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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.

[posted 09/21/2000]
Question: Had off and on virus-like symptoms for about 6 wks. with constant fatige, no appetite, hair loss. Lost 11 lbs during this period (I'm 39, 5'9, 126 lbs) Doctor suspected hyperthryoid and found nodule, my TSH normal (2.48) so I'm not hyper. Scan revealed cold, solid, hard, moderate size nodule. Surgeon recommended surgery after FNA revealed calicifications, epithelial cells w/atypical features. Macrophages and follicular cells w/ nuclear grooves. Final report: recommend histologic evalualtion. What does this mean to you? I left his office still confused. How accurate is a frozen section? Do the charactaristics found in the FNA warrant thryoidectomy because of increased chance of cancer in the future if frozen section is benign? If thyroid not removed due to benign frozen section, should I disregard suspicious FNA findings and not worry? Thanks for some answers. I have confidence in my surgeon, but he has a very "guarded" nature and is hard to talk to.

Answer: If there is any doubt, most physicians would remove a cold nodule. Another option would be to send the slides to a national FNA center for a 2nd opinion(easily arranged by asking the original pathologist to send them- a minor cost). However, this will do nothing to address your initial problem.

[posted 08/15/2000]
Question: In August of '97, I had the left side of my thyroid and the mid isthmus removed due to having a large benign nodule growing on it. Since then, I have been prescribed 65 mg of thyroid daily. Today, after observing blood results, my doctor has changed the drug and the dosage. She is now prescribing .075 mg of Synthroid. She has explained why but I did not quite understand. Why is she doing this? I felt fine on the 65 mg thyroid.

Answer: Usually there is a tendency to have either hypothyroid(a low thyroid state produced by inability of your thyroid to meet your bodies demands) or a goiter. The goiter is enlargement of the remaining thyroid in its attempt to meet the demands of your body for thyroid hormone. Your md is either following the TSH, which should be kept low or the size of your thyroid. Both work and if the thyroid is getting larger or the TSH is elevated we would increase the thyroid hormone replacement(levothyroxine) to correct the problem.

[posted 08/20/2000]
Question: I am a 34 year old women who has a thyroid cyst on the left lobe. Before the FNA the ultra sound showed the cyst to be 3.5 x 1.7 x 3.0 cm. The FNA removed 2.2 ml of brownish fluid which showed it to be a colloid cyst with a large number of red cells and hystiocytes some of which contain haemosiderin and a small number of follicular epithelial cells. My thyroid levels are normal, and I have no discomfort or pressure symptoms. My GP and the surgeon he refered me to want to remove the entire thyroid gland and part of the parathyroid gland. This seems very odd to me as everything I have read seems to indicate that rarely is the entire thyroid gland removed even in the event of cancer. So why would the entire gland need to be removed for a benign cyst?

Answer: Shouldn't. See an endocrinologist or a 2nd surgical opinion. Some cysts can contain malignant cells -this would be an indication for the surgery-but you did not have any of these. Most would just follow the cyst and reaspirate it if it reaccumulated. There would be absolutely no reason for the parathyroidectomy unless you blood levels of calcium were high as well as having high levels of parathyroid hormone. But, the thyroid and the parathyroid are not clinically tied together at all so you would have to have two separate problems which I doubt strongly.

[posted 07/18/2000]
Question: About two years ago, a doctor found a small nodule on my thyroid during a routine physical,(lower, right) and ordered a sonogram. It turned out to be non suspicious. A year later, I had changed physicians, and he ordered a follow-up sonogram. He told me the nodule had not grown, and there was no cause for concern. Within a couple of months, and because of my own concerns, (weight problems) I went to an endocrine specialist for a second opinion. She did blood work, a cortisol test, and wanted to biopsy the nodules, (She said she felt two, one on each side) which I have not done yet. She said the results of my blood work were normal, the nodule had not grown, (based on the previous sonogram, which only showed one nodule) and has not presented any problems, and then perscribed Synthroid, .125 mg. My question is this: Why would she place me on meds if everything is testing normal, and there are no ca

for concern? Who do I trust at this point, or do I need to seek a fourth opinion before beginning Synthroid? A week has passes already. I just stare at the pills wondering what to do.

Incidently, my main complaints were (are) extreme fatigue, muscle pain, headaches, fluid retention, and obesity. I am 41. I also take Vioxx for arthritis in my back. I have recently had some thinning of my hair.

Answer: You are describing a multinodular goiter. This is a common and usually without major consequences. The potential risks are developing a low thyroid(an elevated TSH) or slow growth of the thyroid causing a goiter. This would be a cosmetic problem. Your endocrinologist is probably using the synthroid to avoid the goiter. This would depend on your TSH. That is, if it is normal, then the synthroid is for growth supression. I assume someone has done a thyroid scan as well as an ultrasound? The only reason to biopsy multiple nodules is if one of them is cold on scan. This would increase the risk of thyroid cancer. But, if the scan is normal, than a needle biopsy is a waste of time/money/pain. The fact that the nodule has not grown as well as the fact that you have several usually means that you like 10% of the population have multiple nodules on your thyroid. We biopsy single nodules that grow, as well as cold nodules of any variety.

[posted 06/16/2000]
Question: I have been on Throid medication since January 1997. Started with Synthroid .1 mg. Just switched to Levoxyl .112 mg. on May 24, 2000. I never experienced anything except dry skin and constipation from Synthroid. I am now experiencing aching joints, severe constipation, headaches, extremely tired, cold intolerance, weight gain, fatigue, depression, memory loss. My family doctor says all this could not happen from changing brands of medication. Yet I read don't change brand names ever. All these symptoms started within the last 5 weeks. Is it possible this is due to change in medications? Do you think I should see an Endocrinologist?

Answer: If the medication is to blame, your TSH will be higher/lower. Check this, if in the normal range not the medication. If out of range, your medication needs adjustment. You can change brand names, just keep track of the TSH and ensure it is in the low normal range.

