Drug Infonet provides drug and disease information for your healthcare needs. Visit our FAQ page to find answers to common health questions. Look on the Manufacturer Info page to link to pharmaceutical company pages. Click to Health Info and Health News for the latest in healthcare developments.
Drug Infonet brings this free resource to you so that you become a more informed consumer of healthcare.
Drug InfoNet Doctors' Answers to Frequently Asked Questions - Thyroid
Doctors' Answers to "Frequently Asked Questions" - Thyroid
Related Women's Issues
These comments are made for the purpose of discussion and should NOT be used as
recommendations for or against therapies or other treatments. An individual patient is
always advised to consult their own physician.
Thyroid glands [posted 1/5/99]
Question: I was born without thyroid glands and I have been
taking synthroid for 18 years. Presently, I am taking one and a half tablets of 0.1 mg of
Synthroid a day. I have known all my life about my thyroid problem, but I have never had
an interest in the effects or the health hazards that lack of thyroid glands can cause
until now. In a general summary, what are the effects and hazards of not having thyroid
Answer: Shouldn't be any if you get replacement.
However, is there any other associated genetic association? Offhand, I don't know, but a
genetic counselor might. Check with one in your home town.
Low Thyroid [posted 1/4/99]
Question: I have had problems that imitate hypoglycemia. I am
also on Synthroid .225 mg. The glucose test revealed that after four hours, my glucose was
52. After five hours, 63. I also had a TSH that was .19. Was the TSH low because of my
hypoglycemia or was my hypoglycemia low because of my TSH? Sometimes, when I urinate,
there seems to be a sweet smell afterwards. Does this mean anything?
Answer: You are on slightly too much synthroid,
but not enough to usually give any symptoms. Anyway, hypoglycemia would be a
rare/non-existent manifestation of too much thyroid. Do you get symptoms with these
glucoses? Also, some people who have hypothyroidism will eventually develop diabetes
mellitus and often low sugars are an early manifestation of the DM.
Numerous Concerns Regarding Thyroid
Problems [posted 12/08/98]
Question: I have been diagnosed as hyperthyroid since August
1996. It took some time to level me off at 150 mcg Synthroid. For most of 1997, I
complained to my Doctor that I was fatigued and that my thyroid was off. Tests indicated
that it was normal. I have a very mild case of HCV & it was suggested that it caused
my fatigue but a liver specialist ruled that out. My wife underwent a series of operations
in 1997 and it was suggested that stress was causing my fatigue. I took antidepressants
for 3 months-stress was not the cause of my fatigue, either. In February of this year, at
my insistence, my thyroid was checked again and I was found to be overmedicated. I started
taking 125 mcg Synthroid 4 times a week and 150 mcg 3 times a week. I felt great for a
month and then fatigued. I "flipped flopped" the way I was taking my meds and
felt good for a few weeks. I was up and down like this for 2 or 3 months. To make a long
story short, my Doctor and an Endricinologist told me that my thyroid was normal and that
neither it or the Synthroid was causing me to be up & down like that. Since June, 6th,
with my doctor's okay, I have been taking the different dosages of Synthroid every other
day. This helped and I also stopped using caffeine on June 20th which seems to really have
helped. I recently had my thyroid tested and it was way off. The Doctor wanted to put me
back on 150 mcg Synthroid daily. I was afraid so I declined. Right now I feel better than
I have in 6 months. I am not fatigued! I still , however don't think that I feel as
good as I did before this thyroid mess. Will I ever? Last question: What is going on with
these thyroid tests?? I tell them that I'm fatigued and they tell me that my thyroid is in
normal range. They tell me that my thyroid is off and I tell them that I feel fine.
I have to go with the way I feel. I am not at 100%, but compared to what has happened to
me in the past year or so - I can live with this, but I am very confused.
Answer: Your fatigue is probably not due to your
thyroid. Get enough synthroid to keep your TSH in the normal range and then start looking
for other causes. Check your adrenal gland function and your B 12 level, both commonly
affected in hypothyroid patients. If these are ok see a sleep specialist, especially if
you snore. The most common cause of general fatigue-without clear cause is sleep apnea.
Hashimotos Thyroiditis [posted
Question: I was diagnosed post-partum 1994, age31 with
Hashimotos Thyroiditis Hypothyroidism. My doctor explained it was from a virus I
could of had as far back as childhood. I take Synthroid 0.150. I just had a complete blood
test done. All good results. I still experience so many of all the listed symptoms. Do
they ever go away? Why cant I get them under control? My biggest complaint, is the
tiredness. I'm soooo tired all the time. Sometimes I can hardly function from the fog
rolling around in my head, nothing shakes it. It lasts for hours each day. I recently (2
mos. ago) saw a homeopathy doctor (M.D.). He said it could be an overgrowth of yeast
(after asking me 200 questions). I've been good on this diet, some symptoms actually went
away. What can i do for the tiredness?
Answer: Is your TSH normal? That is, is your thyroid completely
replaced? If so, then you need to look for another cause of the fatigue. Anemia, low
adrenal function, low B 12 are all conditions which commonly coexist with hypothyroidism,
ensure these have been checked. If nothing else shows consider a sleep evaluation to rule
out sleep apnea, especially if you snore. I am not a big proponent of the yeast
explanation since everyone has yeast in their body at all times and treating it only
yields modest/few results.
Hypothyroid Questions [posted
Question: Since the fall of 1996, I began slowly experiencing many unusual symptoms
of tingling/dumbness, bowel changes, loss of appetite, fullness in back, dizziness, pain
and achiness all over, fatigue. In Feb. 1998 I was diagnosed with hypothyroid. Lab results
indicated TSH level 16 and antibody levels over 300, however 'T' values normal. I have
been on 'synthroid' since Mar 98, starting with 50mg dosage which brought TSH level down
to 7. My dosage was increased to 75mg, which brought TSH level down to .067 by June 98. In
Sept. 98 my TSH level was tested again and it had shot back up to 15.5 even
though I was consistently on 75mg everyday. My doctor has increased my dosage to 100mg to
try and stabilize my level. During this entire period I have only improved in a very broad
sense (increased appetite and weight gain) however most of my symptoms still exist.
I am concerned that something more is triggering these symptoms. Does this sound like a
typical hypothyroid reaction?
Answer: Yes, but, check your B 12 levels and adrenal function. About
10% of patients with hypothyroid will have concurrent other neuroendocrine dysfunction.
