Welcome to Cleveland Clinic Online Health Chat

Welcome to Cleveland Clinic Online Health Chat

Moderator: Welcome to our thryoid webchat. Please submit your questions early. All
questions will be addressed during the live chat at 12 noon ET (11 am CST)Wednesday Jan.
29th

Moderator: Welcome to Cleveland Clinic's online health chat about the thyroid disease and
management with endocrinologist Dr. Suman Jana and endocrine surgeon Dr. Jamie
Mitchell. The chat will be live today, Wednesday, January 29th at 12 noon ET (11am Central
Time.) Please submit your questions by typing in the box below and then click ‘Submit
Question". Questions submitted early are in the queue and ready to roll.
Moderator: There are a number of health articles about the following conditions that may
help to clarify some common questions. Please feel free to review the following prior to the
chat.

Thyroid Disease
http://my.clevelandclinic.org/disorders/Hyperthyroidism/hic_Thyroid_Disease.aspx

Thyroid Cancer
http://my.clevelandclinic.org/disorders/thyroid_cancer/hic_thyroid_cancer.aspx

Hypothyroidism
http://my.clevelandclinic.org/disorders/hypothyroidism/hic_hypothyroidism.aspx

Hyperthyroidism
http://my.clevelandclinic.org/disorders/hyperthyroidism/hic_hyperthyroidism.aspx

Post Partum Thyroiditis
http://my.clevelandclinic.org/disorders/postpartum-thyroiditis/hic-postpartum-thyroiditis.aspx
Thyroidectomy
http://my.clevelandclinic.org/services/Thyroidectomy/hic_Thyroidectomy.aspx

Goiter
http://my.clevelandclinic.org/disorders/Goiter/hic_Goiter.aspx

Hashimoto’s Disease
http://www.endocrine.niddk.nih.gov/pubs/hashimoto/hashimoto_508.pdf
Moderator: Thank you for joining today's chat. Please submit your question(s) by typing in
the box below. We will begin in about 10 minutes.

Moderator: Welcome to Cleveland Clinic's online health chat about thyroid disease and
management with endocrinologist Dr. Suman Jana. Dr. Jamie Mitchell is unable to join us
today, but all endocrine surgery related questions will be answered at a later time. These
answers will also be posted to the transcript, and sent to the individual that posted.

Moderator: Please submit your question(s) by typing in the box below. Dr. Jana is beginning
to answer your questions, which you will see in the chat transcript. Thanks for joining!

Moderator: Your thyroid gland plays a critical role in your overall health. The thyroid is a
butterfly-shaped endocrine gland located at the base of the neck that is responsible for
controlling metabolism (the energy produced and used by the body) and regulating the body’s
sensitivity to hormones.

More than 20 million Americans have some type of thyroid disorder. Yet, many thyroid
conditions remain undiagnosed due to rather vague symptoms and an absence of pain.
Nevertheless, when thyroid conditions are ignored, they can lead to serious health
conditions.

Diseases of the thyroid cause either underactivity or overactivity of this gland. Underactivity of
the thyroid results in hypothyroidism (also known as Hashimoto’s thyroiditis) and goiter.
Hypothyroidism can produce symptoms of weight gain, sensitivity to cold and brittle nails and
hair. In Western countries, hypothyroidism is largely due to an autoimmune response,
although iodine deficiency can also cause underactivity – which is largely in other parts of the
world that lack iodized salt. Hypothyroidism is associated with several other diseases,
including heart disease, type 1 diabetes, celiac disease and metabolic syndrome. Overactivity
of the thyroid is seen in Grave’s disease, which results in bulging eyeballs, anxiety and
sensitivity to heat among other symptoms. Enlargement of the thyroid can be the result of
noncancerous goiter, which may or may not result in hypothyroidism or hyperthyroidism, or
cancer. Radiation exposure, such as x-rays—especially in children—can affect thyroid status.

Lab tests of TSH (thyroid stimulating hormone), T3 and T4 help in the diagnosis of thyroid
conditions. Recent changes in screening guidelines that have a lower threshold limit of TSH
hormone affects the thyroid status of millions of adults in the U.S. This has resulted in the
diagnosis of many more patients with hypothyroidism.
Lab results, symptoms and physical exam help direct physicians to the proper diagnosis and
treatment of the thyroid. Diagnosis and treatment are key steps in the management of a
thyroid problem, and will help in the control of related symptoms.

Moderator: Your thyroid gland plays a critical role in your overall health. The thyroid is a
butterfly-shaped endocrine gland located at the base of the neck that is responsible for
controlling metabolism (the energy produced and used by the body) and regulating the body’s
sensitivity to hormones.
More than 20 million Americans have some type of thyroid disorder. Yet, many thyroid
conditions remain undiagnosed due to rather vague symptoms and an absence of pain.
Nevertheless, when thyroid conditions are ignored, they can lead to serious health
conditions.
Diseases of the thyroid cause either underactivity or overactivity of this gland. Underactivity of
the thyroid results in hypothyroidism (also known as Hashimoto’s thyroiditis) and goiter.
Hypothyroidism can produce symptoms of weight gain, sensitivity to cold and brittle nails and
hair. In Western countries, hypothyroidism is largely due to an autoimmune response,
although iodine deficiency can also cause underactivity – which is largely in other parts of the
world that lack iodized salt. Hypothyroidism is associated with several other diseases,
including heart disease, type 1 diabetes, celiac disease and metabolic syndrome. Overactivity
of the thyroid is seen in Grave’s disease, which results in bulging eyeballs, anxiety and
sensitivity to heat among other symptoms. Enlargement of the thyroid can be the result of
noncancerous goiter, which may or may not result in hypothyroidism or hyperthyroidism, or
cancer. Radiation exposure, such as x-rays—especially in children—can affect thyroid status.
Lab tests of TSH (thyroid stimulating hormone), T3 and T4 help in the diagnosis of thyroid
conditions. Recent changes in screening guidelines that have a lower threshold limit of TSH
hormone affects the thyroid status of millions of adults in the U.S. This has resulted in the
diagnosis of many more patients with hypothyroidism.
Lab results, symptoms and physical exam help direct physicians to the proper diagnosis and
treatment of the thyroid. Diagnosis and treatment are key steps in the management of a
thyroid problem, and will help in the control of related symptoms.

Moderator: Good news! We have just been joined by endocrine surgeon Rosemarie Metzger.
She will be available to answer your thyroid surgery related inquiries and is excited to get
started!

Moderator: Apologies for the delay. We are having a couple of computer issues here and
physician changes. I will begin shortly
Moderator: Cleveland Clinic is a national leader in caring for patients with all types of thyroid
conditions, from the routine to the complex. Our patients benefit from access to a
multidisciplinary staff, the most advanced technology and the latest clinical trials for thyroid
conditions. Cleveland Clinic’s endocrinology program is ranked 2nd in the nation in U.S. News
& World Report’s annual America’s Best Hospitals survey.

