should certainly have a thyroid test checked as soon as possible, as some people need an increase in thyroxine dose during pregnancy.


8 Pregnancy and the baby

I was diagnosied with Graves disease in June 2006 following the birth of my second son in February 2006. I was told to stop breastfeeding immediately which I did and I was treated with PTU as I had a reaction to the first medicine I was on.. I became pregnant again in July, 2006 and was treated for Graves disease using PTU throughout pregnancy. My daughter was born in April 2007. She was tested for hyperthyroidism a few days after birth and her levels were fine. However I have been breastfeeding her exclusively until recently when I have started her on solids.(she is just over 5 months) My question is she is very hyper. On average she sleeps for about 45 minutes from 7am till 7 pm. She will sleep for about 3 to 4 hours at night. (wakes at least 3 times during night). She has been like this nearly since birth. I have found out in past 2 weeks that I am once again hyperthyriod and am wondering if my daughter could be slightly too. She has not been tested since birth. As her bloods were ok after birth is there any need to have her rechecked.

Thanks.

Response

Dear Ms

Firstly there is normally no problem to the baby when you breastfeed with Graves’ disease even if you are on PTU. It is very unlikely that your second child is hyperthyroid, but it would be quite in order to have the baby checked just in case. The antibody that stimulates the thyroid could possibly appear in the breast milk. A study has reported this in 2006, therefore you should have your child checked.