Thyroid Questions [posted
Question: I am a 35 yr old female. Recently went to my family md for symptoms he
agreed sounded like hypothyroidism --low blood pressure, heart palpitations, dry skin,
weight gain (5'5", 157lbs), fatigue, etc. Also found I had MVP. My blood tests were
negative he attributed symptoms to MVP. Went to an endocrinologist that used a reflex test
to test for hypothyroidism. He assures me I am hypothyroid and prescribed 0.1mg (1 tablet)
Synthyroid per day to increase after 3 weeks to 1-1/2 tablets per day. This is only day 2
after taking the tablets, and I feel very, very tired and headache. Any thoughts??
Answer: Well, its not the MVP. As to the thyroid what was your TSH? Should be
elevated if you are truly hypothyroid. Occasional patients have concurrent adrenal
insufficiency;but, usually this gives weight loss. Keep increasing the synthroid until the
TSH is normalized.
Effects of Radiation on the Thyroid [posted
Question:I read with interest the answers to questions on hyperthyroidism. I
wondered what the side effects to radio active iodine are?
Answer: Iodine is mainly only concentrated and used in the thyroid gland. The
side effects would mainly be radiation and would depend a lot on dosage. What information
do you need?
Thyroid Concerns [posted
Question: I am currently 46, in 1997, I had blood tests mainly to check
cholesterol. The blood tests revealed a very low TSH. The blood test was repeated and the
TSH was lower. I had a scan and it was suspicious for thyroid cancer but when I was sent
for a biopsy, the nodule could not be located, and I did not have the biopsy. I had
another blood test with an Endocronologist and the TSH had returned to normal but
antibodies were very high. Her course of treatment was to do nothing as the TSH was
normal. This course of treatment did not agree with my Family Doctor's philosophy and
since I had been worrying over the thyroid cancer and waiting 4 months for the biopsy, my
Family Doctor sent me to a different Endocronologist. She diagnosed Hashimoto's
Thyroiditis and said her course of treatment was to take levoxyl for one year which she
said would hopefully let the thyroid gland rest and allow the antibodies to go away. She
told me to come back in one year with one blood test after two months. The does of levoxyl
was 1.0. At the first follow-up blood test, my TSH measured too little to trace. Since
then, I have been going back to her every two months and she has been lowering the levoxyl
dose. I am now at .05 and my TSH measures .03. After six months of treatment, I asked her
to rerun the antibodies to see if they were gone. They are not and measure: Thyroglobulin
Antibodies - 161, microsomal (TPO) AB 140, and Antibody A 60.0. The specialist is lowering
the levoxyl after each blood tests. The Family Dr. believes treatment should be aggressive
and overdosage of the levoxyl is required. The specialist believes that the levoxyl could
put me into hyperthyroidism but is not ready to discontinue the levoxyl altogether. Can
levoxyl treatment stop the antibody attack on the thyroid? Is it dangerous to have TSH
levels in the .03 range due to medication? Am I risking heart problems with a family
history of heart disease?
Answer: The first endocrinologist was doing what most physicians would
recommend. Taking thyroid would not be expected to have any effect on avoiding the
autoimmune nature of the problem since the organ is still present and able to be
"attacked". You're spending a lot of money without any hope of changing the
problem. Go back to the first endocrinologist, he/she is correct-not your FP or the second
Hyperthyroid [posted 10/6 /98]
Question: I am a 31 years female with hyperthyroid. I am under proper medication.
Is there any food or diet that I should avoid under hyperthyroid condition besides kelp
and seaweed? Is there any food will enhance my body back to normal?
Answer: No, you've got them. Unfortunately no food will have much effect.
Thyroid [posted 10/2/98]
Question: I was diagnosed with hypothyroid and my Doctor has started me on .05
synthroid which i have been on for 5 days now..my symptons, which were very dry eyes,
nose, mouth, and skin seem to be getting worse not better. is it too soon to tell? Can you
tell me if you heard about anyone else that had these symptoms for hyprthyroid.my father
and sister had their's removed and I had radiation treatments on my face in the 50's but
ultrasound proved negative on nodules.
Answer: Well, you probably aren't close to replacement levels, usually 0.1 mg or
higher in most patients below 75 and above 100 lbs. Wait till its fully replaced to get
Thyroid [posted 10/1/98]
Question: I have been taking synthroid for 2 years now - my dosage has steadily
been adjusted - most recently to 300 mcg. I noticed that on the prescription this time it
said not to take with iron, vitamins or antacids - what effects could this have. I take
antacids almost on a daily basis for heartburn. Also, can my taking lotensin and norvasc
for hypertension cause any problems with the synthroid. My biggest complaints with my
thyroid disease (besides the weight gain) is my constant fatigue - it is getting harder
and harder to get to work and to go through a full day without wanting a nap or two during
the day - will this sympton every go away.
Answer: If it is due to the thyroid it will vanish once your TSH is in the
normal range. Iron can interfere with absorption as can aluminum containing antacids.
Carafate is also a culprit in patients with heart burn.
Thyroid: Thyroxin [posted
Question: My mother is 60 years old and had a hypertyroidism. After starting
therapy with synthetic thyroxin she began to loose weight, unregular heart beats,
trembling, lost of power etc. Do you know if there is any experiences with allergic to
tyroxin, because the values of their blood tests after subliment with thyroxin are quite
o.k.? Other deseases like parkinson or some other nerve deseases have been checked and are
out of question.
Answer: Was the hyperthyroidism treated? Or did it burn out and she become
hypothyroid? There are rare instances of intolerance to levothyroxine since it is the
human equivalent. Some will develop allergies to beef or pork dessicated thyroid
replacement;but, very rarely to levothyroxine. There are occasional patients who need very
slow replacement, also, there are sometimes associated syndromes like Adrenal
Insufficiency, myasthenia gravis or B12 deficiency seen in patients with thyroid disease.
These should be checked since the treatment is completely different. These associated
syndromes occur about 4-10% of patients with thyroid disease.