Moderator: About the Speakers
Dr. Suman Jana is an endocrinologist in the Department of Endocrinology, Diabetes and
Metabolism in Cleveland Clinic’s Endocrinology & Metabolism Institute. He is board certified
in internal medicine for endocrinology, diabetes and metabolism and nuclear medicine. A
medical school graduate of the All India Institute of Medical Sciences, he completed his
internal medicine residency at the Bronx-Lebanon Hospital Center and his nuclear medicine
residency at St. Vincent’s Hospital. He also completed his fellowship in endocrinology at St.
Vincent’s Hospital in New York. Dr. Jana’s specialty interests include thyroid cancer and
thyroid nodules, thyroid and parathyroid disorders, cushing’s syndrome and pituitary
disorders.

litvolt: I have many symptoms of hypothyroidism despite falling in the normal range of thyroid
screening labs. All other diagnostic tests to account for my symptoms have been negative. Do
you think it would be beneficial to have a trial with a low dose of Synthroid to see if my
symptoms respond?

Suma_Jana,_MD:

None of the symptoms we evaluate for thyroid is specific for thyroid. We need to exclude other causes of
symptoms like anemia, vitamin deficiencies, low electrolytes (calcium/sodium,/potassium), autoimmune disease
and chronic inflammatory state like rheumatoid arthritis, lupus, fibromyalgia, chronic fatigue syndrome, etc. If
all are excluded and TSH is 3.5 or more, then a trial of low dose thyroid hormone under the supervision of an
endocrinologist can be an option for patients younger than 60 and no history of heart disease, stroke, or
osteoporosis. I have couple of patients who did feel better after trial. Again, this can only be done only under
supervision of an endocrinologist and fulfills the above conditions.



Mragle90: My mother-in-law has thyroid issues; however she is having some problems losing
weight. Two years ago in May she had a heart attack as well. My question is how can she
take off some of her weight the healthy way without any medications because it's hard to find
any that she can combine with her medications?

Suma_Jana,_MD:
Your mother-in-law needs to cut down on her sugar and carbohydrate containing drinks and foods. And also do
  some exercise.

1. Drink water avoid fruit juice, coke, pop etc, coffee/tea black is the best, if
   needed use sugar substitute and skimmed milk
2. Avoid chewing gums of mints, if needed use sugar free products
3. Snacks: avoid cookies and candies, can use nuts/vegetables/pop corns
   without caramel/fruits for snacks,
4. Meals: avoid too much bread/pasta/rice/potatoes/corn, in a meals eat ¼
   plate salad, ¼ cooked vegetables, ¼ protein, and last ¼ carbs.
5. Exercise 45 minutes.. per day 5 days or more per week, exercise should be
   cleared by cardiology due to history of heart attack. She may not be able
   to do 45 minutes at the beginning, so she should start 10 minutes per day
   at the beginning and slowly go up every couple of week by 5 extra
   minutes. May need a stress test to clear that. If she develops chest
   pressure/pain during exercise, she should stop exercise and if the pain does
   not go away in 5 minutes, she should call 911. If pain goes away, then she
   should contact her cardiologist before doing any more exercise.


  Judylucy: What is the difference between Hashimoto's disease and hypothyroidism? Does
  Synthroid® help both?

  Suma_Jana,_MD:

  Hashimoto’s disease is one of the most common causes of hypothyroidism. Hypothyroidism is treated with
  Synthroid®. There are other causes of hypothyroidism therefore, not all hypothyroid is from Hashimoto’s. On
  the other hand Hashimoto’s disease could be present but not severe enough to cause hypothyroid, in that case
  doesn’t need Synthroid®.



  jamiehambleton: I currently take Armour Thyroid 105mg daily (within the past month
  bumped up from 90mg) and I have gained 5 lbs in the past month. Previous to that I was on
  Synthroid for a year and a half and gained 20 lbs. Is this "normal" for a thyroid condition? Is
  there anything else that can be done? Is surgery necessary? I have high chloesterol from my
thyroid and am obese also. This is becoming very concerning to me that despite exercise 5
days a week and watching what I eat I continue to gain weight at a rapid rate.
You need to keep your TSH within normal range, preferably close to 1.0
No need for surgery
To help your weight cut down on sugars and carbohydrate containing drinks and foods. In
addition to exercise you should:

Suma_Jana,_MD: You need to keep your TSH within normal range, preferably close to 1.0
No need for surgery
To help your weight cut down on sugars and carbohydrate containing drinks and foods. In addition to exercise you should:
 Drink water avoid fruit juice, coke, pop etc, coffee/tea black is the best, if needed use sugar substitute and skimmed milk
 Avoid chewing gums of mints, if needed use sugar free one
 Snacks: avoid cookies and candies, can use nuts/vegetables/pop corns without caramel/fruits for snacks,
 Meals: avoid too much bread/pasta/rice/potatoes/corn, in a meals eat ¼ plate salad, ¼ cooked vegetables, ¼ protein, and last ¼
carbs.
 Exercise 45 mins per day 5 days or more per week.

CynthiaHartz: Even though I am taking Synthroid and a T3 - my hair continues to thin. My
scalp cycles into a period of redness and soreness (to the pt where it feels as if someone is
pulling on my hair). Steroid injections help this. (although I am so keen to be using steroids
regularly.) I am also on bioidentical estrogen and am on the tail end of perimenopause... Also
taking Adovart and progesterone. However - scalp biopsy and all blood tests indicate no
autoimmune disorder. Any suggestions to reduce hair loss?

Suma_Jana,_MD: You should to see a dermatologist to exclude any scalp disease. Optimize your
thyroid hormone levels (keep in mind too little or too much both can cause hair loss). You need to
check androgen levels like testosterone and DHEAS level. If they are high you may get help from
using androgen blocker like spironolactone or aldactone (one type of water pill used to treat
hypertension).

CUSuzi: I have Hashimoto's, hypothyroidism and many thyroid nodules. I've been on
levothyroxine for about 6'years. My blood work pre-medication was coming back normal, but
the medication was recommended. The nodules are now so large that they are now encircling
my trachea and pushing my carotid artery, but there is no decrease in the flow or in my
trachea. They are also beginning to go down to my sternum. I'm told I need surgery to remove
the thyroid. Is there anything that can be done non-surgically? I am worried about damage to
the laryngeal nerves. If surgery is recommended, is a general surgeon who specializes in
thyroid surgery good? Or do I need otolaryngology?
Rosemarie_Metzger,_MD: From your history, it does seem that you likely need thyroid
surgery. In your case, with multiple thyroid nodules and Hashimoto's disease, a total
thyroidectomy would be recommended. There is not any non-surgical option in this setting.
Total thyroidectomy is a common surgery and in the hands of an experienced endocrine
surgeon, the risk to the recurrent laryngeal
nerves is on the order of 1-3 %. There are six endocrine surgeons here at the Cleveland
Clinic, of which I am one. We all have advanced fellowship training in endocrine surgery and
our surgical practices include large volumes of thyroid and parathyroid surgery.

comptech: My hair, fingernail and toenail growth have slowed to the extent that I seldom
need to trim them. Also my eyebrows are sparse and nearly invisible. Could this be a thyroid
problem even though my tests come back as normal ?

