Kathryn (Moderator) - 12:00 PM:
Our chat on thyroid is now open. You can submit questions at any time during our chat.
Carol (Chicago, IL) - 12:03 PM:
I am 57 years old; I work out, watch what I eat, run half marathons, and I still have a stomach and am over 20 pounds overweight. Could a thyroid problem be a possible issue? How could this be looked into?
Dr. Herman Blomeier (NorthShore)
Hi Carol,
Thanks for the question. Hypothyroidism can slow metabolic processes. Your doctor could screen for thyroid abnormalities by checking a blood test called TSH.
Patti (Mundelein, IL) - 12:09 PM:
I have been on Levothyroxine for a few years now for hypothyroidism. I have been at the same dosage for quite awhile, and my numbers are in the normal range. I still am always tired and do not have energy, my weight does not budge and other symptoms persist. What else might I do to manage my symptoms while my numbers are considered normal?
Dr. Herman Blomeier (NorthShore)
Hi Patti,
If the thyroid function tests are truly normal, then your thyroid is likely adequately replaced. Symptoms alone lack sensitivity and specificity, and so we usually do not solely use this for judging adequacy of replacement. IF your symptoms persist, you can discuss with your physician other potential contributing factors.
Linda (Chicago, IL) - 12:13 PM:
What's the reason for being able to visibly see the thyroid? Should it be visible to the eye just by looking at a person?
Dr. Herman Blomeier (NorthShore)
Hi Linda,
This could sometimes be a normal finding. It can depend on the anatomy of the neck and location of the thyroid, for example. The best test to assess the thyroid and look for nodules if there is a mass or enlargement would be a thyroid ultrasound.
Sylvia (Northfield, IL) - 12:18 PM:
My psychiatrist suggested adding thyroid hormone to my antidepressant. Can that affect my thyroid's ability to return to normally functioning later on?
Dr. Herman Blomeier (NorthShore)
Hi Sylvia,
Thyroid hormone treatment just replaces the deficiency in the body. If you are mildly hypothyroid, this may be useful with symptoms. The American Thyroid Association in general recommends against the routine use of levothyroxine
for the treatment of depression in people that have normal thyroid function, as the data is not sufficient to assess efficacy.
Stephanie (Northbrook, IL) - 12:24 PM:
I was just diagnosed with Hashimoto's disease on Tuesday. I started the medication this morning (I also have Sjogrens). What should I expect with symptoms? How long might it take for me to feel like myself again?
Dr. Herman Blomeier (NorthShore)
Hi Stephanie,
Patients usually start to feel better within 2 weeks, but it can take several months to get back to baseline, especially with more severe hypothyroidism.
Lana - 12:27 PM:
If thyroid hormones and TSH are in normal range, but TPO antibodies are positive, can I already have hypothyroid symptoms? Can the cause of hypothyrodism be identified and treated before it starts affecting the hormone levels?
Dr. Herman Blomeier (NorthShore)
Hi Lana,
Symptoms of hypothyroidism are usually more related to the lack of thyroid hormone, not the presence of antibodies. If the TSH trends up and starts to get close to or above normal range, sometimes we do start treatment. In general, the usual course of Hashimoto's is gradual thyroid function loss. The rate of hypothyroidism is usually about 5% per year.
Denise (Evanston, IL) - 12:33 PM:
I was diagnosed with a thyroid condition and Graves' disease as a teenager. I have been on medication, but have gained a lot of weight in my 20's. I was told this would occur, and also that I will need to remove the thyroid gland once I decide to get pregnant. I am now 27 years old and just got married. Is this surgery always necessary? If so, why?
Dr. Herman Blomeier (NorthShore)
Hi Denise,
This is a good question, and probably something you should discuss with your doctor. The anti-thyroid medications (PTU or methimazole) need to be used with caution with pregnancy. Achieving a permanent cure for the Graves' disease (either surgery or radioactive iodine) is sometimes an option to consider before contemplating pregnancy.
Donna (Lake Forest, IL) - 12:40 PM:
I have a history of cystic fluid collections in the thyroid, bilaterally. How often are these normally checked? Should I see an endocrinologist or my internist for follow-up?
Dr. Herman Blomeier (NorthShore)
Hi Donna,
In general, the decision to biopsy a thyroid nodule is based on ultasonographic features and size. Purely cystic nodules we will often not biopsy and can be followed, but mixed cystic nodules again would depend on size and appearance on ultrasound, in which case discussing with an endocrinologist may be helpful. I would start with your internist and see what she or he thinks the best course of action is.
Terri (Chicago, IL) - 12:45 PM:
I was diagnosed with a cold nodule in my thyroid about 30 years ago. My PCP sends me for periodic radiologic biopsies, which are always benign, but then I'm told that any one of the biopsies can show cancerous cells depending on the angle they take the biopsy from. Should this be a concern? Would removing the thyroid be a possible option?
Dr. Herman Blomeier (NorthShore)
Hi Teri,
In general, a benign FNA (biopsy) is reassuring. We do initially do periodic ultrasound monitoring of benign thyroid nodules, first at 6-12 months, then at increasing intervals over time. If the nodule is stable in size and appearance usually no further biopsy would be needed, only if worrisome ultrasound features are seen or there is substantial growth. If you have had multiple biopsies of the same nodule and all are benign the risk of this nodule being anything worrisome should be low. If benign nodules continue to grow over time, then surgery can be a consideration.
Heather (Wilmette, IL) - 12:53 PM:
What are your thoughts on bioidentical hormone replacement therapy for thyroid conditions?
Dr. Herman Blomeier (NorthShore)
Hi Heather,
In general, we do not recommend or prescribe this, given concern for safety or efficacy when compared to approved and commercially available products.
Betsy (Skokie, IL) - 12:55 PM:
How much do you think diet can play a role in controlling my thyroid? (I have Hashimoto's)
Dr. Herman Blomeier (NorthShore)
Hi Betsy,
Hashimoto's disease is an autoimmune disease, so impairment of thyroid hormone synthesis is due to destruction of the thyroid cells. Diet can sometimes play a role more in absorption of thyroid hormone medication, which is why we suggest taking it on an empty stomach. So for example, calcium, iron and high fiber can all affect absorption. Coffee, compared to water, can also reduce absorption. Monitoring levels should ensure you are getting the right dose, though!
Sharon (Evanston, IL) - 12:59 PM:
Good afternoon. I had a benign mass removed from my right thyroid lobe last year. Subsequently, I've developed hypothyroidism and have developed hives. I've tried levothyroxine and synthroid. The hives get worse on these meds. Is there anything more I could do? Are the hives caused by the thyroid?
Dr. Herman Blomeier (NorthShore)
Hi Sharon,
Allergies to thyroid hormone are very rare, but patients can sometimes have allergies to dyes or other inactive ingredients found in the pill. You could also try Tirosint, which is another formulation of Levothyroxine that is free of dyes, alcohol and sugars. However; I would discuss this with your doctor and consider seeing an allergist if these symptoms persist. Hope you feel better.
Kathryn (Moderator) - 1:00 PM:
This will be our last question.
Kathryn (Moderator) - 1:04 PM:
Thank you very much for your questions! We will be sure to work on additional content to provide more information. If you would like to learn more about thyroid disorders, or speak to a specialist like Dr. Blomeier, you can contact the
Department of Endocrinology.
To address some more of your questions on hypothyroidism, Dr. Blomeier has provided some follow-up answers, which you can read on our blog.