Armour - Thyroid Preparation
Question: I need to know if there is a drug called armor for thyroid patients and
any information you can give me about it
Answer: Armour has made a dessicated thyroid preparation for some time. This is
made from the thyroid glands of animals, usually cows, but other drugs like sheep can be
used. It will be listed by animal and is one of the older preparations, also changing the
dosage is more difficult since there are less dosage variations. We generally don't use it
since the batch to batch variability is larger than the synthetic thyroid more commonly
used. However, patients who have been on it for years without problems are not usually
Hyperthyroid Medication and Birth
Defects [posted 8/12/98]
Question: Is there any risk of birth defects if the father is under hyperthyroidism
medication, Carbimazole 5 mg daily?
Answer: Minimal to none.
Thyroid Medication [posted
Question: I am 38 years old, had a total hysterectomy at age 27 and have been on
HRT since then. After, I had my hysterectomy I started to have a problem with weight gain.
I have seen several doctors and some associate the weight gain with the hysterectomy and
some with aging. I have currently been seeing a physician for weight loss, and had to have
my thyroid checked before starting the program. At that time I was having dry skin,
constipation, weight gain, fatigue, fluid retention (which has been a problem since my
hysterectomy and I do watch sodium intake), but my thyroid test showed a normal T4 and TSH
with the T3 being low. The doctor prescribed 1 mg Synthroid q.d. After taking this for 2
months I started having problems like dry skin, staying cold and not losing weight (the
doctor stated the thyroid medication would help with the symptoms and help with my
metabolism, which I was told years ago was sluggish to low). The doctor repeated the
thyroid test and my T3, T4 were in range but my TSH level had dropped, but still was
within normal range. I understand that it is not uncommon for the TSH to drop due to the
medication. Should I be taking thyroid medication just because the T3 level is low and I
have symptoms of hypothyroid without having a low TSH level? I have asked some of the
physicians that I know and they have varied opinion on this. Please let me know what you
Answer: The most accurate predictor of a low thyroid is your TSH level. I would
not treat a patient with a normal TSH and normal T4. I would not expect any difference in
how they felt since they are not hypothyroid. TSH is produced by your pituitary and is
extremely sensitive to low levels. T4 and T3 vary a lot from day to day and person to
person. Secondly, a low thyroid generally causes weight loss not weight gain. I know this
is counter intuitive, but clinically accurate.
Thyroid Medication [posted
Question: Has the "Armour" thyroid medication been discontinued?
Answer: Not as far as I know.
Hyperthyroidism and PTU / Beta
Blockers [posted 7/31/98]
Question: I was diagnosed with hyperthyroidism today and am taking 1 Beta Blocker
and 6 PTU pills daily. The doctor believes it may be Graves Disease. I will see an
endocrinologist and an ophthalmologist within 10 days to get a second opinion. What causes
the weight loss? Do the Beta Blockers continue the entire time I take PTU?
Answer: The weight loss is due to the excess thyroid hormone secreted by your
thyroid gland. The beta blocker will probably be decreased somewhat, but usually you stay
on the beta blocker until your thyroid gland is back to normal. This is usually
accomplished by I 131 radiation, but occasionally reverts to normal after a
Thyroid Nodule [posted 7/23/98]
Question: I am a 41 year old Asian female diagnosed with a thyroid nodule. I had an
ultrasound scan which showed a simple cyst in the right lobe (dimension: 2.3 cm on the
long axis, 1.4 cm in AP dimension, and 2.1 cm in the transverse axis. The left lobe is
normal, so is the thyroid isthmus. The thyroid function test ( T3 uptake, T4, T-7, TSH )
shows normality. I went to see a thyroid specialist who prescribed Synthroid medication. I
have been taking one tablet of 0.05 mg daily for the past six weeks with no apparent sign
of the nodule's mass reduction. This doctor told me that the nodule feels firm and round
as opposed to rock-hard and irregularly shaped, the latter two qualities indicating to him
an association with cancerous tumor. What really concerns me is the doctor's assertion
that the qualities of my nodule through his hand feeling are enough to rule out cancer,
that biopsy tests are of no use to him and he does not recommend them. I have done some
literature search which seems to suggest the reliability of of two biopsy tests:
radioactive iodine scan and fine needle aspiration. Could you be so kind as to offer a
second opinion on whether or not I should follow my doctor's recommendation and do without
any biopsy test, and if not what biopsy test(s) should I have? My reading on this subject
seems to indicate that thyroid cyst does not respond to thyroid hormone (thyroxine)
treatment. Therein is my second question: what is the best way to manage a thyroid cyst,
short of surgical removal?
Answer: With a minimal of reading you appear to know more about scans than your
expert. Single nodules need to be imaged with thyroid scans. If cold, biopsied. If not
cold, the suppression technique can be followed or a fine needle aspiration. To perform
the FNA you will need a physician competent to perform the aspiration and the analysis of
the aspiration. This may be the limiting factor. However, I'm puzzled as to why he/she
hasn't done a scan, which is usual in these situations.
Thyroid and Weight Gain [posted
Question: I used to weight 165 pounds at 5'4", but now weight 265. Please help
me find a diet that will help me to lose this extra weight. I have had hypothyroid for
four years now.
Answer: Contrary to popular opinion, hypothyroidism does not cause weight gain -
usually weight loss. I know this violates common sense, but that is what controlled
research shows. As to a diet, no great ideas here. If they worked, there wouldn't be so
many. No one has any great advice on weight loss, possibly some of the newer drugs out may
help curb your appetite. Wait and see.
Ceasing Thyroid Medication
Question: I am 25 and had a complete thyroidectomy in 1991 because of a benign
goiter. I am currently on 0.150mg of synthroid and I take my medicine religiously every
morning. I had it drilled into my head that I have to take this medication everyday for
the rest of my life in order to survive. My question is what happens if I quit taking this
medication? Also, how long does it take for the body to realize it? I was told by a doctor
that if I quit taking my medication for 2 weeks I would be in the hospital. Is this true?
Answer: Assuming there is no residual thyroid you would feel the difference
within one week and severe symptoms in two. Not necessarily would you be in the hospital,
but you certainly wouldn't be at the top of your game.
Question: In 1986, I had one half of my thyroid removed. Since the surgery, I have
felt a constriction/object in my throat. I have been to several doctors and have had all
kinds of tests, including a Cat Scan, Endoscopy, tube down the nose, regular TSH tests
that all come back normal. My doctor says it is in my head, but I was pretty upset with
his statement. Over last few years it has gotten much worse. My throat feels extremely
lumpy always and radiates down into my neck. Do you have any suggestions on where to turn
next? I am on a daily dose on Synthroid and my thyroid tests stay normal.