[posted 06/18/2000]
Question: In May of 1999, I was referred to an ENT for testing on a lump in my throat that had been irritating me for years. (It swells for no apparent reason producing pain in my neck) After ultrasounds and the uptake & scan, the ENT stated I had goiters in my Thyroid and put me on 50 mcg of Levoxyl for treatment and what I took as to "shrink" the offending one. My TSH and T4 levels were normal at the time treatment began, so I'm assuming my thyroid was working correctly. Since I've been on the medicine, I've been tired, irritable, suffered from repeated bouts of diarrhea,insomnia and constipation and have lost a significant amount of weight (14 pds in the past yr). In January of 2000, I was switched to Synthroid as my insurance wouldn't cover Levoxyl (go figure!). But my questions are: 1) Are the symptoms I've been experiencing being caused by the meds? I have told my ENT about this and was told it wasn't the meds that I was anemic. So I had this checked and was told by my DR that I wasn't anemic.2) Can Synthroid cause an itchy rash? I have noticed a few spots of dry, red itchy patches on my chest and upper thighs since I've switched brands. And lastly 3) If it is the meds that are making my sick? Can I just stop taking them or do I have to be weaned off the med so my thyroid takes over again? I asked my ENT and he said that I could just stop but I'd probably be on them the rest of my life if the goiter grew more, closed off my airway and had to be removed.(He was very rude about this too) Any information you can provide would be helpful. Thank you.

Answer: Synthroid is used for a variety of purposes, but generally to replace a low thyroid or to keep the thyroid from enlarging(goiter). The success of replacement to shrink the thyroid is variable, but there are no other alternatives other than surgical. If your thyroid was/is normal in producing thyroid, then stopping the thyroid will be of little consequence for the 6-8 weeks it will take to see if your symptoms abate. Problems occur with stopping thyroid replacement if your thyroid is not producing thyroid hormone. However, the synthroid is unlikely to be the cause since the dosage is so small(most would use 0.1 or so depending on your weight to reduce thyroid size). Anyway, stop it, have your TSH rechecked in 3-4 weeks to ensure that you have not become hypothyroid while taking this dosage(due to gland slowly failing, not due to taking the medication). You will know in 4-6 weeks.

[posted 06/14/2000]
Question: I recently had a thyroid antibody panel done. The results were microsmal tpo 1600 which is high, but my thryoglobulin ab was negative or under a negative 10. I have history of first diagnosis Graves, but over last few years my newer doctors say no. Then diagnosed with Hashimotos in 93, strugling with Beta blockers to slow down thyroid (hyperthyroid), I leveled off with pregnancy. After 2 months of giving birth, my thryroid stormed. I have a huge goiter (reason for dr. diagnosing me in 1st place), started taking thryoxin and leveled a bit. Ultrasound showed no more goiter, shrunken thryoid. Now a couple of yrs later, ultrasound showed a nodule 6 months ago, follow up 6 more months later- now ultrasound shows significant change in shape of entire thryoid gland,and again goitered. It would have made sense of Hashimotos progression if TGAB would have been high as well, but what is it that the microsomal is high and the other not. My thryoid levels look normal, and my current physician is looking to find an expert because he is uncertain of where his expertise is in this. Help?

Answer: Well, regardless of the etiology you need a needle biopsy(called a fine needle aspirate) of the nodule after you have a thyroid scan.

[posted 06/8/2000]
Question: I am 35 years old and I have had Lupus for 7 8 years. 3 Months ago I was diagnosed with Papillary Carcinoma of the Throid . I had a complete thyroidectomy. I'm now on Synthroid 100mcg.I also take 10 mg of predinsone everyday and plaquenil for Lupus.My questions are:
1) Doctors said the cancer was small so they opted not to do ANY treatments at all. mainly because of my Lupus.
2) I saw a my thryoidgloben test which was taken 4 days after surgery it was 89 which is high. Doctor told me not to worry about it since it was so close to surgery and I was not on syntyroid yet.
3) Does synthriod cause constipation, and the urge to pee all the time and irregular periods? And also my levels are currently ok but is this enough to keep cancer away.And will it come back since I had no treatments? Im still worried. Thank you

Answer: If you had a complete thyroidectomy, 100 mcg would be a very small dose for most patients. Ensure your TSH is in the normal range. The synthroid doe not cause constipation, but hypothyroidism does. Usually a complete thyroidectomy is sufficient for papillary cancer, but you need close follow up.

[posted 05/24/2000]
Question: I was recently diagnosed with Thyroiditis. My T3 and T4 levels tested high and my TSH tested low. My thyroid swelled to 1 1/2 times its normal size, I was extremely tired, had a rapid heartbeat and ached all over my body. This happened with about a week and last about three weeks. Then, as suddenly as it came, the symtoms went away. I took radioactive iodine (but not an uptake) and it was determined that I had thyroiditis and not Graves' Disease as had been suspected before the test. I am currently on a beta blocker, but no other medication. I was told the condition can sometimes correct itself. What are the chances of this happening? I have always had regular menstral cycles (like clockwork) and this month, I had only a little bit of spotting. Is this due to the hyperthyroidism and is it a normal symtom? I'm 31 and would like to start a family. Is there anything I can do to avoid it flaring up again?

Answer: Usually thyroiditis is thought to be due to infectious causes, viruses are blamed. Consequently, it doesn't usually reoccur with any frequency. Your period irregularity is almost certainly they over active thyroid. Once your thyroid is back to normal, you should have no trouble conceiving (at least in terms of your thyroid). However, having taken the Radioactive Iodine, you should keep an eye on your thyroid levels since either the thyroiditis or the RAI can eventually cause a low thyroid. Check your thyroid functions about once a year or with any changes in your period/hair/skin.

[posted 04/11/2000]
Question: I am currently taking synthroid .15mg but my TSH continues
to be zero. My T4 is 13.9, T3 35.1 and T7 is 14.3. What
would you recommend to bring my TSH up to normal range? And
what is the repercussion for having a zero reading?

