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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 glands?

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 12/04/98]
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 12/01/98]
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 11/13/98]
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 11/4/98]
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 10/29/98]
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 endocrinologist.

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 concerned.

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 10/1/98]
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 [posted 8/13/98]
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 switched.

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 8/10/98]
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 think.

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 8/4/98]
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 "storm".

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 7/17/98]
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 [posted 7/17/98]
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.

Thyroid problem
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: It’s 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.

Hyperthyroidism Treatment
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 disease.

Underactive 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?

Thyroid replacement
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.

Hashimoto’s Thyroiditis
Question: I am a 26 year old female and have recently been diagnosed with Hashimoto’s 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 cancer?

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. Hashimoto’s 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 "thyroid disease"?

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 cold medicines.

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 Grave’s 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 specialist’s 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. What’s 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: Grave’s 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 doesn’t 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 their thyroid?

Answer: Possibly, I’d get the dose correct and see if any changes occur. They probably won’t. 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 shouldn’t take it, would it interfere with Synthroid medication levels?

Answer: This really isn’t a problem to take them together.

Bipolar Disorder
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 yourself lucky.

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 body’s 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 generic equivalent.

Hashimoto’s/Neck Tenderness
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 Hashimoto’s 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 Hashimoto’s versus some other thyroid problem? For practical purposes it probably doesn’t 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.

Decongestants/Thyroid disease
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.

Thyroid Disease
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 clues.

Thyroid screening/depression
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.

Thyroid Drugs
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 your decision.

Hashimoto’s thyroiditis
Question: What causes this condition? Why would it occur in a thirteen-year old girl?

Answer: Hashimoto’s 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 Hashimoto’s 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 Hashimoto’s, the production of antibodies, called antithyroglobulin antibodies, reflect the inflammation and destruction of the thyroid.

Thyroid Symptoms
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.

Carotene Metabolism
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 can’t 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 skin itching?

Answer: Levothyroxine is the generic name of a medication used for thyroid supplementation. The Physician’s 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.

Swollen Thyroid
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.

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