Answer: Its frustrating to have your physician say something this stupid
isn't it? I'm not sure what is causing the problem. That is scar tissue from the surgery
or some local damage induced by the surgery. Have you had a swallowing evaluation by a
speech therapist? This is often overlooked in the evaluation. Do you have any reflux (or
better yet treat yourself with H2 blockers like Tagamet , Zantac available OTC) since this
often produces a strange sensation in the throat.
Question: I am a celiac girl. I hyperthyroidism and I have to take tenormin, but in
these days I have had diarrhea. Do you know if tenormin (or inderal) is useful for me?
Answer: The usual treatment for hyperthyroidism is either medications like
propylthiouracil or Tapazole to reduce thyroid activity. Or ablation with radioactive
iodine or surgery. Beta blockers are given with PTU or Tapazole to block the effect of
hyperthyroidism. Rarely given alone. It would not be contraindicated with celiac disease.
Question: If the Immune system attacks the thyroid, and the diseased portion of the
Thyroid is removed, could other organs be attacked?
Answer: In general, autoimmune disorders of the body tend to be systemic.
Whether other organs are affected depends on the individual. Graves Disease tends to
affect the eyes and occasionally the heart and this is the most common autoimmune thyroid
Question: I was diagnosed with an underactive thyroid nearly a year ago. The
diagnosis came, not because I was feeling any symptoms, but because I changed doctors,
went off the pill and so decided to get a full medical evaluation so we would have a
baseline. My TSH was 230 and my T4 was super low (I no longer remember the number). The
doctor identified it as Hashimoto's Thyroiditis and put me on a Synthroid regimen that we
are still fine-tuning. I did not know enough to be concerned at the time, but I have been
researching this condition for the last year and I have never heard of such high number.
On top of this, I felt no symptoms so now I fear that my body will experience severe
stress at some point and I will be oblivious to it. For example, I could be pregnant and
my TSH could get out of whack. Since I won't feel any different, I won't get checked and I
will end up miscarrying. Am I worrying unnecessarily?
Answer: Yes. First, the elevation of TSH is not related to the severity of the
disease although logically one would conclude this. Many patients with lower TSH values
will have much more symptoms than those with high values. Second, as long as you get an
occasional TSH you won't have a problem. This is about once a year (once you achieve your
optimal dose). Some recommend every six months for the first few years and then once a
year. If you get pregnant, they will automatically check it regularly. You may need a
slightly higher dosage, but not usually. Take your medications and worry about something
more difficult. The difficult job was the first diagnosis, not the replacement part of it.
Thyroid and severe constipation
Question: My girlfriend started taking .025 mg Synthroid about 8 weeks ago.
Approximately 4 weeks ago she started having constipation. It has gradually become worse.
Her doctor raised her Synthroid to .05 mg daily. In the meantime she had taken all kinds
of laxatives per doctor recommendation. Magnesium citrate did nothing the first time she
took it. She also drank senna tea, used oil enemas, sennakot tablets, and increased the
fiber in her diet. None of these worked very well. After another trip to the doctor and
another bottle of magnesium citrate, this time it worked. Shortly after the problem
returned. The doctor has now scheduled a flexible sigmoidoscopy to check for polyps. My
question is, have you ever heard of a thyroid condition causing such severe constipation,
or do you think the two are unrelated? Will the constipation go away after the synthroid
takes full effect?
Answer: An underactive thyroid is a potential cause of constipation. It may be
worthwhile to wait until she is at complete replacement(usually 0.1 to 0.125) and if the
constipation persists to go ahead with the procedure.
Question: My Wife is taking Synthroid. When she was 15 she had a large amount of
her Thyroid removed. She has also been taking some hormones I believe to regulate the
hormone imbalance. She has become very emotional. It is becoming very hard to tolerate her
(and this is coming from everyone). She cries for no reason and also becomes very angry.
The mood swings have gotten a lot worse over the last two years. Is there anything you can
help me with? Is there anything I can do?
Answer: If her TSH is normal, its not the thyroid. When did she have it checked
last? If these are OK, I'd check out the rest of her hormones-- particularly estrogen and
progesterone levels. Does she think she has a problem? If not it probably is not related
to any biologic process other than depression. Any alcohol or drug use?
Question: Are the generic forms of synthroid effective, and are there any adverse
side effects to taking these drugs?
Answer: Many generic thyroid replacements are available. In general, I have not
seen much difference between brand name and generic. I would ensure that the pharmacist
keeps the same company and does not switch from generic company to generic company since
batch to batch and company to company there is very good reproducible levels. Your thyroid
will be checked by TSH levels and the dose adjusted accordingly. So, regardless of who
makes the drug if the dose from batch to batch is equal there won't be any problems. Many
patients prefer brand name Synthroid since the difference in cost between brand name and
generic is so small for thyroid replacement. Check the price with your pharmacist, but it
usually is about $5 a month difference for this drug class.
Question: I am a 27 year old woman with a 9 month old baby. My delivery was quite
normal except the fact that I lost a lot of blood. I am breast-feeding my baby. In the 6th
month I noticed that I am losing my memory. I had severe abdominal pain and heavy white
discharge. I was losing weight (I weigh 93 pounds) and feeling very tired. I had increased
pulse rate (above 110), rapid heartbeat, and low blood pressure (88/55). My fingers were
shivering. Maybe because of all this, I am feeling irritated most of the time, which was
not my normal behavior. My family practitioner upon checking my blood results noticed that
the TSH level is considerably low(<.1)and T4 level is high(11.5).Although she first suggested that I have hyperthyroidism, after checking with her chief, she concluded that there is no noticeable correlation between these two hormone levels. Therefore, she told me to wait for one more month. Now I weigh 100 pounds, and there is some improvement altogether. The doctor hasn't checked my blood for the second time. She told me that I would not need any treatment. Will hyperthyroidism go just like that without any treatment? Family history: My eldest sister has systemic lupus erythomatosus.
Answer: Generally, a low TSH is very suggestive
of hyperthyroidism as long as the blood levels of T4 and or T3 are high. Newer assays are
so sensitive for TSH that some practitioners no longer routinely check T3 or T4-although,
these are helpful with high levels of estrogen or other binding proteins. I'd get your TSH
rechecked, but these are very suggestive of hyperthyroidism.