Answer: Zero means you are being over replaced. The TSH works opposite of the blood levels. That is when your thyroid is too low, the TSH is high(above 5 or 6) and when your thyroid is too high the TSH is low(below 0.3). Decrease your synthroid dosage. It will take 6-8 months before you will know the results since it tends to stay depressed after over replacement for a long time-at least 2-3 months. Taking excessive thyroid will only result in some osteoporosis and occasional extra heart beats. Checking your T4, T3 and T7 is a good waste of money. Focus on TSH.

[posted 03/29/2000]
Question: should you watch your sugar intake and carbohydrate intake after removal of the thyroid?

Answer: Not particularly if your thyroid levels are replaced correctly.

[posted 03/26/2000]
Question: When I was first put on thyoid meds (Levoxyl 75 mcgs/day and Cytomel 5 mcgs./day), my TSH was 1.27, T4 at 0.5 (little low), and T3 around 260. I have definitely noticed swelling since being on the Levoxyl and need to know if you can GAIN WEIGHT from these meds when your levels are so close to being normal???? In other words, if you really don't need the thyoid medication and ARE taking it, can this cause WEIGHT GAIN???? Help!!!!

Answer: Why in the world are you taking thyroid replacement with these levels? Your thyroid is normal, stop taking unnecessary drugs.

[posted 03/22/2000]
Question: I was originally diagnosed in October of 1999 with hypothyroidism. My TSH at that time was 1.27, T3 in the normal to low end range, and T4 was low at 0.5. I was prescribed Levoxyl at the time and have recently added Cytomel to my regimen for the continuing depression and lack of energy. I have noticed that the Levoxyl seems to make me retain fluid. Is this normal?? I have also continued to stay on a 900 calorie diet for the past 6 months due to the small amount of weight gain (6 lbs.) I experienced before starting meds. Even though I run or do some cardio 4 times per week for 45 minutes and keep my calories low, I can't lose a pound!! Will this worsen due to the water retention, hypotyroid condition and thyroid meds?? I have heard that some people do not respond well to synthetic meds and was wondering if I should change to Armour Tyroid. Also, what do you think about adding Wellbutrin to my regimen for the depression. Will the Wellbutrin cause any extra problems like weight gain or work against my thyroid meds? Can my throid ever be normal again on it's own??

Answer: I don't see that these values are indicative of hypothyroidism. I would stop the thyroid and recheck yte athyroid values in a couple of weeks. See an endocrinologist if that is a viable option. Most physicans would not treat these numbers by themselves.

[posted 03/21/2000]
Question: I have been on Synthroid since 1984. I am wondering this. Could either the medicine or disease have anything to do with feel anxious, nervous, anxiety? I've been on it so long that I don't know if maybe this could be the problem or maybe need to look at things differently.

Answer: You need to know your TSH level. This is how we adjust thyroid hormone levels. If in the normal range (usually .5 to 5.0 or so depending on the lab)the Synthroid is not the problem. If the TSH is low, this indicates an over replaced thyroid and could be the reason for your symptoms.

[posted 03/14/2000]
Question: My daughter is taking synthroid because of a multi nodular goiter that was found when she was 10 years old. She is now 16 and has been on the medication. She does not always take the medication every day. What will happen if she goes without the medication for a long period of time and why it is important to take it every day? I need to have an answer for her.

Answer: She is taking the thyroid replacement to reduce the size of the thyroid over time. If unreplaced, many of these will procede to a large "growth" in her neck that is unsightly. Taking replacement will keep it from getting larger. So, missing a dosage isn't as big a deal for her as for someone who is low in thyroid. Her thyroid levels are probably ok, but the gland is enlarging to produce these levels and would slowly grow if not for replacement.

[posted 02/28/2000]
Question: What is the clinical pathway for counteracting gross overdose of levothyroxine? Instead of providing micrograms, pharmatist provided medication in milligrams. Pt in coma-- reversible?? Long term effects??

Answer: The mathematical correction to convert mcg to mg is very easy and would not explain your problem. Overdosing levothyroixine is very difficult and is treated with beta blockers.

[posted 02/28/2000]
Question: Hi, I have had symptoms of slow thyroid ever since my daughter was born 2 years ago. I have had my thyroid tested twice since then. My level was 1.15 which my arnp says is within normal parameters so she won't treat it. I know this is frowned on but I have thyroid pills from a friend and since taking them my fatigue,skin trouble, hair loss, and lack of sex drive, have all signifigantly improved. Could she be wrong, and how do I go about getting a prescription for T-1 which is what is helping me so much. Please help, I have the cure but want to do it the right way. Thanks.

Answer: Was this a TSH? If so, you could check free T4 and T3 levels, but TSH is very, very sensitive to hypothyroidism. If this is your thyroid levels, ensure that your TSH is checked. If elevated, you have your answer.

[posted 02/7/2000]
Question: I have taken Synthroid since I was 10 years old for hypothyroidism. Never before has anyone fully informed me the effects of my condition or medication. When younger, I was always incredibly thin and had a high energy rate. About 8 years ago, I switched medical doctors, and he decreased my synthroid dosage. Since then I have battled uncontrollable weight gain, headaches, incredible fatigue and bouts of light depression. Also, I have never menstruated on a "normal" cycle - I can have 5 weeks BETWEEN periods. My endocrinologist told me weight gain was an indication my medicine levels were "off", but when I couldn't control the weight he instead put me on a 1100 calorie diet (talk about getting tired!). Of course I lost weight, but that's because I didn't eat. I exercise regularly, consume about 1500- 1800 calories a day, and my doctor still says I eat too much and don't exercise. He also says my T4 and TSH levels are "within the normal range". He also doesn't know what makes me tired or have headaches. Could any of this be caused by my syntroid levels being too low? I never had any of these problems before I changed to a lower dose.