Suma_Jana,_MD: If TSH is between 1 and 3.0, look fior other causes. In absence of thyroid
hormone level abnormal, they are less likely from thyroid.

PcTech: My hair doesn't seem to be growing, I have not had a haircut for nearly a year and
what I have left is dry and breaking. Also my fingernails are the same way, seldom do they
need trimmed. Also have other symptoms, cold hands, dry skin and sparse eyebrows. Could
all this be caused by my thyroid?

Suma_Jana,_MD: If your blood level of thyroid hormones are normal, you need to look for other
causes. If you have untreated or under treated hypothyroidism, these symptoms could be caused by
your thyroid.

nezimm: Is it normal for TSH numbers (with in a two month) period vary dramatically? Ie., 1st
reading 1.19, 2nd reading 3.13, Third reading 0.728. Do TSH numbers vary throughout the
day (like blood pressure) or should changes come about more slowly? Two different doctors
have answered this differently.

Should low Total T3 be treated? If so, what treatment would be expected.

Could treating symptoms of hypothyroid (even though testing results are normal) decrease
goiter size?

Suma_Jana,_MD:
Thyroiditis can cause such a variation, as well as if you are taking any thyroid medicine, like if
you take T3 that can influence your TSH level fasted than T4. If your TSH was varying so
much, you should get tested for TPO antibody (marker of Hashimoto’s thyroiditis), if positive
you should be followed with TSH at least once a year or any time you have sever symptoms
of hypothyroid, and when you develop hypothyroid you need treatment.
If your TSH is normal, no need to treat low T3. In this case low T3 could be from so many
other reasons and not related to your thyroid problem, one example is, if you have any other
sickness it will cause some low T3, (I will not go into detail).
Treatment with thyroid hormone is not recommended routinely if TSH is normal (less than 3.0)
to just goiter. Goiter could be from thyroid nodule, in that case you need a thyroid ultra sound,
and if you have a nodule more than 1 cm, you need biopsy.

tabialex: I am female, age 71 of Asian descent, thyroid enlargement noticed at age 14,
subtotal thyroidectomy in 1979, goiter on both sides and positive antibodies. My current test
results are TSH-1.71, T3 FREE-3.2,
T4 FREE-1.2 and I am on no thyroid supplements. If I were to have a total thyroidectomy
would I no longer have the antithyroid antibodies? Recently my primary care physician
ordered an ANA test which came back Positive, Pattern 1-Speckled, Titer 1-1:320. Is this in
any way related to autoimmune thyroid disease? I will be evaluated further but would like to
know from a thyroid specialist if there is a connection between the this test an autoimmune
thyroid disease?
Thank you for your help.

Suma_Jana,_MD:
Both are autoimmune disease and they can co-exist. Anyone who has one form of
autoimmune disease are more prone to get another form of autoimmune disease. If you under
go total thyroidectomy, yes, your thyroid antibodies will go down, but your antibodies so far is
not doing any damage, so why will you taking such drastic step? I will not suggest you to
undergo thyroidectomy for just antibodies. Now your thyroid is working fine based on you lab
results, but once you take it out you have to take medicine for thyroid.
For ANA positive, talk to a Rheumatologist.

catg64: I have thyroid nodules which I had biopsied and were benign. Is there anything to
shrink the nodules short of a surgery? My TSH was .603

Suma_Jana,_MD: no medicines to shrink the nodule, in 1990s, T4 and or T3 was used to
shrink the size, but 99% people got side effect from those and only 1% had shrinkage,
therefore, not recommened by ATA (American Thyroid Association.)

senojmd: Recently I had my thyroid removed due to 4 cm growth on left side and cancer on
right side. Dr has me currently on 100mg levothyroxine for 6 weeks then I go for a re-
evaluation. I am low on energy and feel lethargic. Is this normal or should I request a increase
in med?

Suma_Jana,_MD:

Usually a starting dose of levothyroxine (Synthroid®) after complete removal of thyroid is 1.6 mcg/Kg body
weight, i.e., for a 70Kg body weight dose will be 112mcg. If your body weight is close to 70Kg or 154 lbs, 100
mcg is close, so blood test after 6 weeks and adjusting the dose further is the standard. However, this dose is
average dose, so some individual may need more, and others may need less. You may need more, and lab tests
in 6 weeks will help to make that decision.



DaisyBe: I am presently taking levothyroxine 25 mcg and my TSH is 1.21. When starting
meds (about 8 mos ago) through family doc it was 5.41 and doc started me on 50 mcg.
Changed it to 25 mcg because TSH was then 0.75.
I am still quite fatigued and having other symptoms like stomach and IBS type problems. With
it being winter, some nights I can sit and watch TV in the evening with 2 pairs of socks,
slippers and a heavy blanket on - and my feet (and nose) are still freezing. The rest of the
family simply uses a blanket and they are comfortable. House temp is 69 in evening when
watching TV.
I was wondering if the type of medicine could have been changed but was told I could not
change the medicine - only the amount (dosage.)
I am wondering if this sounds like a thyroid issue or perhaps parathyroid problems coming
back - - I had parathyroid surgery there at Cleveland Clinic several years ago. Wondered if
you had any thoughts. Thank You!

Suma_Jana,_MD: TSH close to 1.0 is acceptable. If you can have your calcium level
checked which will reflect your parathyroid status. If abnormal check PTH level. you may have
vascular problem, rhematological called Raynouds which can cause decraesed blood flow to
extermities.

mehring: I have been diagnosed as Hypo ( hashimotos) but most of my symptoms were that
of hyper? Is that common?

Suma_Jana,_MD: I am not sure what age group you fall, in elderly (and young children),
there are atypical presentations. However, I will still suggest you to exclude some other
causes for your symptoms.
OhioBella: I am wondering what exactly the function of the thyroid is and what are the
    symptoms of a thyroid that is not working?

    Suma_Jana,_MD:

    The thyroid makes hormones that control metabolism. Metabolism is the pace at which your body processes
    things (i.e., how fast it burns food to make energy and heat from it).

    Symptoms of hypothyroidism:

   Tiredness
   Unexpected weight gain
   Constipation
   Depression
   Dry skin
   Difficulty performing physical exercise
   Decreased mental ability to concentrate and focus


    OhioBella: I am 67 yrs old and scheduled for an ultra sound guided biopsy of the right
    thyroid. I had an ultra sound done in July and again in January 2014 and there are 3 new
    nodules! How do they biopsy a thyroid or nodule? How worried should I be? What should I
    ask the doctor doing the biopsy? What should one do if the biopsy of a thyroid comes back
    inconclusive...cancer....or negative?