Question: I am a 26 year old female and have recently been diagnosed with
Hashimotos Thyroiditis. I was diagnosed with hyperthyroidism when I was 12 and had
to get regular check ups, but I was never put on medication. My thyroid problems
"stopped," according to my doctors, at age 16. This past year, my thyroid again
became enlarged, thus the recent diagnosis. I am now on synthroid at 0.1 mg/day. Would
being put on medication at the earliest signs of thyroid problems have prevented further
progression of the disease? Is it normal to experience severe mood swings while my body
adjusts to the synthroid, and if so, how long can I expect them to last? Will I encounter
problems getting pregnant in the years ahead? What are my chances of developing thyroid
Answer: Hashimoto's Thyroiditis is one of the more common disorders affecting
the thyroid. It affects both men and women, but women predominate. It appears to be an
"auto-immune" disease, although this has not been specifically proved. There are
usually antibodies directed against the thyroid gland. The most common is the
antithyroglobulin antibody and antimicrosomal antibody. Clinically there is usually an
enlargement or goiter seen. Usually at this time there is normal thyroid gland function,
but over time the gland slowly fails. Treatment is directed at replacing the deficient
thyroid hormone. Treatment with thyroid hormone when goiter is seen, but prior to complete
glandular failure can prevent the enlargement of the thyroid. This will not prevent the
progression of the glandular failure. Hashimotos is occasionally seen with other
auto-immune type diseases like Sjogrens syndrome, lupus erythematosus, pernicious anemia,
etc. In the absence of these diseases there is no appreciable other organ involvement.
Question: I take 175 mg synthroid daily, since my thyroid was removed. I have been
told thyroid replacement should have no interaction with other drugs. Is this true? Also,
should I not be taking the over-the-counter cold medication that warns off those with
Answer: Synthroid(levothyroxine) is a commonly used medication for replacement
or suppression of thyroid hormone. Decreased absorption has been documented with ferrous
sulfate(iron), aluminum hydroxide(found in antacids), Carafate(sucralfate), infant soybean
formula, and bile acid sequestrants. There should be no interaction with over the counter
Thyroid - Synthroid/Levothyroid
Question: As a thyroid cancer patient, I have been using a combination of both
Synthroid and Levothyroid to get my TSH levels exactly where my doctor wants them. About 3
weeks ago I developed shortness of breath. I had my TSH levels measured, a chest x-ray,
and a physical exam by the doctor. Everything was normal. My TSH was lower than the
average person's because it needs to be, but it has been lower in the past. I am about 90%
sure that my shortness of breath is caused by anxiety. However, I am wondering about the
possibility that I may be having an allergic reaction to Synthroid. I know this is rare,
but how rare is it? If it were a true allergic reaction would I be having these prolonged
breathing difficulties (non-stop for two weeks)? I feel like I can't get a deep breath. I
quit taking the Synthroid for about 6 days. I did notice some improvement although I still
had breathing difficulty intermittently. Today was my 3rd day back on and I notice the
breathing problem start abruptly about one hour after taking my Synthroid, although I have
taken it before and not notice a reaction like that.
Answer: Although I am sure that some people have had allergic reactions, I've
never seen one. If there is a reaction it is probably to the binder in the medication.
However, I would ensure that you have not developed a concurrent medical condition.
Occasionally, people develop heart or other problems with thyroid disease. A diagnosis of
anxiety for a cause of dyspnea is always a diagnosis of exclusion. That is, ensure there
is no other cause.
Question: My wife was diagnosed with Graves Disease about 13 months ago. She
has been taking some thing called PET to lower her thyroid output. She has blood tests
regularly and her levels are coming down, but as soon as she stops the medication they
jump back up again. Due to a specialists strike she has been unable to consult
personally with a specialist in this field. Is there any cause for concern about being on
these drugs for a prolonged period of time? She does not want to have her thyroid removed,
as her mother is hypo and she does not wish to have to take replacement drugs.
Answer: Under and over active thyroids are extremely common. Approximately 8-10%
of women and about 3-4% of men will experience this problem. There are several treatments
available for over active or hyperthyroid patients. It sounds like she is taking PTU
(propylthiouracil). This drug can affect white blood cell counts and is rarely used over
six to eight months. It is usually 3-5 months are the average. Typically the drug is
decreased at intervals and if the thyroid is still overactive it is continued. If the
thyroid remains overactive for in excess of six months of so radioactive iodine or
surgical ablation is usually chosen. Proper dosing of I 131 will usually restore proper
function without the need for additional thyroid hormone. However, be advised that
patients with hyperthyroidism will have hypothyroidism about 30- 40% of the time in the
absence of treatment. Consequently, treatment will not necessarily increase the likelihood
of eventual drug treatment.
Question: I am a thirty year old female who has had 2 miscarriages. I went to an
infertility specialist who determined that I have an underactive thyroid. Do you know of
any connection between hypothyroidism and miscarriages? Also, how does synthroid (the
doctor prescribed it, but I haven't started taking it yet) affect a pregnancy?
Answer: Thyroid replacement should have no direct effect on the fetus. That is,
Synthroid will not directly affect the fetus. An underactive thyroid is one potential
cause of being unable to carry a fetus to term. You won't really know if it is your reason
until you correct your thyroid problem. However, from a practical point of view, you
should correct any and all problems that could interfere with carrying your child to term.
Question: A year and a half ago I had I-131 treatment and went hypo in a few
months. I felt terrible; slow pulse, tired, etc. My TSH was 7.1. After several months on
Synthroid 0.125 I tested within normal range. A few months later I tested at 0.22, so the
dose was lowered to 0.1. I was tested again last week and the TSH was 11.8. The reason for
the test was that I was experiencing hyper symptoms; fast pulse, excitability, diarrhea. I
was sure the Synthroid dose was too high. But the test shows it was too low so it's upped
again. Whats the matter? With a TSH of 11.8 I should have felt terrible. Could
something else be going on? My original diagnosis was Graves. The normal values for this
lab are 0.32-5.00.
Answer: Graves is a systemic disease which can affect many organs besides
the thyroid. The thyroid merely happens to be the most common. If your symptoms continue,
I would have your physician reassess you. Also, I would recommend a visit to an
endocrinologist if that approach doesnt work.
I-131 Treatment/Pap Smear
Question: I had a I-131 treatment (10/31/96) for hyperthyroidism. When I had my
annual pap smear two weeks ago, it came back with abnormal cells for the first time ever.