Answer: It doesn't sound as if your thyroid is the culprit. But, get the T4 levels and TSH and get back to me. If you are going to have this the rest of your life, you need to know how to interpret the tests-pretty easy actually. 10 years is very young for hypothyroidism. I would ask him/her to determine the type of hypothyroidism that you have. For example, Graves Disease is a systemic autoimmune disease and some patients will have other manifestations. There is also a type of autoimmune disease that has other endocrine associated disorders. B12 deficiency, adrenal insufficiency, vitiligo are the common manifestations of this type of hypothyroidism. But, first get a better diagnosis for the cause of your hypothyroidism.

[posted 01/30/2000]
Question: Initially, I had a weight loss/gain problem and my doctor has gradually over 14 years raised the dose from 125 to 200. I suffer mood swings which make me feel bad after I have particularly shouted at my son. I also find as I am studying for exams at the moment that my concentration is erratic. Is this age (I'm 48) or is it the medication? My other concern is that I read a large dose like I have does promote osteoporosis. How serious is this and what can I do to prevent it?

Answer: I assume this is Synthroid? If your TSH is in the normal range, probably not the thyroid. Look for other options, estrogen withdrawal(menopause), depression. There will be no osteoporosis if your TSH is normal however, you should get a bone density at this point to determine if you have a problem.

[posted 01/26/2000]
Question: My younger sister has been diagnosed as hypothyroid. I have high levels of thyroid autoantibodies and my doctor has put me on synthroid. My older sister also has thyroid autoantibodies but her doctor says she should wait until her thyroid tests become abnormal before starting therapy. Why the difference in treatment?

Answer: Most physicians would wait until the thyroid becomes underactive. Treatment will not change the course however, some feel that you can avoid enlargement of the thyroid(goiter) by early replacement. If your thyroid is enlarging this is probably a good idea. If small, most would watch levels every 6 months and start replacement as it dips. Also, there will be a higher risk of B12 deficiency, diabetes mellitus, adrenal insufficency and vitiligo in most of these families. These should be looked for occasionally by your physician.

[posted 01/16/2000]
Question: After having my throid gland taken out due to cancer, I was put on Synthroid 300mcg. I began to have chest pains and high pulse rate and blood pressure. The dosage was lowered to 200mcg. Since then I have been having consistent diarrhea and a rash. Could this be related to the dosage of the synthroid?

Answer: You need to know the TSH level as well as your free T4 and Free T3 levels. This sounds like a high dosage, but the test will tell.

[posted 01/19/2000]
Question: For about 2 1/2 years now I have something no one uderstands. First of all, I am not a hypochondriac. I feel "pressure" in my head, a "fullness". I feel like someone is squeezing my neck or like I am hanging up side down. My upper eyelids have been puffier for this time and they get worse when I feel the pressure coming on. the pressure seems to get worse with even mild exersion. I hear a "swishing" sound in my ears.I someitmes feel I can no longer bear it. My doctor said I have muscular/vascular spasms. I went to an ENT doctor and also had my sinuses X-rayed. 16 years ago I had half my thyroid removed because of a nodule. I requested a thyroid blood test, twice, and it came back normal. One night I had had it and went to the ER. They took a CT scan. My remaining thyroid lobe is enlarged and my trachea mildly displaced. I had a thyroid scan a few days later. My doctor sent me to a surgeon. ( I felt I needed an endocrinlolgist) The surgeon said no need for surgery since I had no nodule or tumor. When I had my nodule years ago I also felt a fullness in my head and the "swishing". Any ideas about my condition? Also, could my thyroid continue to enlarge? Why are my blood tests normal if the gland is enlarged? Thank you.

Answer: The thyroid can enlarge without being underactive-this is called a goiter. Oral replacement is usually successful in avoiding further enlargement. The swishing is probably flow noises in your carotid arteries. They run about 1/4 inch behind your ear drums and if there is a flow noise you will often hear it here. Anxiety is another cause.

[posted 11/30/1999]
Question: I took the radio active iodine for thyroid. My symptoms were swelling,fatigue,weight loss,and arthritis in my legs. It took almost a year to get my synthroid dose regulated. After 3 months of three .05mg Monday-Friday and two .05mg on Sat.& Sun. Now I am having a problem with lower back and leg pain. If my dossage is off again would it cause these problems?

Answer: You should know your TSH level first to find out if your thyroid is in the correct range or not. I doubt the pain is the thyroid. Arthritis is commonly worse when the thyroid gets replaced, but shouldn't wax and wane like this.

[posted 12/1/1999]
Question: History:
15 years ago diagnosed with Hashimotos, underactive thyroid. TSH of > 25 when originally diagnosed. Had iodine tests and needle biopsy. Most of 15 years on .150 mg synthroid, have been on .175 mg for about 2+ years.

My Question:
- recently went to my doctor for TSH test as I felt I was High -- have lost 34 pounds in last 1.5 years mostly due to diet and exercise. I was getting dizzy and heart palpitations and nausea. My TSH was 7.12, which means hypo (low thyroid). We waited 10 days and tested again and my TSH was 5.44 but I am no longer getting the dizziness and heart palpitations.
- why as my weight drops, do I need higher levels of synthroid?
At 160 pounds, on .175 mg, my TSH was 3.6 (Dec 97)
At 145 pounds, on .175 mg, my TSH was 0.31 (Feb 99)
At 130 pounds, on .175 mg, my TSH was 1.77 (June 99)
At 128 pounds, on .175 mg, my TSH was 7.12 then 5.44 (current - Nov 99)
Other symptoms:
Although my dizziness and heart palpitations are gone, I am having trouble with my breathing and have had a couple of severe asthma attacks in the last month, more severe than ever experienced in my lifetime. I usually only have asthma difficulties with strenuous exercise.
I have difficulty sleeping at night -- wake up and cannot fall back asleep -- laying awake all night and then get very sleepy during the day, often struggling to stay awake at my desk.
My doctor says other blood tests are normal, for iron, cholesterol, etc.
A few years ago when I was low, my doctor tried taking me from .150 to .200 and within a month I was hyperthyroid, so we settled on the .175mg. I hesitate to go to the .200 again.
Shouldn't my dosage strength go down as my weight decreases ?