    Rosemarie_Metzger,_MD: Most biopsies are done these days with the guidance of an
    ultrasound. The ultrasound probe is placed above the nodule and the needle is viewed
    passing into the nodule. Thyroid biopsies are very routine - typically, any nodule greater than
    1 cm is recommended to be biopsied. There are several different types of doctors who do
    thyroid biopsies - endocrinologists, endocrine surgeons, and radiologists. The advantage of
    having an endocrinologist or endocrine surgeon do the biopsy is that they are also the one
    providing your comprehensive care and are the one to follow up on the biopsy results. We do
    these biopsies right in the office. There is nothing specific, per se, to ask the physician prior
    to biopsy. Biopsy results can be variable. First, the pathologists need to see enough cells to
    make
a diagnosis - if not, it will be 'non-diagnostic'. If there are enough cells to make a diagnosis,
then the results can range from 'benign' to 'malignant'. There are several 'intermediate or
inconclusive' diagnoses in between benign and malignant that may require either another
biopsy or surgery for a diagnosis. A diagnosis of cancer by biopsy almost always leads to a
recommendation of thyroid surgery. Benign biopsy results mean that the nodule can be
'followed' with follow up ultrasounds to evaluate for change in size - unless the nodule is big
enough to cause symptoms - in which case surgery may be recommended to help alleviate
the symptoms (compressive symptoms).

raymaks:
Is there any possibility of one having a problem with the thyroid and is not aware in such a
way that the condition can go unnoticed? Can thyroid infection clear on its own?
Is goiter disease is a thyroid complication? How can one ensure that they keep their thyroid
healthy? Can thyroid condition be treated nutritionally? Can one get thyroid infections by
sharing a cup with an infected person or through kissing? What is the relationship between
thyroid, tonsils and sinusitis? Can infection of thyroid lead to tonsillitis? Can thyroid glands be
removed in case of infection?

Suma_Jana,_MD: some people feels symptoms more than others, but if you have suspicion
let you doctor know and they can check your TSH level. Thyroid infection by virus or
inflammation from antibodies can clear on its own, if symtomatic needs supportive care, if
develops hypothyroid needs thyroid meds.Thyroid infection doesn't happern from kissing or
other things you mentioned above.To keep thyroid healthy avoid to much of iodine, kelp, soy,
and goitrogens. Please note that I told too much, so normal amount in daily food is OK.Except
is extreme cases, there is no need to revome thyroid for infection or inflammation.Thyroid in
not related to tonsil, or sinus.

OhioBella: Are thyroid problems genetic through the family? My cousin has had thyroid
problems and being watched and now I have a thyroid problem and I am having a biopsy
soon.

Suma_Jana,_MD: Yes, thyroid disorders run in families and are more common in women than in men. According to the
American Thyroid Association (ATA), women are five to eight times more likely than men to have thyroid problems. It is also noted
that one in eight women will develop a thyroid disease during her lifetime.


patrice43015: What are the best tests for a Hashimoto's patient? My previous TSH was 19.
My family doctor does not want to do any additional tests other than the TSH. I feel horrible all
of the time. Thank you.
A TSH level of 19 is abnormal by any lab standards and needs treatment. I am assuming that
you meant 1.9. The TPO antibody is a test for Hashimoto’s disease commonly used.
However, if your thyroid hormones are normal even though you have TPO antibodies you will
not require treatment. In our institute for first time test we always use TSH and Free T4. T4 is
one of the thyroid hormones. We do so because TSH comes from Pituitary gland, if for some
reason pituitary is not normal we can miss the diagnosis. However, Pituitary abnormality is
not very common, so for all practical reasons TSH testing is reasonable. Commonly, TSH
reflects the thyroid status more accurately than T4 alone. “Our brain (pituitary) knows best”.

Suma_Jana,_MD: A TSH level of 19 is abnormal by any lab standards and needs treatment. I am assuming that you meant
1.9. The TPO antibody is a test for Hashimoto’s disease commonly used. However, if your thyroid hormones are normal even though
you have TPO antibodies you will not require treatment. In our institute for first time test we always use TSH and Free T4. T4 is one
of the thyroid hormones. We do so because TSH comes from Pituitary gland, if for some reason pituitary is not normal we can miss
the diagnosis. However, Pituitary abnormality is not very common, so for all practical reasons TSH testing is reasonable. Commonly,
TSH reflects the thyroid status more accurately than T4 alone. “Our brain (pituitary) knows best”.


conteer: Do you have any patients with hashimotos that are also suffering from peripheral
neuropathy and upper back soreness/tightness? If so what do you think is the cause and how
do you treat it? Thank you.

Suma_Jana,_MD: There are few case reports. But there is no specific Rx. Still best option is to optimize your
thyroid hormone levels, and get your neuropathy treated by neurology. Multifocal motor neuropathy is a specific
disorder which has shown improvement with intravenous immunoglobulin therapy. This treatment is only useful in this
specific disorder and given by neurologist. There are some markers to diagnose this disease like antiganglioside
antibodies. Make sure that you don’t have any Vit deficiency, like B12, if recent needs to be treated. A gluten free diet
can help if you have celiac disease.


BettyPietro: I was taking 50 mcg Synthroid & 17.5 mcg. My Free T3 and Free T4 is at the
lower end of the range. Free T4 was 0.7 (0.7-1.8) & Free T3 was 2.7 (1.8-4.6) my TSH was
0.117 (0.4-5.5). My doctor was concerned with the TSH and did not seem to care that my
FREES were low. I had no hyper symptoms and no heart palpitations. The doctor left my
Synthroid alone and lowered my Cytomel to 10 mcg. The doctor told me if I didn't like this
dose that he/she would recommend another doctor. This did not make sense since my Free
T4 was almost below the range. This was 6 weeks ago and I am now having hypo symptoms.
Why are so many doctors hung up on TSH levels? I know Cytomel suppresses the TSH, and
therefore it is not a reliable test when taking a T3 medication.

Suma_Jana,_MD: You are partly right that T3 suppresses the TSH. Once your T3 is lowered your
TSH will go up then instead of going up on T3 go up on your T4 to keep your TSH close to 1.0. We
depend on TSH because “your brain knows the best”. TSH comes from an endocrine gland in your
brain called Pituitary. Low TSH has been shown to cause osteoporosis (you don’t feel it) and irregular
heart beats called Atrial fibrillation (may come suddenly). Overall humans need less T3 than animals.
Ideally, humans need 10% T3 and 90% T4. We can convert T4 to T3 easily. So, even if we want to
give T3, ideally 10% should be OK. But, T3 kind of gives a kick and high energy level so people get
used to that and then when brought it down they feel like crashed (kind of similar effect happens few
hours after energy drink).

