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Doctors' Answers to "Frequently Asked Questions" - Hypothyroidism

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.

Anemia and Hypothyroidism [posted 1/14/99]
Question: I am a 40 year old female with a multi-nodular goiter/hypothyroidism. I have bouts with anemia and my doctor recently prescribed 325 mg ferrous sulfate t.i.d. I am concerned about this high dosage of iron in conjunction with synthroid. I am to take the iron for 3-4 weeks and return for more blood work, possibly an anemia study. Can you give me any information? I also take a small dosage of xanax for panic disorder, but will soon be substituting this for paxil. Will all these drugs interact effectively? I am concerned about this.

Answer: Well, just don't take the thyroid with the iron since it is one thing that can interfere with absorption. If there is a time between pills, there usually isn't a problem. As to the others, there shouldn't be a problem with interactions.

Hypothyroidism [posted 1/14/99]
Question: I have been Hypothyroid since 1980. My TSH level in April was 9.0, when it was rechecked in July it was 40.96. My Synthroid level was increased from .02 to .175. After 3 weeks at this new level I still have the same symptoms of fatigue, mental confusion, etc. I have recently been diagnosed as a Hepatitis B Carrier. Could this be the cause of the drastic change in my TSH level and how long does it take for the increased dose of Synthroid to make a difference in my symptoms?

Answer: The Synthroid should work within 1-2 weeks. Hard to know if the hepatitis has any effect, but many people continue to lose thyroid function over time. Full replacement for most people is .25 to .3 mg so you can see that you had some partial function of your thyroid at first. Also, about 10% of thyroid patients develop B12 deficiency, Addison's Disease (adrenal insufficiency) or other auto-immune problems like myasthenia gravis. If your TSH is normalized I'd look in these areas before the hepatitis. Although that could be the problem, treatment is more limited.

Coumadin/Toprol/Blisters [posted 1/12/99]
Question: I am 49, with a hypothyroid. I was hospitalized earlier this month with atrial fibrillation. While on the medications in the hospital, I experienced an extreme amount of sweating in the upper thigh area and under my arms. When I returned home I noticed what appeared at the time to be a blemish on my upper inner thigh. Now I have full blown blisters on both legs, fingers, inner arms, chin, neck and back. My doctor advised me to stop the coumadin and to slowly stop the toprol (taking it once a day, then every other day, then skipping a day, then no more). During this whole period I stopped my thyroid medication. Since taking these medications have been very drowsy. Any ideas as to the cause of this outbreak?

Answer: No, but stopping the thyroid would explain the fatigue.

Hypothyroidism treatment [posted 1/11/99]
Question: I've been on Synthroid .05 mg daily for about 18 years. I have problems getting to sleep even on this low dosage. My thyroid levels are checked yearly and are ok. What side effects on hypothyroidism would occur if I went without medication? Also heard there was a health food drug on the market that you can purchase over the counter for thyroid problems. I believe it was referred to as Armour? I'd like more info on non-prescription thyroid medications.

Answer: Armour makes a desiccated thyroid preparation, but it is prescription only. Hypothyroidism will accelerate the aging of your body, elevate cholesterol, decrease cardiac function, etc.

Hypothyroidism [posted 8/13/98]
Question: I have just been diagnosed as borderline hypothyroid, and my doctor has prescribed .025 mg of Levothyroid to be increased in 2 weeks to .05 mg. A friend told me that she has heard that Synthroid (and its generic equivalents) pose an increased risk of breast cancer. Is this true? Also, if my hypothyroidism was pregnancy-induced, is this replacement therapy temporary, or will I need to take levothyroxine for the rest of my life?

Answer: No risk of breast cancer with thyroid replacement. Usually once hypothyroidism occurs it will be lifelong. However, if it is due to thyroiditis (a painful inflammatory condition of the thyroid) it can return to normal - this occurs about 5% of the time.

Hypothyroidism [posted 8/13/98]
Question: Two years ago I experienced an episode of atrial fibrillation that took about 18 hours to convert. I was then diagnosed with hypothyroidism and experienced a weight gain of over 40 pounds. After two frustrating years I have recently changed physicians. I am taking 25 mg of Atenolol, 10 mg claritin, .175 mg levoxyl, and a multi-vitamin. Regardless of serious effort, weight loss has been extremely slow. My new physician explained that I have Hashimoto's thyroiditis and that the one episode two years ago was due to the fact the with Hashimoto's you actually at first experience hyperthyroidism. I am impressed that she is taking one step at a time to help correct elevated cholesterol, somewhat elevated TSH and my weight problem. She has suggested that I start taking phenteramine saying that will help with weight loss and boost my metabolism as I am terribly tired all the time. Is this a safe medication? She will be checking my blood pressure and weight every 14 days. Also, must I always take the atenolol from just one episode?