(I have had normal annual pap smears for the past 17 years. Could the I-131 treatment have
altered cells that would make this pap come back abnormal? The nurse in my doctor's office
has said that I just need to repeat the pap in 6 months so they can look at the change
before determining what further needs to be done. I know it just requires patience, but
that is difficult when from this end. When I get the opportunity to talk to my doctor, I
will ask him this question also.
Answer: Abnormal pap smears are pretty common since most cytologists over-read
to avoid missing any possible cancer. If treatment is necessary it will require a
culposcopy and possible cryosurgery (freezing the core of the cervix to slough the cells).
While this is time (and money) consuming it is pretty non-invasive. However, about 40-50%
of the time the next smear will be normal. Sometimes I get a second opinion from a
pathologist with a specialty in cytology prior to going further with procedures. This has
saved several women extra procedures. As I said they tend to be over read. The I 131 would
not be expected to have any effect on your cervix. The reason I 131 is used so readily it
that the thyroid is the only organ in the body that uses(and concentrates) I 131.
Question: Can an increased amount of Synthroid, over a normal dosage, contribute to
depression/paranoia for a person who has hyperthyroidism and has had radium treatment for
Answer: Possibly, Id get the dose correct and see if any changes occur.
They probably wont. Other problems common with thyroid disorders are B12 deficiency
(a possible cause of paranoia). I would check with their doctor that there is no
underlying problem that can be corrected.
Question: What kind of nasal decongestant/antihistamine can a person with
hypothyroidism take safely? If it indicates that anyone with thyroid disease
shouldnt take it, would it interfere with Synthroid medication levels?
Answer: This really isnt a problem to take them together.
Question: I was diagnosed with bipolar disorder approximately four and a half years
ago (at age 30). After close consultation with my physician, we came to a medication
regime which includes clonazepam, lithium, and Xanax. In addition, I have moderate asthma
which is treated with Azmacort and Ventolin.
This medical regime also includes consistent blood testing for lithium serum levels and
a thorough thyroid profile. After undergoing my regular blood work in July 1996, I was
instructed to lower my daily lithium dosage from 1500 mg to 1200 mg. In addition, I was
placed on Synthroid tablets for 50 days to adjust my thyroid function. Then, in February
1997, after the same battery of blood tests I was told that I needed to begin taking
Synthroid again. My physician said that my TSH was slightly elevated. My question is this
will I always be thrust into a juggling actbetween managing my bipolar disease and
maintaining proper thyroid function? I might add as a note that I have not noticed any
adverse health effects from this apparent hypothyroidism. Quite to the contrary, I have
experienced the longest period of "normalcy" with regards to my bipolar
disorder. I would greatly appreciate any comments on this issue.
Answer: Lithium can cause a underactive thyroid. This usually clears after the
lithium is taken away, but not always. The problem is that most patients will need to be
on lithium for the rest of their lives. So, generally once a low thyroid is encountered
you will be on thyroid replacement for the rest of your life. Your physician is treating
the thyroid before it causes a problem, which is by far the best way. Many patients are
not lucky enough to have a physician smart enough to watch for these problems, so consider
Question: I am 38 years old, and have just been put on medication for
hypothyroidism. My T-4 was normal, but my TSH was 8.5. My symptoms are weight gain of
about 20 lbs. (I was about 8 lbs. over my weight before this), extreme fatigue,
depression, thinning hair.
I have also had some irregular heart beats. Isn't this TSH level low for these
symptoms? I'm taking 0.05 mg in medication. Also, these symptoms are more severe now than
they were before I started. Could this be anything else?
Answer: An elevated TSH is the bodys way of indicating that it has
insufficient thyroid hormone. Curiously, the absolute elevation has little bearing on the
severity of the problem. Many patients with levels of 50-60 have less symptoms than those
with levels 10-15. Treatment is to give additional thyroid hormone until the TSH is
normal. Hopefully, your symptoms will resolve with additional thyroid.
Irregular heart beats are fairly common with replacement of thyroid hormone. These
usually abate with time. That dose that you are on is probably insufficient for full term
replacement. This would usually require at least 0.075 or more.
Thyroid Hormone Replacement
Question: I had radiation treatments for Hodgkin's Disease 3 years ago, and now it
appears my thyroid isn't working correctly. The doctor prescribed Synthroid, which I
understand to be T4. Why doesn't the T3 need to be replaced also? I have also read about
natural desiccated thyroid, or thyroid extract. How does that compare to the Synthroid?
Answer: Hypothyroidism is a common problem following head and neck irradiation.
The replacement is fairly simple, T4 is converted by your body as needed T3. Synthroid is
the better drug because it is more exact in dose from batch to batch. Desiccated thyroid
is cheap, but varies a lot form batch to batch. Most physicians prefer synthroid or
Question: I have been treated for Hashimoto's thyroiditis for about 3 years now,
and I am a little frustrated with my doctor's most recent explanation. My thyroid seems to
be feeling fine one day, and swollen thenext. I have also experienced pain, and recently
went back to my doctor with a very swollen neck. She had a CAT scan done and when it came
back normal, she said that I must have "bled" into my thyroid. She said that
happens in some cases. From what I've read, only 10% of Hashimotos cases have pain.
My doctor also said that this bleeding should happen only once. From my experience, I've
had major swelling several times, and I'm not so apt to except her explanation. Should I
seek other medical advice?
Answer: Have you had anti-bodies quantified? That is, are you sure this is
Hashimotos versus some other thyroid problem? For practical purposes it probably
doesnt matter. Are you on suppressive doses of thyroid hormone? This can help. Also,
I would say that the 10% figure is a little low, however if it is you, it is 100%. First,
ensure your diagnosis is correct.
Question: My wife, 26, 113 lbs, 5'2", is a Hypothyriod taking thyroxin 1.0 and
is now suffering greatly from allergies. All of the OTC medications with decongestants say
that she can't take them. WHY? Is there any OTC medication she can take? We have also been
told that many OTC drugs for cough, cold, flu and some stomach remedies are the same, so
what exactly do we have to watch out for?
Answer: I would ignore their warning and take the medication. I can think of no
problem produced by this combination.
Question: I am currently being treated by a physician (FP) for weight loss. Thyroid
tests were required and the T-3, T-4, and thyroxine levels all fell within the normal
range. However, my concern is that 15 years ago I saw an endocrinologist who diagnosed me
with Hashimoto's Thyroiditis. After so many years of taking Cytomel (Rx), I moved to a new
area of the state and stopped all treatment for the past several years. Is it now possible
that I no longer have this disorder, or is another test necessary to confirm the diagnosis
besides the ones listed above? (such as a thyroid antibody test).