OhioBella: I have been told that Ohio has many cases of thyroid problems.....is this true and
why would this be so?

Suma_Jana,_MD: Thyroid problems are very common in Ohio. There are a number of
environmental exposures or triggers that can contribute to autoimmune thyroid disease.
These include infections, life stress, iodine intake, smoking, medications such as amiodarone
and interferon, radiation, and environmental toxins. Environmental exposures may be subtle
and occur over a long period of time thus making it difficult to determine in a patient and link a
specific exposure to thyroid autoimmune disease.

Glendac: Is it possible to have normal thyroid tests and still have thyroid problems? All tests
are normal but I have small nodules, feel tired, sluggish, dry skin, can't lose weight, brain fog.
All the symptoms! Any suggestions?

Suma_Jana,_MD: None of the symptoms we evaluate for thyroid is specific for thyroid. We need to
exclude other causes of symptoms like anemia, vitamin deficiencies, abnormal electrolytes
(calcium/sodium,/potassium), autoimmune disease and chronic inflammatory state like rheumatoid
arthritis, lupus, fibromyalgia, chronic fatigue syndrome, etc. If all are excluded and TSH is 3.5 or more,
then trail of low dose thyroid hormone under the supervision of an endocrinologist can be an option for
patients younger than 60 and no history of heart disease, stroke, or osteoporosis. I have couple of
patients who did feel better after trial. Again, can be done only under supervision of an endocrinologist
and fulfills the above conditions.

aryanee89: I just want to know if there are any other medications of levothyroxine that can
corresponds to on how control the weight changes? I've been taking authyrox 100mcg for
almost 3 months and I can see that I gain so much weight even though I tried doing exercises
and food diets.

Suma_Jana,_MD: need to keep your TSH close to 1.0. need to take thyroid meds in empty
stomach with water only. foods, coffee, and medications can interfere with your thyroid med
absorption. there are other factors which contributes to weight, make sure they are exclude.
OhioBella: Should a person be on vitamins, supplements or iodized salt for helping the
thyroid?

Suma_Jana,_MD: There is no need for vitamins or supplements, rather avoid too much iodine like Kelp
and avoid too much soy products. Just use normal amount of iodized salt and soy, not too much. If you are
deficient in any vitamin, you should take that. Supplements like selenium, zinc, glutathione, Vit D etc. can
potentially help theoretically, but there is no research study to support that. Excess amount of these substances
can potentially cause harm. So, none of these are routinely recommended. Three-four Brazil nuts per day can
provide selenium and could be OK to take.

jrcarr: I have Hashimoto Thyroid Disease and was diagnosed in 1998. My nodules are
growing very fast with multiple nodules now appearing. I am being scheduled for frequent
biopsies of the nodules. The biopsies are frequent and recurring. Do I have any other
options?

Suma_Jana,_MD: Usually follow up US thyroid is yearly once FNA is benign. Sometime nodules in
the Hashimoto’s thyroiditis may not be a real nodule. There are areas of inflammation that may appear
like nodule.

adrenal: I have both hypothyroidism and acute adrenal insufficiency--although I do not have
Addison's. (Last January, prior to the beginning of treatment with steroids, my cortisol level at
8:00 was 1.) I have not been able to locate a doctor who has experience handling both of
these conditions simultaneously, or even any experience handling adrenal insufficiency that
does not involve Addison's. Could you please explain to me how the treatment of these two
conditions should be coordinated? Could you also tell me who, if anyone, has an expertise in
this area?
Finally, the effects of long term steroid use are extremely risky for me--even before these
problems, I had high cholesterol and high blood pressure; my father died of cardiac arrest at
age 45. Given the considerable increase in risk associated with steroids, I would like to work
with a doctor who is willing to supervise/is knowledgeable about a means of using
supplements or other medications to reduce the dependence on steroids.

Suma_Jana,_MD: Addison’s disease is also called primary adrenal insufficiency and associated
with deficiency of both cortisol and aldosterone. On the other hand secondary adrenal insufficiency is
associated with only cortisol deficiency. This is usually associated with high dose of steroid used in the
past. However, treatment is low dose of short acting steroid like hydrocortisone or cortef usual dose is
10-15 mg in the morning, 5 mg at noon and 5mg around 3-4 PM. It is very important to take this
medicine everyday and increase the dose during stress and sickness. Thyroid hormone replacement can
potentially unmask the adrenal insufficiency. Cortisol should be always replaced before thyroid
hormone. Thyroid hormone dose can change after adequate replacement of cortisol. You need an
endocrinologist to take of your current condition. Adrenal insufficiency needs to be confirmed first by
doing ACTH stimulation test.

Lowry: What other methods of disabling the thyroid are there other than removal or
radioactive iodine? Two friends have just gone through these procedures for Graves Disease
and afterward were told by other doctors that neither is great and radioactive iodine should be
avoided. What is your opinion?

Suma_Jana,_MD:
Thyroid blocking medicines like methimazole and PTU can be used to treat Grave’s disease.
Iodine I-131 (radio active iodine) is a very effective permanent treatment to kill thyroid for
Grave’s disease and most commonly used in USA. This Rx is not used in children and
pregnant woman.
Removal of thyroid by surgery is another way to treat Grave’s disease in appropriate patients.
This method is also very effective. Commonly, after surgery and I-131 treatment, patients
develop hypothyroidism and require thyroid replacement therapy with levothyroxine or
Synthroid®.

CynthiaHartz: I have heard that TSH levels closer to 1-2 are more desirable and therefore
warrant thyroid hormone low dosage when symptoms exist. What are your thoughts?

Suma_Jana,_MD: Please refer to an earlier response to litvolt at the beginning of the chat.

marthalm: How can I get more information about what causes low thyroid, causes and what
all can be caused by it? I have taken Levothyroxine for over 5 years in increasing amounts
and I really don't see any improvement. I am still losing hair, still am overweight, tired most of
the time, dry skin and I don't sleep well. This is the only health condition I have with the
exception of high cholesterol.

Suma_Jana,_MD: The most common cause of low thyroid is Hashimoto’s thyroiditis. If your thyroid
hormone levels are optimum and you still have these symptoms, you need to look for other causes e.g.,
sleep apnea. If TSH is fluctuating then need to optimize you levothyroxine treatment, most likely your
thyroid hormones are not stable, need to see an endocrinologist. You may need to make sure that you
are taking the medicine properly, i.e., empty stomach first thing in the morning only with water, not
taking other medicines with it, not drinking coffee/tea with it, waiting for 45 –60 mins before eating
any food or drinks like coffee/tea, and waiting for 4 hrs before taking iron/calcium/metals/antacid etc.
kostelan: My thyroid doctor has diagnosed me with hyperthyroid. With medication, she has
my TSH levels and blood pressure under control. We are keeping a watch on it every 6
months.I was just in to see her and failed to ask a question. My gastro intestinal system is out
of wack. I am very irregular...sometimes good and most times feel constipated. Do you feel
my thyroid is doing this? Can I take a stool softener or Metamucil on a daily basis?