Answer: I doubt that the thyroid is responsible for your problem. You need a slightly higher amount, but I would have difficulty understanding why you have lost so much weight, look for another cause.

[posted 11/25/1999]
Question: Is Kelp bad to take when taking synthroid? I am currently taking 100mcg. of synthroid. Some people say it's O.K. because kelp helps the natural thyroid repair itself. On your FAQ board, you mentioned that kelp decreases the natural thyroid function(because kelp is high in iodine and high iodine intake can shut down whatever is left of the natural thyroid production). Which is true? I have gotten different answers to this.

Answer: Kelp is to be avoided- especially in any large amounts. It can make a normal thyroid patient hypothyroid pretty rapidly. The effect in patients on thyroid replacement is less pronounced since the oral replacement is already replacing what your thyroid would be producing. However, most patients on thyroid replacement are only replacing part of the bodies production. So, some of their thyroid comes from their natural production and some from the pills. Hence, if the underlying thyroid is decreased by the kelp, they will become hypothyroid also. However, if they are at full replacement(no thyroid production from their gland), there is little effect of the kelp.

[posted 11/21/1999]
Question: My energy level has increased in the last month since beginning Levoxyl, 100mcg.
QUESTION: Is there a best time of the day to take the Levoxyl which increases late day energy level??

Answer: Probably not. The thyroid is in your system for 4-5 days with a very long biologic half life, just take it roughly 24 hours apart.

[posted 11/5/1999]
Question: I am very concerned about the possible after effects of my upcoming Thyroidectomy. I am primarily concerned with weight gain and the effect it will have on my fertility.

You state in your archives that although having hyper/hypothyroidism can cause weight loss or gain, replacement hormone therapy cannot. How is this possible when the thyroid has been removed? If I do not take an adequate dosage of Synthroid would I not develop hypothyroidism and therefore gain weight? I have always been thin and I am worried about gaining significant weight following my surgery. I continue to read accounts on the Internet of those who have gained weight in spite of Synthroid therapy. My doctor brushes this off.

Can you please tell me how long it usually takes to regulate Synthroid dosage following thyroidectomy? My other more serious concern is what might happen to my menstrual cycles/fertility and how long it might be before I will have a normal TSH so that I can try to conceive.

Thank you for your attention to my questions!

Answer: You can have problems if the thyroid is not replaced correctly. But, this is an easy problem. Keep your TSH in the normal range and it is ok. Try moving it from the low end of normal to the high end of normal and see which side you feel better on. Now you're ready for your internship. Not rocket science is it? As long as your thyroid hormone is replaced, your body will function exactly as before in terms of fertility, weight etc. It usually takes 4-8 weeks to find the exact dosage but, 2-3 weeks for a close approximation.

[posted 11/15/1999]
Question: I require 9-10 hours of sleep daily. Is this thyroid
related and treatable?
My body temp averages 97.9F. My TSH is normal, but my
T3 Uptake is very low and my T4 is very high.

Answer: With a normal TSH, probably not. A scan would establish the problem.

[posted 11/10/1999]
Question: My 6 year old son was dx with hypothryoridism. He has been on Synthroid for two weeks. He seems much more emotional lately---is that a side effect of synthroid? What side-effects do we need to watch for with a child on Synthroid?

Answer: Shouldn't be any if the dosage is correct.

[posted 10/11/1999]
Question: For 18 years, I have shown an extreme sensitivity (anaphylactically allergic) to iodine. I am currently be tested for hypothyroidism as I have had the classic symtoms of this disorder. I am concerned that if I have this condition that I may not be unable to to take Synthoid if it is produced with iodine. I recognize that Synthoid and its generic counterparts are a T4 synthetic hormone. Unfortunately I have had numerous and near fatal anaphylactic reactions as well as serum sickness from medications. Would you be able to fill me in on some of the details of this medication?
Thank you.

Answer: Not usually a problem since the iodine is bound to the molecule and not free.

[posted 11/12/1999]
Question: What TSH level is considered normal? How can my Dr. and I determine the correct Synthroid level? Is a TSH once a year enough, or is a TSH recomended more often? What kind of tests should I be having to check for a reoccurance of thyroid cancer, and how often? In Oct. 97, 90% of my thyroid was surgically removed, due to cancer. I underwent radiation to remove the rest. I am taking Synthroid, on 0.175 and my hair is still falling out, my memory is poor, am constipated, I have very dry skin, and my doctor wants to decrease my dosage. I think I may need an increase.

Answer: Usually it needs to be between 0.3 and 5.5 but this varies somewhat with the reference lab. What is yours?

[posted 11/12/1999]
Question: I was born with hypothyroidism and have been on medication since I was about six months old. I have had rumors that taking synthroid can cause me not to be able to have children. Is this true?

Answer: False.

