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Ask Dr. Marie
I hope you find this Question & Answer section helpful, and that you share it with your friends. Feel free to forward, post, or reprint it.
I hope you find this Question & Answer section helpful, and that you share it with your friends. Feel free to forward, post, or reprint it.
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Q. I am in my early forties and I have been suffering from a long list of symptoms for the past six years. (muscle tightness and spasms, fatigue, memory fog, loss of sex drive, carpal tunnel syndrome, pain in my feet& depression)Over the years I have had blood work done, and only one time did one of my thyroid numbers come back low. Can you tell me the proper blood tests that need to be done to check the thyroid? My current doctor is having me do a thyroid trial; tomorrow I will start taking Armour thyroid 30 mg. How long will I have to take it to see if I notice a difference?
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A. I would make sure you have a recent complete blood count to rule out anemia, etc.; a complete metabolic profile to check kidney, liver, etc. and YES thyroid profile which at the minimum should include a TSH (the most sensitive and important) along with a T3, T4. Further thyroid tests include thyroid antibodies which would not be routinely done unless you had a definite problem.
I would also make sure you have a copy of all your test results, subtle changes from your baseline readings could be important. And thyroid disease can be mild or minimally abnormal on blood testing but treatment could make a big difference to how you feel. So if you are borderline low, you might benefit from a trial or "experiment" of seeing how you feel on medication. You would have some idea of your response quickly - a few weeks or so. If you are low however, your doctor will start the medication slowly and at the lowest dose so as not to trigger heart palpitations or other symptoms - so be patient as they build up the dose.
Q. I have a question for the doctor. My Endocronologist is basically leaving it up to me what TSH level I want to be at during pregnancy. I have read as much as I can find on the issue and I think I should be between 1.0 and 2.0 TSH. (My background: I just had RAI I-131 done because I have been hyperthyroid my entire adult life and now that I want to have a child, they told me I needed to do the RAI I - 131 since I am allergic to PTU and was becoming more and more hyperthyroid. So, I had the RAI I-131 done on July 2, 2007. I am not currently taking any thyroid medication.) My TSH levels are still increasing with each test and now I am at 4.1. He says he is happy to medicate me if I wish but he thinks since I am feeling great, he is fine leaving me as I am or simply lowering my TSH a little. I don't know what to do. Should I push to medicate down to 1.0 to 2.0 as I have read suggested other places? Put another way, what is the optimal number for a woman going into pregnancy? This month my period was much lighter than ever before and I am worried that is a result of higher TSH numbers. When my TSH levels stabalize, I want to try to get pregnant, so I want to do what is best for fertility, myself, and of course the baby.
Thank you for any guidance you can give me.
A. Almost certainly you have been given a high enough dose or I-131 to eventually "destroy" or wipe out your thyroid gland function (or perhaps as I don't know what dose you received, I can say it is a very good possibility that it will happen). Radiologists go with a higher dose rather than risk the hyperthyroid condition coming back. Because it is very likely and because even subtle low thyroid function can impair fertility, I would tend to favor starting the lowest dose of thyroid hormone and follow the TSH. It is likely only a matter of time before you will need to start medication. Waiting for symptoms or until your TSH is much higher given your circumstances seems unnecessary and runs the small chance of effecting your fertility and wellbeing. There is never harm done in taking a low dose of thyroid - you could always chose to stop sometime and see if your tSH rises. Starting thyroid medication does not commit you forever to treatment ALTHOUGH if your gland was totally wiped out from radiation then you will obviously need lifelong treatment. So the only risk of starting thyroid right now is that you won't know if indeed your own thyroid will stop working altogether. I would lean toward the side of a small dose to keep TSH normal or midrange for now, have your family, then decide whether you need to stay on or not.
Of course once you are pregnant, you may need an even higher dose of thyroid hormone - but fortunately the blood test is easy to monitor.