Suma_Jana,_MD: If your TSH is optimum, most likely, this is not from your thyroid. You can
take stool softener or Metamucil.

HASHIMOTO: Wondering if corticosteroids would normally have an effect on a goiter's size?
Dosage for shingles was 10 mg. for 10 days, taken with pills dwindling to the 10th day. Read
something about hashimoto's encephalopathy and steroid responsive treatment. Although not
related to thyroid disease, my response to this steroid treatment was amazing, and the size of
my goiter was noticeably reduced for about a month, and has since gone back to where it was
. I felt remarkably clear headed and like a different person after that treatment. (Not RA
positive in recent blood work) Is there a correlation that the steroids would have had on my
goiter, and is there a test for the Hashimoto's encephalophy, or a treatment for the thyroid
goiter that would involve steroids? Thank you for this opportunity.

Suma_Jana,_MD: Hashimoto's encephalopathy is a diagnosis of exclusion when a patient
has encephalopathy and Thyroditis, spinal fliud TPO- antibody is one of marker, when all
other acuses has been excluded.
we don't use steroid for goiter, unless some one has a very sever thyroidditis (usually
subacute) causing sever pain, high body temp, and other sympotoms of sever hyprthyrodism.
Please keep in mind in shortterm, steroid may make you feel better, but high dose for long
time can lead to osteoporosis, glaucoma, Diabetes, HTN, weight gain, etc

Suma_Jana,_MD: To help your weight cut down on sugars and carbohydrate containing drinks and foods. In
addition to exercise, you should:
 Drink water avoid fruit juice, coke, pop etc, coffee/tea black is the best, if needed use sugar substitute and
skimmed milk
 avoid chewing gums of mints, if needed use sugar free one
 Snacks: avoid cookies and candies, can use nuts/vegetables/pop corns without caramel/fruits for snacks,
 Meals: avoid too much bread/pasta/rice/potatoes/corn, in a meals eat ¼ plate salad, ¼ cooked vegetables,
¼ protein, and last ¼ carbs.
 Exercise 45 mins per day 5 days or more per week
You need to check TSH and make sure not higher than 3.0. If >3.0 needs further evaluation. There are approved
weight loss meds like Belviq and qsymia, as well as gastric bypass surgery can help to lose weight.

staciers99: I have been told that I have a an enlarged goiter, a cyst, and mass but the blood
function test results came back fine. I have had many doctors in the last 3 years including an
infectious disease doctor from Cleveland Clinic tell me that they would not be surprised if my
thyroid was the issue. My question is: I have been trying to lose weight for the last 6 weeks by
eating fruits and vegetables, lean meat (mainly poultry), and limited carbohydrates with no
sweet drinks. I have lost 1 pound! Only 1 pound! I was told that this too could be tied to my
thyroid. How do I know what to do to aid me with this? Is there a test I should have done? Any
help would be greatly appreciated.
To help your weight cut down on sugars and carbohydrate containing drinks and foods. In
addition to exercise, you should:

dkmgray: Can you recommend an expert in treating thyroid disease anywhere from
Williamsburg to Va. Beach, VA?

Suma_Jana,_MD: I can’t tell off hand but I can send a message to our staff member if any one has any specific
recommendation. You can also do a goggle search and look at their experience and affiliation, any one affiliated to a
university hosp should be good. It doesn’t mean that others are not good. My thinking logic is if any one involves in
teaching medical students/residents/fellows they will be up to date with current recommendation.
The American Thyroid Association (ATA) has a list of thyroid specialists that may be searched by location. You are
welcome to visit
http://www.thyroid.org/patient-thyroid-information/endocrinology-thyroid-doctor/
for further informtion.
Suma_Jana,_MD: TSH should be kept close to 1.0 and not >2.5. To help your weight cut down on sugars and carbohydrate
containing drinks and foods. In addition to exercise, you should:
 Drink water avoid fruit juice, coke, pop etc, coffee/tea black is the best, if needed use sugar substitute and skimmed milk
 Avoid chewing gums of mints, if needed use sugar free one
 Snacks: avoid cookies and candies, can use nuts/vegetables/pop corns without caramel/fruits for snacks,
 Meals: avoid too much bread/pasta/rice/potatoes/corn, in a meals eat ¼ plate salad, ¼ cooked vegetables, ¼ protein, and last ¼
carbs.
 Exercise 45 mins per day 5 days or more per week

Panda: I have hypothyroidism and I am on Synthroid, 88 mcg. I used to be on 112 mcg and
my weight was in the normal range. Now that my dosage is lower I have gained 40 pounds
over 5 years. My TSH numbers were in the negative range and that is why the dosage was
gradually reduced. Now the TSH is normal but my weight isn't. I am 5'5 and 172 pounds
which makes me overweight and I am very concerned. What are your recommendations?
TSH should be kept close to 1.0 and not >2.5. To help your weight cut down on sugars and
carbohydrate containing drinks and foods. In addition to exercise, you should:

eatveggies: Hello, I'm a 68 yr female, had a left hemithyroidectomy in June 2013 at Johns
Hopkins for a suspicious thyroid nodule (benign). Presurgery US report:
Right thyroid lobe measures 4.4 x 1.1 x 1.7 cm.
Small complex nodule in mid to lower pole measuring 5 x 2 x 5 mm with
solid and cystic component. No detectable flow within this nodule.
Solid hypoechoic nodule in right pelvis measuring 8 x 4 x 8 mm with no
detectable flow
Left thyroid lobe measures 4.9 x 1.6 x 1.9 cm.
Heterogeneous solid nodule with hypoechoic rim measuring 2.4 x 1.5 x 1.7
cm in the midpole, likely corresponding to previously biopsied nodule.
There is increased vascularity within this nodule.
Now on Synthroid 25 mg daily. Will have follow-up labs to monitor dosage. I still have
hypothyroid symptoms - fatigue, weight gain, dry skin, cold intolerance. Do goitrogens and
soy from a vegetarian diet interfere w/synthroid absorption? Might iodine/zinc supplements
help? When & how best to monitor nodules in right lobe?