Answer: Looks safe, but questionable. A lot of your fatigue is the weight, a lot is the atenolol. If you haven't had any further spells you might try a vacation from Atenolol. This would have some risk of recurrent Atrial fibrillation, but within a few days you would know how much it is contributing to your fatigue. A lot of patients gain weight on beta blockers due to lack of energy-they just don't feel like doing anything and subsequently gain weight. I would try this before I'd use the phenteramine, but there is some risk of recurrent A Fib.

Hypothyroidism and D.E.S.
Question: I have been diagnosed as having hypothyroidism as well as other things. I currently take synthroid and cortone acetat and testosterone injections- all as replacement therapy. I took human growth hormone as a child. (yes I have heard about the cruetfeldt-jacob connection with hgh) So I think it would be safe to say my hormone systems are pretty messed up. I thought I was probably all alone in this but I am beginning to meet other men who have symptoms and take the same kind of meds as I do- more than I would imagine living in a small town like mine. Some of us-myself included-have minor birth defects, (if such a thing exists). In talking with others there is at least one thing in common between us, and that is we all had mothers who took D.E.S. You can see by now that I am not a Dr. or chemist, but I can not help but wonder if there is a connection or if anyone is researching this.

Answer: The deficits you have are very uncommon. There are familial syndromes which would cause multiple hormonal deficits-- so if you are related this is a possibility. The two possibilities that come to mind are that your physician has misdiagnosed multiple patients or some other relationship exists-- possibly DES. We really don't know the full syndrome in offspring.

Question: Do you fully recover from this illness? I have been on thyroxin for 2 years and still do not feel 100%. I have no other illnesses and take 1.5 mg per day.

Answer: Depending on the cause of your hypothyroidism, most patients will require thyroid replacement for the rest of their life, especially if they have Grave's Disease or Hashimoto's thyroiditis. Hypothyroidism from Thyroiditis can occasionally revert to normal. You'll need to find out what type of hypothyroidism that you have.

Question:In the last 18 months I have been having some medical problems causing me to wonder what disorder I have. It started with classic symptoms of perimenopause. I was placed on HRT. Some of my symtoms disappeared but my period are still quite irregular. Then symptoms of fatigue, weight gain and foggy memory started to occur. I was given a blood test and I was told that I was borderline hypothyroid. Of course during the period of time between symptoms of perimenopause and hypothyroidism I started having problems with my teeth. They were begining to become loosen (diagnoisis-gingivitis) and the roots were decaying. My dentist said that thyroid problems could be the cause of my dental problems and that I should have it corrected soon. My physician says she wants to want till my dental problems are corrected before possible starting me on medication. Now I wondering should I be seening an edocrinologist? Am I perimenopausal ? (I started taking HRT at age 41) What is my problem since all can produce similar symptoms? Is there a way to pin down a diagnois?

Answer:There are very few reasons to put off starting thyroid replacement. About the only one with any validity is a patient with angina who will have more angina with thyroid replacement. I can really think of no reason why your physician would put off replacing your thyroid if it is indeed low. Hypothyroidism can be due to glandular failure or to failure of the pituitary gland. With your menopausal symptoms, I would be absolutely sure that your pituitary is functioning. In general, a good family practice physician, internist or endocrinologist could do these tests. If it is only your thyroid any of the three could replace the hormone. If the pituitary is not functioning correctly, I'd see an endocrinologist.

Termination of Medication
Question: My mother was an extremely healthy, self-sufficient 85 year old. She had taken thyroid medication for hypothyroidism for fifty years of her life. After her last checkup, her physician took her off thyroid medication completely. She had an episode with atrial fibrillation and then had a stroke. All of this happened within a two week time frame. She died. In the reading I have done since her death, I have discovered that medication sometimes has to be reduced for the elderly, but I haven't found it stated anywhere that thyroid medication can be totally terminated after so many years. If you would comment on this, I would appreciate it very much.

Answer: It depends on why she was taking the thyroid. For example, if she was taking it for goiter suppression, then it could be stopped "cold turkey" without problems. However, this is somewhat unusual on the surface. We rarely stop things that seem to be working and especially try to avoid changes in the elderly unless pushed.

Question: What are the "normal" ranges for the various thyroid levels (T3, T4, TSH), and what kind of results could indicate hypothyroidism in a 25 year old female?

Answer: Ranges for normal of these hormones vary by each particular lab. These can be obtained from the lab or your physician and are no secret. Generally, TSH is the most sensitive test for hypothyroidism. An elevated TSH means that there is insufficient thyroid hormone or hypothyroidism. Usually this means a TSH above 6 or so depending on the lab and the assay. T3 and T4 are occasionally of help-- usually in hyperthyroid states not hypothyroid states. If the TSH is normal, this is about 98% specific that the thyroid is normal.