[posted 08/27/1999]
Question: I am 46 and have been menopausal for 22 yrs. because of hysterectomy. I have been on HRT for those 22 yrs-estrogen only. I got sick 7 yrs. ago and became overweight, irritable, emotional, fatigued, loss of hair, stomach problems and for 2 yrs. I went to doctors telling them something was wrong. They tested my thyroid and it always showed to be normal. As far as the stomach pain-they treated me for bladder infection which I don't believe I ever had and told me I had acid reflux which I did not ever have the symptoms for that. I went on for two years getting sicker every day. Finally when my heart rate got up to 148 and I got tremors and became very ill, the blood worto s finally showed that I had hyperthyroid. I was given radioactive iodine and for awhile I felt good. By the way all stomach symptoms went away and I have never had stomach problems again.I did not have acid reflux or bladder infections-it all stemmed from my thyroid disorder. One of my questions is why when I was so sick did this disorder not show up in the blood work? Since that time I have been placed on Synthroid. I don't believe I have ever been put on enough dosage for me to feel well. I have had constant numbness and tingling in my hands and arms as well as numbness in my big toes. Also I have been severly fatigued. Last year I went in and my blood work showed me to be way off in my level. My doctor increased my synthroid from 0.15 to 0.30. I began to feel better and behold the tingling and numbness went away. I just went back in for another blood work and my thyroid showed that I was taking too much thyroid hormone because my TSH was low. My doc cut my level back down and guess what the numbness and tingleing are back and I feel horrible. I am in agony and consumed with frustation because the blood work and the way I feel does not match. WHY!!!!!! My B12 level was checked and is ok. Also my vitamin D and calcium levels are ok. I have also been diagnosed with osteopenia and my doc had put me on fosomex which I could not take because of side effects and also miacalcin which I reacted with horrible headaches and I am not able to take it.I am young and trying to take care of myself. I am afraid of the bone thinning. Right now my doc has said for me to continure my hrt and calcium supplement and stay off of any additional meds. to increase my bone mass. The bone density only shows thinning in my spine. I am confused about my thyroid and feel like I have been through an emotional and physical hell the past 7 years and now the bone thinning even creates further problems because excess thyroid can even thin bones more. Is there any light you can shed on why the blood work and the way I feel don't match up and why the osteopenia when I have taken hrt and my calcium and vitamin d level look ok?

I will appreciate your response.

Answer: Your TSH should be in the normal range if you are receiving enough replacement. So, you should know what this number is. Too much will cause bone loss which you can't tolerate. You should ensure that your blood levels of vitamin D and parathyroid are normal. Hyperthyroidism does cause osteoporosis which is probably the problem.

[posted 08/25/1999]
Question: I was diagnosed with hypothyroidism in 1989. 3 years ago, I suddenly started running very high thyroid levels. No tests were run beyond TSH. A year later, I suddenly went in the other direction, even when my doctor said I was on the highest dose of thyroid available. Finally she ran several tests, including a thyroid scan, which showed that there was no activity in my thyroid gland at all. We realized I had been taking L. Thyroxine instead of the Synthroid she prescribed so her diagnosis was that I had become resistant to L. Thyroxine her assumption was that the previous year of high thyroid levels was a case of thyroiditis. I have had no problems on the Synthroid except for trying to get my druggist to give me the brand name instead of the generic. Recently, he gave me quite a lecture that the two drugs are the same, though he did finally refill my prescription with Synthroid. So now I'm totally confused! If the two drugs are the same, how could I from .15 mg up to .3 mg daily of L. Thyroxine and still end up with TSH levels nearly equal to my not taking any thyroid whatsoever? And if L. Thyroxine and Synthroid are the same thing except for name, how could I be resistant to one and not the other? Or was there a different problem going on that my doctor was unable to diagnose and could it happen again?

Answer: Your pharmacist is correct, there should be little difference. I do find that some patients need slightly different dosing with different manufacturers, but not that would give a difference between 0.1 and 0.3. What you are describing is progressive loss of thyroid function. In general, complete replacement is about .025 to .03 mg. Initially, there was some functioning of your thyroid allowing your dosage to be 0.1. As your thyroid continued to shut down, you required higher dosing to replace what your thyroid could not. This is a fairly common event, especially in thyroiditis and inflammatory diseases of the thyroid and why we check the levels periodically. You did not generate resistance to the L-thyroxine, your doctor is mistaken. I do have patients who prefer the brand name and the difference for this drug is pretty small.

[posted 08/25/1999]
Question: I am currently taking .112 mcg of synthroid. My doctor
me that, whatever I do, not to stop taking it suddenly.
Is there anything bad that will happen (besides a
reappearnce of symptoms) if I stop taking it suddenly?

Answer: There would be no problem of suddenly stopping it. The drug will be in your system for 4-5 days in any event. If you are hypothyroid, it would not be a good decision, but would not yield any immediate problem. Patients who are truly hypothyroid experience problems in about 3 weeks-fatigue, depression etc.

[posted 10/29/1999]
Question: Since being on thyroid medication (0.01mg) had lots of allergies,to
all kinds of outside, inside stuff e.g perfume and related stuff, \
Pollin and related stuff, Garden Treatments stuff, and synthetic
stuff. Any information on this and any questions from any other people.
Need really good answers please. Thank You.

Answer: I suspect your dosage must be 0.1 not 0.001 but in any case, I know of no correlation between treatment of hypothyroidism and allergic symptoms.

[posted 08/24/1999]
Question: I've had numerous symptoms for at least 4 years that pointed to a thyroid deficiency. A month ago I was diagnosed with hypothyroidism (TSH of 7.5 -other levels were normal). With the Dr.'s permission, I did NOT start taking Synthroid, but tried other natural means of improving thyroid function , such as implementing a low- fat, low-sugar diet with protein at every meal, daily aerobic exercise, and taking supplements such as L-tyrosine, selenium,potassium, and magnesium.
Three weeks later I was retested since symptoms such as fuid retention, heart palpitations, and frequent menstrual flow had ceased to a problem (these were all long-term symptoms). The level of TSH had dropped two points (to 5.5),
and my blood pressure had gone from 138 over 84, to 122/80!
Since I've shown that much improvement, my Dr. has allowed me to continue and will test again in 3 months.

My question is, could the day-to-day fluctuation of TSH ( in an untreated patient) vary as much as 2 points(do you say 2 mg.?)or was that truly a significant improvement?

Answer: You have chemical hypothyroidism. That means that your body is producing enough thyroid hormone, but at the price of slight overdrive of your thyroid gland. Over time, we think that this can produce goiter production. About 40% of these patients(some say more) will eventually develop hypothyroidism where the gland cannot produce enough hormone in spite of overdrive, so check your TSH once a year and with any change in energy levels. I doubt the blood level explains any of your changes, probably the exercise-keep this up.