Suma_Jana,_MD:
To monitor thyroid nodules you should get ultrasound thyroid once a year, if any new
suspicious signs like increased vascular, calcification, irregular border, or significant increase
in size, needs biopsy.
Goitrogens can potentially interfere: but you can still eat then normally don’t do too much.
Iodine will not help rather make more hypothyroid, Zinc can help theoretically but no data to
support that, as this is a metal too much can potentially harm you, so we don’t regularly
prescribe them, as you are already on synthroid, I don’t see any need to take Zinc.
However, you need to keep your TSH around 1.0. For first year hypothyroid rate is high with
time so you should get your TSH check every 3-4 months and adjust the dose as needed.
After 1st year you can get it checked once in a 6-12 months.

catg64: I have two nodules which when biopsied turned out to be benign. They had increased
in size fom one u/s to the other. Is there anything beside surgery that will stop growth or
decrease nodules?

Rosemarie_Metzger,_MD: No, not really. Historically, some people were started on thyroid
hormone to try to 'shrink' nodules, but this practice has largely fallen out of favor. If the
nodules are not otherwise bothering you, then monitoring for growth is the usual way of
following benign thyroid nodules. Significant growth, i.e. greater than 20% in 2 or more
dimensions warrants repeat biopsy. It is important to remember that nodules can be slightly
different sizes from one ultrasound to another just based on who is doing the ultrasound.
These slight differences in measurement are typically not concerning.
Gregmoney7: I have had 2 ultrasounds on my thyroid since 2012 -2013. The interpretation is
as follows:[The right thyroid lobe measures 4.7 x 1.6 x 1.4 cm. There is an inferior isoechoic
nodule which measures 0.5 x 0.3 x 0.3 cm. Again, this is difficult to tell if it is exophytic from
the gland or just adjacent to the gland. This appears similar to the prior study.The left thyroid
lobe measures 4.7 x 1.5 x 1.4 cm. The left thyroid lesion is seen. Thyroid isthmus measures 5
mm and shows no focal abnormality. -IMPRESSION: 5 mm solid right-sided nodule is similar
in appearance to the 12/11/2012 ultrasound. Again, it is difficult to tell if this is exophytic from
the thyroid gland or just adjacent to the gland.]Would you recommend further testing
considering I still have symptoms (brain fog especially) even though my TSH stays between
1.0 - 3.0?

Rosemarie_Metzger,_MD: The right sided thyroid nodule does not meet our standard criteria
for biopsy (which is 1 cm or greater). If you have specific risk factors for thyroid cancer - i.e.
history of head and neck irradiation, family history of thyroid cancer, or an inherited syndrome
that is associated with thyroid cancer - such as FAP, then you will want to follow this more
closely and biopsy might be recommended even if it is smaller than 1 cm. Otherwise, given
that the nodule is stable, you can increase the interval of your thyroid ultrasounds. I doubt
that your brain fog is related to your thyroid nodule.

Rose5: Hi I was diagnosed with Hashimoto by an endocrine physician. I am on Armour 90 mg
by wellness MD and the endocrine physician who diagnosed me felt I should not be on any
med but was ok with low dose of Armour 30! He was worried about atrial fib if I was started on
this med now! My blood work has been monitored! Does Armour cause atrial fib long run?
What other recommendations do you have for this diagnosis?

Suma_Jana,_MD: Atrial Fib is from too much of thyroid hormone (T4, T3) leading to low
TSH. So if your TSH is not low risk of Atrial fib is not high. Compared to T4, T3 has a high
potency to suppress TSH. In armour thyroid there is relatively higher percentage of T3 than
we really need. Armour thyroid is made from thyroid gland extract from pig and cow. Now,
animals need more T3 than humans. T3 helps them with more thermo genesis (body heat
production), because they don’t put on any cloths, they need to preserve body heat by more
heat production.

FLOR1: My thyroid was lowered to 88mcg 6 months ago from 100. I was told this was based
on TSH results.
I am 76 years old and have been taking thyroid since I was 10. With the lower dose I seem to
have all the symptoms of bring hypothyroid including lack of energy, nails and hair problems,
very slight depression, etc. but otherwise in good health. My doctor feels that the higher dose
is bad for my heart(my HDL is 80) and I think that I know my body but what is your thought?

Suma_Jana,_MD:
Thyroid hormone effect on heart is on the rhythm and oxygen consumption. So, even if you
have very good HDL (which will protect you from heart attack), but cannot protect you from
irregular heartbeats we call Atrial fibrillation (A Fib). As well as low TSH can cause
osteoporosis. So, I will not suggest keeping your TSH below the lower limit of normal. I will
also suggest you to make sure that you don’t have any other cause of your symptoms which
is masked by high dose of thyroid meds, like anemia, vitamin deficiency, electrolyte problem,
sub clinical depression, rheumatoid arthritis, fibromyalgia, etc.
After that, to improve you symptoms you may talk your doctor to a dose between 100 and 88,
and still keep your TSH within normal range. I.e., you can take 1.5 pills on Sunday and 1 pill
of 88 all other day and see how your TSH responds.

jamiehambleton: is there a difference in generic vs. brand name armour thyroid?

Suma_Jana,_MD: very small difference, in generic you may get thyroid medicine from
different maufacturer, leading to slightly differnet level of thyroid hormone in the blood. so
taking generic medicine can make your blood level of thyroid hormones vary from time to
time. 95% of the pts can adjust to that on their own and do not need anything. 5% may need
brand name. also you can request your pharmacisit to give you same manufcaturer all the
time, and each time refill for 90 days,

dkmgray: I seem to require a lot of sleep--too much, according to my mom. I can sleep all
day and night, getting up to go to the bathroom and eat or drink to take meds. Haven't done it
multiple days, though. Thyroid removed in 1967 at age 14. I have had sleep studies done and
use a CPAP.
Other subsequent diagnoses: diabetes type 2, fibromyalgia, aortic stenosis, back & leg pain
for which I take Conzip; mild depression for which I take one Effexor.
I have blood work done every 3 mos, which is okay. Would low thyroid cause me to sleep a
lot, or might it not be a constellation of symptoms, any one of which may cause it? Just
curious if you have a suggestion or opinion? Not sure where to turn for help.

Suma_Jana,_MD: If you are on thyroid medicine and your TSH is OK, then you are not low thyroid
any more, and probably your symptoms are from something else. However, your TSH should be kept
close to 1.0. You may talk to your sleep doctor to make sure your C-PAP is working, make sure your
DM-2 is under good control (high blood sugar may make you feel fatigue and sleepy all day). Some
weight loss and exercise can boost your energy level. If you didn’t have aortic stenosis, a small dose of
T3 may be helpful after optimizing the above things. But, in presence of aortic stenosis it can be little
complicated.
Moderator: Thank you for your patience during this chat. Due to the # of questions that are
being submitted and # of people connected to the chat - we do not have the opportunity to
edit some of the answers for grammar. Questions are being sent out possibly faster than you
can read - and then followed by a log period.
The transcript will be posted in 2 weeks and you will be notified by email when it is.

OhioBella: If I have a thyroid that isn't working or has a bad biopsy then should I be put on
supplements or medication? What if I have to have surgery....then what medication?