Question: I am a 32-year-old female trying to get pregnant. I have taken all tests to make sure I am healthy, and so has my husband (whom is normal). My gynecologist had me take a TSH and found that my thyroid was underactive. He suggested that I see an endocrinologist, but my family doctor said he could treat me with Synthroid (0.05 mg). I have taken it for one month and my TSH levels are slightly better. Should I see an endocrinologist, or should my family doctor still treat me? Does Synthroid cause birth defects or mental retardation if I get pregnant while on it? With the dosage I am taking should I be getting normal menstrual periods? Without it I am getting my period every ninety days? Will a higher dosage of Synthroid bring on my periods to be normal?

Answer: A low thyroid is a notorious cause for infertility problems. This will be reflected in a high level of TSH. Curiously the amount of elevation does not correlate greatly with the thyroid shortage and very high levels sometimes indicate less severe hypothyroidism than moderate elevations. However, you should be replaced with Synthroid until your TSH is in the normal range. This will usually take 0.1 to 0.125 for most young women, although there is a great range. We start with small doses like 0.05 mg to ensure that people don't react. Since thyroid is a normal body hormone, there should be no effect whatsoever on a fetus, and it should help normalizing your periods. I doubt that you need to see an Endocrinologist, but have your doctor check thyroid anti-bodies in order to see if this is Graves Disease, Hashimoto's Disease, or some other cause. The treatment is similar, but Graves Disease can involve other organs that need to be watched.

Hypothyroidism treatment
Question: My wife has been diagnosed with primary hypothyroidism and has over 3 weeks worked up to 100 ug/day Thyroxine. She is 44 years with no heart problems. She is experiencing a type of skin rash-- red spots over various parts of her body. This worsened on the last increase of Thyroxine from 75 ug to 100 ug. It is a somewhat itchy complaint. Do you think that this is a temporary condition caused by returning levels of ho?

Answer: I’ve never seen a patient with a rash from levo-thyroxine. However, it is listed as a possible cause in the Physicians Desk Reference. You might try desiccated thyroid for a while and see if there is any difference. If not, then I doubt if it has anything to do with the thyroid medication. Graves Disease has occasional skin findings. You might ask your physician if she has this variety of thyroid failure.

Hypothyroid / Arthritis
Question: I am a 40 year old female and I have been treated for hypothyroid for about four years. After being diagnosed, I was prescribed Synthroid and currently take 0.125 mg daily. Since the onset of the disease and its treatment, I have developed arthritis. I have an inflamed and swollen knee joint, disfiguring swelling and lumps on some fingers and toes and frequently have flare-ups in other joints that come and go. I have been to two specialists who advised me that my condition does not show as rheumatoid arthritis. There is no doubt that I am affected by this disease, but blood tests don't prove this. Is there any medical information or evidence to link either thyroid problems and/or treatment with the onset of arthritis? Is the arthritis a side effect of the disease and/or treatment?

Answer: Offhand, there should he no connection between the two. However, Hashimoto's Thyroiditis is basically an autoimmune disease, so I could be convinced that some patients will develop an autoimmune arthritis. Also, some hyper/hypo thyroidism appears to be viral or infectiously induced. Consequently, this could trigger arthritis. I would need to know the type of arthritis and the cause of hypothyroidism before I could help you.

Question: I would like to know if it is still possible to get Proloid. Synthroid hasn't worked right for the past 12 years. I took Proloid for 34 years and always had my weight under control. With Synthroid, I have gained weight. Please help.

Answer: Proloid is no longer manufactured mainly because it was never useful in treating hypothyroidism. Thyroid replacement is not effective in managing weight loss. Consequently, I doubt seriously whether changing to Synthroid has any appreciable effect on your weight. As long as your TSH is in the normal range you are receiving adequate replacement. I'd make sure you are on the correct dosage. You really won't see any effect on your weight by changing these medications.

Question: I've been diagnosed as hypothyroid, however, I also have an enlarged goiter and am undergoing an ultrasound soon. I am taking synthroid .025mg daily. My question is that I have both symptoms of hypo and hyperthyroid. Is that common? I am 36 years old and believe I've had undetected thyroid problems for years.

Answer: Most patients with your problem have Grave's Disease. This gives hyperthyroidism usually followed by hypothyroidism at some later date. Also, the symptoms of hypo and hyper overlap so that some are similar/identical. Your current dosage of synthroid is insufficient for replacement or suppression (of goiter size). Women your age usually need a minimum of 0.1 mg, which is four times your current dosage. Discuss this with your doctor.

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