[posted 08/21/1999]
Question: My teenage daughter has moderate depression. She also may have some cognitive impairment since she does very well at math, but has some problems with reading comprehension.
She has been on Prozac for a year which has helped alleviate her depression. However, her cognitive weakness has not
improved and may be worse. She scores around the 45 %ile in reading comprehension. Since she is always feels cold and has a low body temperature, I had her
blood checked for thyroid 2 months ago. Her results are: T4 4.6 (ref 4.5 to 12.0) TSH 2.8 (ref 0.5 to 4.2) FTI 1.55
ref 1.2 to 4.9).

Since her TSH is normal, I am not worried about thyroid disease per se. However her T4 is at the bottom of
a normally distributed reference range which is 2 standard deviations around the mean. 95% of the population
are in the ref range, 2.5% above and 2.5% below. My daughter is therefore in the lowest 3% of the population
with her T4. Her T4 is about half of the average person's level.

Is it possible that the low T4 is contributing to her depression? Her doctor has her on 25 mcg per day
of synthroid to see if it helps with her mood and cognition.

My question to the Infolink doctors is: Can it hurt to try the synthroid? Let's say that the synthroid dose is raised
to the point that her T4 is in the middle of the range and her TSH drops to the low end of the TSH
reference range. If her depression and cognition are helped, is it OK to continue the synthroid at that
level indefinitely? Thank you in advance for your opinions.

Answer: Wouldn't hurt unless it causes cardiac arrthymias(possible but unlikely). The long term risk of over-replacement of thyroid is osteoporosis but not a major issue in the short term. I would have some criteria picked out ahead of time prior to starting the thyroid so you can judge it's effect. I doubt you'll see much difference. Has she been checked for dyslexia? ADD?

[posted 08/20/1999]
Question: Since about April of this year, I have experienced symptoms I have never had. Such as heart palpitations, arrythmias (sp.?) and high blood pressure, things I have never had a problem with before. My concern is that there may be a connection between the over-the-counter supplements I take daily (Vitamin C, multivitamin and calcium tablets) and the symptoms I have experienced. I have been to my regular physician who did a complete blood workup and all my vital signs were good (cholesterol a bit high but that will come down as I improve my eating habits and exercise more). The doctor did increase my thyroid medication because my TSH was a bit high. He feels that my birth control pills may be tapping into the thyroid medication, therefore the need to increase the thyroid medication. I did go online to your FAQ sheet about thyroid problems people have experienced and found it very informative. However, I wanted to post this question with the hope that you might be able to shed some light on my symptoms. I recently split up my pill taking. Taking only thyroid medication and birth control pills in the morning, the vitamin C and multivitamin supplements along with the calcium tablets in the evening. Well, it seems I'm feeling less anxious and my heart palpitations seem to be considerably less. I'm feeling calmer than I've felt in four months. Is there a connection that you know of?

I anxiously await your reply.


Answer: Nothing obvious. Synthroid can be affected by iron supplements, but this would decrease the absorption(giving a high TSH by the way). The palps would usually be due to an overabundance of thyroid.

[posted 08/19/1999]
Question: Is there any connection between hypothyroidsm (regulated and non-regulated) and vaginal dryness?

Answer: Some since skin in general is dry with hypothyroidism. Hypothyroidism also usually causes menstral irregularities and the changes in sexual steroids can also do it.

[posted 10/17/1999]
Question: I am a 39 year old female, in 1997 I started having the following symptoms, hair loss, lethargy, joint pain and swelling, weight gain, weight loss, eye tremors, shakiness, nausea, anorexia, then hunger. Heart palpatations, and depression. Heart palpatations would accompany diarrhea sometimes. Then bouts of constipation and weakness episodes.
I was diagnosed with Hashimotos, normal TSH, elevated microsomal antibodies, normal scan, but probable colloid cyst upon ultrasound. No treatment was given. Symptoms continued, went to emergency room with palpatations, chest pain, and shortness of breath, blood work was normal,except for TSH of 5.2. Went to endocrinologist, was prescribed Synthroid 0.50mcg sid. Was also seen by a cardiologist who diagnosed PCV's and beta blockers, a variety that either made me even more lethargic and did nothing for PCV's. PCV's became more frequent right before period. As soon as period began, PCV's would stop and then after period would return intermittenly and worsen with pre period phase. Migraines started at time of period and then continued during the whole month, everyday. Severe enough to miss work. Loestrin was prescribed continusly with no period. Migraines disapeared. However PCVs continue, recent trip to emergency room for unstoppable PVC's, normal blood work except for TSH of 6.0. Normal ultrasound, normal stress test, cardiolite test revealed a small perfusion abnormality at the apex of the heart, which the cardiologist says is an artifact. When I go off of the "pill" loestrin I get severe migraines and depression, so I stay on them. My most bothersome symptoms now are severe hair loss, lethargy, foggy thinking, memory loss, periods of shakiness and PVC's, shortness of breath, very dry flaky skin especially on lower legs, itching eye lids and water retention. Also periods of weakness and blurry vision. Some periods of nausea. I have had a low cortisol in the past, ACTH was done , normal. ANA was done, one test was positive titer, then 4 months later, negative.
When I asked what would cause a low cortisol the Dr. said he didnt know. No medications prescribed. I was recently diagnosed for GERD, with symptoms of heartburn and trouble swallowing and stomach pain, Prilosec works great. Iv'e had a fasting glucose of 140 once and one of 129. About a couple of months before that I was hypoglycemic, with glucoses from 55 - 70. What could all this be? My doctors are not much help.

Answer: First, you have not had your thyroid returned to "normal" levels. Get enough synthroid to get your TSH in the normal range. Second, about 10% of patients have coexisting adrenal insufficiency. You need an ACTH stimulation test performed to rule this out. But, only after the TSH is corrected. Unless the PVCs are causing you to pass out, they are only a nuisance and the beta blockers will cause a lot of your problems.