Suma_Jana,_MD: A thyroid nodule and thyroid function is 2 different issues. Commonly
nodules are inactive, rarely can they make excess hormone leading to hyperthyroidism
requiring thyroid blocking medicine or radioactive iodine to kill the nodule or surgery to
remove the nodule. However, in majority, nodules are inactive and rest of the thyroid gland is
good enough to maintain normal thyroid function. So, no need for any medication. I am not
sure, what exactly you meant by bad biopsy, biopsy doesn’t cause destruction of the gland,
so thyroid supplement is not needed after biopsy. However, if surgery (complete or partial
thyroid removal is needed) you will require thyroid supplement (commonly used levothyroxine
or Synthroid®).

Suma_Jana,_MD: TSH should be kept close to 1.0 and not >2.5.             Talk to cardiologist about water retention and exercise. To
help your weight cut down on sugars and carbohydrate containing drinks and foods. In addition to exercise, you should:
 Drink water avoid fruit juice, coke, pop etc, coffee/tea black is the best, if needed use sugar substitute and skimmed milk
 Avoid chewing gums of mints, if needed use sugar free one
 Snacks: avoid cookies and candies, can use nuts/vegetables/pop corns without caramel/fruits for snacks,
 Meals: avoid too much bread/pasta/rice/potatoes/corn, in a meals eat ¼ plate salad, ¼ cooked vegetables, ¼ protein, and last ¼
carbs.
 Exercise 45 mins per day 5 days or more per week

cricket03: I had heart failure in Nov of 2012 and there were several problems that I had
neglected. I had also passed a mass when I was in intensive care. By April of the following
year (2013) I had felt like someone was choking me all the time and was diagnosed that day
with hypothyroidism. I had gone from 160 lbs to 190. Lbs I was retaining so much water. I
have now been on Synthroid for 8 months, I am eating healthy and I have not lost any weight.
What can I do to change this? I am active and I have started taking vitamins, I don't know how
else to change this. Any ideas will be appreciated.
TSH should be kept close to 1.0 and not >2.5. Talk to cardiologist about water retention and
exercise. To help your weight cut down on sugars and carbohydrate containing drinks and
foods. In addition to exercise, you should:
nance: Please clearly explain what is meant by a half-life of Synthroid dose.

Rosemarie_Metzger,_MD: Half life refers to the time it takes for the body to metabolize half
of the amount of the drug. The half life of T4, which is the hormone in synthroid, is
approximately 7 days. Meaning, if you took a dose of synthroid on Thursday, and took no
more thyroid medication following that, you would still have circulating T4 in your system
one week later - although it would be decreased by approximately half. Half life is a function
of both the drug and the way the body breaks it down (metabolizes it). Some drugs/hormones
are rapidly metabolized in the matter of hours and others are much longer.

chrishays: How common is it for Abs to be that high? (Tg-Ab 25,000, TPO-Ab 2,700)
Have you heard of low dose naltrexone reducing thyroid antibodies?
Do you think tests to rule out thyroid cancer should be performed? What to start with? (e.g.,
calcitonin?)

Suma_Jana,_MD: high Abs are very common,
There are some claim in the internet, but no convining large study to show that naltrexone can
reduce antibodies. Please understand that Abs can vary with time no matter what you do.
This is your immune system making these antibodies. No need to get frightened by
antibodies, just monitor your thyroid labs once in a while. You may develop hypothyroid in
future, and that time start taking thyroid pill under your doctor's supervision. Abs are not like
lupus or rheumatoid arthritis, so no reason to get concern about these Abs. They only can
make you hypothytoid in future, and you can traet that by taking thyroid pills, synthroid.

janet e.: My acupuncturist says the swelling in my left ankle seems jelly like rather than
watery and suggests I have my thyroid checked. Any thoughts?

Suma_Jana,_MD:
You can request your doctor to check TSH and Free T4. If they are normal, it is unlikely from
your thyroid. Need to look for other causes.

chrishays: Hello. Thank you for doing this chat. I have Hashimoto's, and my thyroid
antibodies have become incredibly high. In a years' time my Thyroglobulin Ab jumped from
2,400 (already 'high') to 25,000; TPO jumped from 929 to 2,800. My dr. says there's nothing I
can do, I just have to "wait for the Abs to finish destroying the thyroid gland."
1) Is there something I can do to lower the levels?
2) What can trigger such high levels? How to find what my triggers are?
3) I'm aware that one autoimmune disease can be followed by another. I'm concerned that
having such high levels might promote this. Is this a valid concern? Is there something I can
do to prevent this? (I have other health issues, perhaps already happening?)
4) In researching high levels, I came across a study involving someone with thyroid cancer. Is
that a common connection?
5) I've heard there might be a connection between Hashimoto's & gluten sensitivity -- your
thoughts on that, please. I look forward to Wed. Thx

Suma_Jana,_MD: If you are concerned about thyroid cancer, get an Ultra sound of your thyroid
gland, and if there is any nodule more than 1 cm get a biopsy done. Thyroid cancer can co-exists with
thyroiditis, in those cases prognosis of cancer is usually good. Autoimmune thyroiditis doesn’t directly
cause thyroid cancer, but when biopsy done they can be misinterpreted with thyroid cancer.

HASHIMOTO: Do thyroid nodules have any purpose? If they are benign does that mean they
are part of the thyroid and act to produce thyroid hormones?

Rosemarie_Metzger,_MD: Thyroid nodules have no specific purpose - and there are many
types of thyroid nodules. Many many many millions of people have them - and most don't
even know it. With rare exception, most nodules are 'inside' the thyroid gland - they are not
sticking off from it. Most nodules do not effect thyroid function at all
. Occasionally, a thyroid nodule will produce thyroid hormone and will contribute to
hyperthyroidism.

Moderator: ChrisH - your remaining questions will be posted in the transcript and sent to you
in an email later today.

alice: Please discuss the differences in Armour thyroid and levothyroxine effectiveness. It
seems that Armour is not readily available currently and must be compounded; is this correct?
My thyroid gland was irradiated in 1981 and I have felt much better on the Armour; but, lately
have had to take the levothyroxine. Please comment with recommendations. I have T3, T4,
and TSH checked regularly at my PCP. Thank you.

Suma_Jana,_MD: Armour thyroid was out of supply in the recent past but now it is available. There
are other preparations like Armour i.e., made from extracts of animal thyroid gland mainly Pig and
Cow. One of them is Nature Thyroid. So, it has both T4 & T3. on the other hand levothyroxine is only
T4. If you like T3, you can go back and try one of the other products or try a small dose of T3 with
Levothyroxine. But, your TSH should be kept within normal range, unless you have a history of
thyroid cancer.

DW: My daughter is 19, and she is taking thyroid hormone for her hashimoto's disease. Her
THS is about 4.7 (borderline level). She is doing ok now except sleep more hours every day
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