Answer: Hashimoto's Thyroiditis is actually a systemic disease where the thyroid
is major target organ. Once it is present it doesn't seem to go away, although the disease
usually waxes and wanes and some patients never have further trouble. The anti-bodies,
however, usually stay positive and are of little help in assessing the activity of the
disease, merely the diagnosis. The tests that your physician has performed indicate that
your thyroid is currently working adequately. This does not mean that in six months or two
years it will not either be hypo or hyper. Look for other reasons for weight loss.
Hashimoto's is often seen in patients with Sjogrens Syndrome, diabetes mellitus, adrenal
insufficiency, pernicious anemia, rheumatoid arthritis and lupus. Maybe these could be
Question: I have recently been diagnosed with severe depression, but due to the
other symptoms I have been experiencing,(such as cold hands, cold feet, low body temp,
difficulty concentrating, memory impairment, dry skin, fatigue) my TSH level was checked
by a chemiluminenscence assay method to rule out possible hypothyroidism. those results
were normal. How definitive is this particular type of TSH assay and to completely rule
out thyroid involvement? Is there any value in performing additional thyroid assays such
as T3, T4, FIT, etc.?
Answer: The new super, sensitive TSH assay is thought to be 99.8% accurate. This
will miss occasional problems, but for clinical purposes is an amazing test. Checking the
T3 and T4 is occasionally helpful in hyperthyroid, rarely in hypothyroid states.
Question: My question is about generic/brand Synthroid. Is the brand better because
it has better production of the drug? How do increased hormonal levels while on BCP affect
the thyroid hormone functioning?
Answer: Synthroid is the brand name for levothyroxine. This has been available
for several years as a generic equivalent. The brand name does not appear to be clinically
different compared to the generic drug. Thyroid drug dosages are increased or decreased
depending on the serum level of the drug. This is usually measured by measuring Throtropin
Stimulating Hormone(TSH). Consequently, when a patient is receiving insufficient drug the
level is increased and vice versa. It may be that the bioavailability of the generic drug
is less or more than the brand name, but this will be corrected by measuring your body's
response to the drug. It is a good idea to keep on the same brand of drug, brand or
generic, since the bioavailability of the drug is usually maintained quite closely by the
manufacturer. Consequently, using the generic drug does not appear to be a problem unless
one keeps shifting manufacturers. I would recommend that if generic is used that one use
the same manufacturer for long periods of time. This is also a drug that has a small
difference in price between brand name and generic than other drugs. This may influence
Question: What causes this condition? Why would it occur in a thirteen-year old
Answer: Hashimotos thyroiditis is an autoimmune disease of the thyroid. It
is one of the most common diseases of the thyroid. Since it is autoimmune in nature, it
tends to run in families. Patients with Hashimotos typically have a goiter or
enlargement of their thyroid gland and it is the most common cause of goiter in children.
Autoimmune disorders all have in common the production of anti-bodies directed against
ones own organs. In Hashimotos, the production of antibodies, called
antithyroglobulin antibodies, reflect the inflammation and destruction of the thyroid.
Question: I have a few subtle symptoms which recently increased. I am a 42 year old
female who has always had an intollerance for heat, which has increased, always was thin,
and now have to deal with losing weight. My heart occasionally has an irregular rhythm,
and my hair is thinning at an alarming rate! There are thyroid problems in my immediate
family. Are my symptoms similar in nature to one with a malfunctioning thyroid?
Answer: Certainly all the symptoms that you cite could be due to thyroid
malfunction. Simple tests by your physician can determine if your thyroid is acting
normally. A very good bedside test for an overactive thyroid is one's pulse rate. For
young people it is almost always rapid with hyperthyroid problems. This is not always true
for older individuals, but should be at your age. If your thyroid is normal other medical
problems could explain each symptom individually.
Question:I am a 13 year old girl. I was recently diagnosed with hypothyroidism. I
come from a family of very tall people. My father is 6'6'',my mom is 5'8'', and 2 brothers
at 6'4''. I have not grown and am wondering if I will catch up in my growth.
Answer: If the hypothyroidism was responsible for your retarded growth you
might-this is a common cause of retarded growth. For girls, most of their adult height
will be reached by the time they start their monthly periods. After the onset of puberty,
girls may grow a couple of inches;but, the growth plates for their bones begin to set with
estrogen and their growth slows and stops. If you haven't had your periods begin you might
get some additional growth.
Question:I've been told that hypothyroidism may interfere with carotene metabolism
which can cause a yellowish discoloration to the skin. Is this true, and if so, do you
have references that document this phenomena?
Answer:A slightly yellowish hue to the skin has been known for over fifty years
in hypothroidism. This is due to carotenemia and is due to high amounts of Vitamin A
precursors in food. Anyone can develop this yellowing if they eat large amounts of yellow
vegtables. Hypothyroidism does increase this tendency.
Thyroid Replacement Therapy
Question:I am a 55 year old Afro-American female. In 1980, my thyroid was removed.
I had had radium treatment when I was 7. I have been receiving Synthroid since surgery at
levels varying from .15 - .3. I have been at the .15 level for 3 months. According to
tests, this amount is appropriate although it surprises both me and the specialist who
receives the information from my GP who monitors the condition. I hate to eat consistently
gained 10 pounds annually fro 2 years after surgery and for the past three years. I am now
a little over 70 pounds heavier than just prior to surgery and have tried consistently to
loose weight. I know that I need to exercise more and have recently changed positions
(from administration) in order to do so. I just began an exercise program. What else can I
do? Is there any treatment other than Synthroid that will work? Compared to the medication
given when the surgeon attempted to shrink the thyroid, I am disappointed.
Answer:I presume your thyroid was removed due to the radiation at age 7. This
increases the risk of cancer of the thyroid and also hypothyroidism. Complete ablation or
surgical removal of the thyroid will require life long replacement-whether it is synthroid
or another equivalent drug is unlikely to matter. Many people have the belief that extra
thyroid hormone will cause weight loss. While this is usually true if the gland produces
the hormone it is not true for external replacement. I doubt that your thyroid has much to
do with your weight gain.