[posted 08/16/1999]
Question: I am currently getting my throid leveled out with levothyroxin (35 days since diagnosed with hypothyroid). Most of the symptoms I experienced have subsided, however two problems still concern me. First I have a sensation of slight blockage when swallowing, and second I have pain on the left side of my throat which goes down into my chest and arm. (Sleeping on my left side is intollerable) My G.P. says there is still some swelling of the muscles in my neck and is most likely causing this pain. She did do an EKG and it was fine.Do you think I should request an Endocrinologist or should I wait to see if the throat blockage becomes a problem or the pain on the left gets worse? Thanks for any information you can provide.

Answer: Probably mechanical and secondary to thyroid enlargement or a thyroid cyst. A CT or MRI would answer this question, possibly a barium swallow.

[posted 10/12/1999]
Question: I had my thyroid removed in 1990. since then I have expierenced weight gain, hair closs that was diagnosed as
alopecia. I have joint pains. Could my hair loss be missed
diagnosed. Is there anything I could do to slow the process
of joint pain. Is there a specialist I could see besides a
general praticer (Family Doctor) they don't seem to concerned when I approach them about it. All I ever here is
that my blood work is in normal range, based on statistics
for a million people. I have insurance so how do I get a

thank you

Answer: See an endocrinologist.

[posted 08/6/1999]
Question: I had thyroid cancer in 1991, had surgery, radiation, the whole works and have been on thydoid medication ever since. I have battled with my weight for 8 years now. After going through the FAQ on this subject, I found some very distrubing information. Each time my weight would go up, or my symptoms would be those of hypothyroidism, my doctors would increase my dosage. Now, I assume that my TSH levels had to have been off too. According to my present physician, patients with a history of thyroid cancer are kept at a higher dosage of thyroid hormone. From what I've read, if you are getting too much thyroid hormone, you may GAIN weight? Is this correct? I was under the assumption that it was the other way around. Why is this? I try to attribute my weight gain to the fact that I have a "thyroid problem". I don't have a thyroid problem - I don't have a thyroid. I am currently taking .2mg, I'm 5'9" and weigh 180lbs. This is unacceptable. I eat well and work out, but cannot seem to take the weight off. I've just had more blood drawn to check my TSH because I am having an increased frequency of migraines and have been prescribed Atenolol, which I'm afraid to take. Please help me figure which way is up. Dose a high dosage like .2mg cause weight gain? And if this is too high a dosage for my body, why keep me on it? Is it supposed to keep the cancer from coming back?

Answer: Thyroid replacement won't essentially change ones weight. This is a common misconception and seems logically that it should be so, however, scientific studies show no change with weight and over-replacement of thyroid. Also, in general an over or underactive thyroid gland causes weight loss. I do have patients who gain weight on beta blockers like atenolol, maybe this is the culprit-worth a try. Do not go to excessive doses of thyroid replacement, this can cause osteoporosis and occasionally cardiomyopathy. If it worked as a weight loss drug we would all use it in this manner. It does not.

[posted 09/29/1999]
Question: I'm a 21 year old college student and was just put on synthroid for hypothyrodism a couple of weeks ago. I am currently attending college, so of course I enjoy drinking with friends. I have had a couple hot flashes with the medicine but that is the only side effect I have noticed. Except for last weekend I went out drinking with my friends, we were drinking jungle juice which contains everclear. The next morning I felt fine and took my pill however an hour or so after that I got real sick with hotflashes, felt like fainting and dizziness. Could any of this been related with mixing the everclear with the medicine.

Answer: Doubt it.

[posted 09/28/1999]
Question: I am feeling paranoid about hypothyroidism because of genetics
and symptoms--but my TSH level (T5 I think?) shows in the very low
normal range. Two of my three sisters, my grandmother, great
grandmother and various cousins have had nodules, surgery, goiters,
etc. I have some but not all of the symptoms -- dry skin,
fatigue, infertility problems. One of my sisters had symptoms
for 10 years before her thyroid enlarged and her TSH levels
were abnormal---I would like to conceive and am concerned that
thyroid problems are causing my infertility---but not showing up
on the tests. What can I do?

Answer: See an endocrinologist for a complete thyroid evaluation. Also, some families have multiple endocrine abnormalities that is low thyroid plus other endocrine glands that are not working correctly(adrendals, B12 etc.). This should be considered, about 10% of families with thyroid disease manifest some other endocrine abnormality.

[posted 09/28/1999]
Question: I was just diagnoised with hyperthryoidism. Can you tell a little about it.

Answer: This is due to overproduction of thyroid hormone by the thyroid. There are several causes ranging from viral infections to autoimmune disease. The first question for your doctor is "what is the cause". This bears a little on the treatment options and the risk of your children getting a similar condition. There are several options for treatment ranging from radioactive iodine to surgery to treatment with a drug called propylthiouracil. The first two are permanent solutions to shutting down your thyroid. Both have some risk of subsequent hypothyroidism(underactive). However, a common course for thyroid is too much followed by too little since most are due to antibodies. There is a variant called Graves that can affect the eyes, so ask your doctor about this.

[posted 09/28/1999]
Question: in may of 1999 i was diagnosed with a hypothyroid and was put on synthroid, which i have been taking for about four months. after three months i was given another blood test which said my levels were normal. in july (after about 6 weeks on synthroid) i was feeling very depressed and extremely stressed. i asked my doctor if this could be a side effect of synthroid, because i have not heard of this being one. my doctor didn't seem to think so, but i haven't really gotten rid of this feeling of being down. is it possible that synthroid could have this kind of side effect?

Answer: Depression sound like low thyroid, "stress"like too much. The important number to know is your TSH level. This should be "normal" meaning usually .05 to 5 or so depending on your lab. Some patients do experience problems with replacement and need to be replaced more slowly. Possible, depending on your TSH levels.

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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