Thyroid and Menopause
Question:I am 50 years old, went through a natural menopause at age 37. At age 39,
I underwent removal of thyroid lobe for Huerthle cells they were benign. I began taking
.15 synthroid to suppress remaining lobe. I just came back from annual gyn exam and was,
of course, handed a script for HRT. I also just found that my bone density is low on a
DEXA scan. Since thyroid med. interferes with calcium absorption, would it be useful to
discontinue synthroid? It would seem that other lobe would "kick in" if I did
this. Since I don't have current thyroid measures or cholesterol measures, I told my
gynecologist that I need to have the complete picture before I jump into 30 years of HRT.
I the mean time, I asked her nurse if she would write a script for nasal calcitonin so I
could at least stop bone loss. The nurse immediately stated, "You know you have to
have your nose checked every 3 mos. (reason not given) if you take calcitonin." My
answer, "Well, it beats having an endometrial biopsy every time you bleed using
PremPro." There's no free lunch, you know. No wonder so many women will not
"comply" with HRT. What is the bias out there on calcitonin? What not try
something first that has fewer systemic effects and can directly affect bone?
Answer: No perfect answers here. First, do not stop the thyroid medication. Hypo
or hyperthyroid conditions will exacerbate osteoporosis. The calcium absorption has little
to do with osteoporosis. Second, in general estrogen appears to be a beneficial drug if
you do not have a high family history of breast cancer. This usually means first degree
relatives(mother, sister,) or numerous second degree relatives. In general, estrogen will
prolong your life and increase the quality as well. You won't be able to get around an
occasional biopsy of the endometrium unless you have a monthly period-another pain for
most women. Finally, there is no reason for quarterly nasal checks except to increase your
physicians income. Maybe the first three months; but, not after that.
Thyroid and Hysterectomy
Question:I had my thyroid removed 2 years ago as it was cancerous. I am currently
47 female and on .30 mg daily. My doctor has recommended I have a hysterectomy because of
excess bleeding and fibroid tumors-not related to my thyroid. My question is should I do
this and go on hormone replacement therapy what side affects, if any, could occur between
the synthroid and estrogen.
Answer: Little if any. The estrogen will elevate the binding proteins ;but, will
not appreciably affect the dose that you require.
Thyroid and Hysterectomy
Question:I have been on thyroid medication for about 30 years. I am 45 years old.
Two years ago, I had to have a complete hysterectomy and oophorectomy (sp??). I have also
in the past been treated for clinical depression. (It is prevalent in my family). It has
been difficult getting the hormones correct. My question is: Could the hormone problem be
what has caused a change in my thyroid condition, necessitating a decrease in my Synthroid
from .3 to .2 as well as my having to get back on anti-depressants? How does one go about
finding if she is getting a proper amount of HRT and what is the balance of thyroid,
depression, and thyroid imbalance??
Answer: These are actually fairly simple. TSH will be elevated with a deficiency
of thyroid and depressed with an excess. Likewise, LSH and FSH are elevated with a
deficiency of estrogen. It these hormone levels are checked with drug changes you will
have exactly the right dosing. This is a little more expensive than "seat of the
pants"; but, is effective.
Question: I had an extremely overactive thyroid about 5 years ago. I was give
radioactive iodine to kill the thyroid. To replace the thyroid I have been on synthroid
since. I weight has increased ever since and I cant seem to loose weight. I am on
.100 synthroid daily. I am thinking of trying less, may taking half the tablet daily. Will
this help stop the weight gain? I am trying to find a way to loose weight. I have often
thought of finding an herbal or natural replacement. Is there such a thing?
Answer: Patients who undergo radioactive ablation of the thyroid gland (or, use
of radioactive iodine to decrease/stop function of the thyroid) do need to receive a
replacement form of the thyroid hormones that the gland will no longer be able to produce.
You are on synthroid, but are gaining weight. There are several possibilities to consider,
the first of which is that the weight loss is due to inadequate replacement of the thyroid
hormone. Thyroid hormone is in large part responsible for our day to day energy level, our
base metabolism rate, and many other bodily functions. The key to determine whether or not
you are receiving enough hormone is to get thyroid function tests checked.
Even though your thyroid has been suppressed by the radioactive iodine treatment, these
blood tests can tell your health care provider whether or not you are receiving the
correct dose of synthroid. Other possibilities include low energy level, low physical
activity, excess calorie intake, or other medical conditions and/or medication you may be
on. A visit to your health care provider may be in order. He or she can check your thyroid
function tests, and do a full history and physical, so as to try and sort out why you are
experiencing the weight gain. You should always first check with your health care provider
before making any changes with your medications, or starting a new one, even if it is
bought over the counter and does not require a prescription.
Question: I am on 0.15mg levothyroxine daily. Can this drug result in excessive
Answer: Levothyroxine is the generic name of a medication used for thyroid
supplementation. The Physicians Desk Reference does not specifically list skin
itching (or, pruritus) as a side effect of this medication. However, allergy
to this mediation, although quite rare, is reported, and the itching may be a reflection
of a mild allergy. More likely, would be the presence of another cause for the itching.
Pruritus, or skin itching can be caused from many conditions, ranging from allergic rash,
exposure to a skin irritant, liver disease, infection, or even excessive skin dryness
alone (which can be seen in conditions involving the thyroid gland). If you are
experiencing a symptom that you feel may be related to a medication, visit your health
care provider. He or she can determine whether the symptom is possibly due to the drug,
and determine the best course of action to take.
Question: I have a Tyroid gland that swells from time to time, I get very tired and
my throat gets very sore, also I retain fluid. I take vitamins which does seem to help me.
Have you any suggestions? Is there a permanent solution? I am living in Ireland,
unfortunately my doctor and the hospital specialist have been of little help. I have been
advised to continue taking multivitamins.
Answer: Vitamins will have no effect on the thyroid with the exception of any
Iodine containing products like kelp, seaweed, etc. These should be avoided due to their
tendency to suppress the thyroid. Have your thyroid functions been testes-especially
during an episode. Hard to know if you have episodic thyroiditis or merely a cyst.
Usually, a scan and thyroid function tests would be ordered.
Back to Drug InfoNet Home Page.
Back to Doctor FAQ main page.
Send your impressions, comments, thoughts, etc. to firstname.lastname@example.org
© 1996-99 DRUG INFONET, Inc. All rights reserved.
Last modified January 05, 1999