Q. Thank you so much for responding to my previous email. It means so much to me that you took the time to help me. I have agonized over whether or not to email you again with this follow-up question, but I have decided it doesn't hurt to just ask. If you cannot answer my question any further, I understand. What I need clarified is: When you say that "even subtle low thyroid function can impair fertility," what TSH number demonstrates that my thyroid function is "subltly low?" The problem I am having is getting anyone to tell me what is "low," what is "just right," and what is "high" in actual numbers of TSH levels. People seem to agree that I need to make sure my level is not too high and not too low for the health of the baby. But my Endocronologist follows the old standards that says any thing below a TSH of 5.5 is normal. The new recommendations for normal have changed over the years and for several years now only a range of below 3.0 was considered normal. Now, the new recommendation is that only a TSH below 2.5 is normal. My problem is, there are multiple studies saying any low functioning thyroid, causing an above normal TSH level, is dangerous to a growing baby, without giving the numbers that are used in any recognizable format. What I cannot determine is: For those studies, what level were they using to refer to "normal" levels? Did the studies just show above 5.5 was detrimental to the baby? Or above 2.5? The studies themselves list the numbers in a way I cannot understand. The units of measurement and the names for the substances are different, so I cannot compare my test results to the levels in the study. My Endocronologist is with Kaiser and he must follow the "normal" ranges that Kaiser adopts, which is that anything beloew 5.5 is "normal." He did say (on his own without me asking) that he will agree to medicate me a little for support during pregnancy. (Side note: For my RAI I-131, the goal was not to destroy my whole thyroid, just my nodule that was overactive.) So, I either need to pushwith him to have medicine to get me down below 2.5 or just take a little medicine, as he is suggesting, and have a much higher TSH level - well above the current recommended 2.5 TSH. I cannot find anyone who will tell me what the safe range is for a baby. If the studies only show a danger if I am over 5.5, then I will happily not take an unnecessary medication, but if those studies show that my baby would be in danger if I am above 2.5, then I will fight to be medicated to that level. Do know the answer to my question? Or know who might? Thank you for your time. I am still very grateful that you answered my previous email.
A. Unfortunately no one can tell you what is the exact TSH range that is optimal for you and your baby however all experts agree that as long as the TSH is "normal" i.e. less than 5.5 and that you feel well with no low thyroid symptoms, your baby is surely not in ANY WAY at risk. In fact your thyroid would be pretty low and TSH HIGH (much above 5.5) to effect the baby. However the ovaries and ovulation is more sensitive to subtle changes in TSH - so for improving fertility and cycles, would take whatever dose of hormones restored you to feeling well, regulate periods, fertility etc. That may mean for some women a TSH in the 2-3 range rather than 5.5. I would agree with you that if there is any doubt about how you feel and your TSH is hovering at 5.5 range - and because you did received radiation - I would take enough thyroid to get your TSH in the mid-normal range rather than high normal.
Q. I feel like I am just having test after test done, with no concrete results from my Doctor. My Primary Care Doc has been doing my blood work checking my cholesterol, which is:
Trig: 230
Chol: 221
HDL: 34
LDL: 141
Chol./HDL Ratio: 6.5
I am working on getting that down with diet and exercise, my father has a history of high cholesterol, and heart disease.
My PC Doc also found that I was b12 deficient. In June of 06 my Vitamin B12 level was at 111. I started getting the B12 shot and it improved my over all well being. I felt more energetic, I was sleeping better and could think more clearly without feeling overwhelmed all the time. She has sent me to another doctor who specializes in Oncology and Hematology because my MCV and MCH levels are steadily increasing inspite of the b12 shots. He doesn't think I am B12 deficient, he thinks I am experiencing a placebo affect.
in 06 they were
MCV 102.9
MCH 36.0
in 07 they are
MCV 103.7
MCH 36.8
My iron levels were checked in 06 and were normal, my folate level was normal as well, but have not been checked since then. I have had my thyroid hormone also checked which was at 1.89 in 07. This is their main concern now are these two blood levels. The specialist wants to rule out everything else before he goes in for a bone marrow test. Do you have any suggestions of things they might need to check for. I am also lactose intolerant. I had a colonoscopy done in August which came out completely clear. These two doctors also thought I might have a blood clot, and had a cat scan done, and a D-dimer test which all came back OK. I just feel that they really don't know what to do, and I am continuely getting these different tests, which I don't mind, but I don't seem to be getting any answers. If the tests get more invasive, or they suggest any type of medication, I will seek another opinion, I am just trying to let them run their course since they started all of these tests. The B12 shots do help, and I can tell when I am due for another one. I have no symptoms or anything bothering me. Any suggestions would be helpful.
A. You asked about your B12 and MCV but I can't help but first say something about your blood fats. From you blood work and low HDL, high TG and LDL, I suspect you have the more apple-shape on a hereditary basis which is why you are at risk for heart disease...however as you probably know, there is so much you can do. Exercise, adding fish oil capsules and eating lots of omega 3 fats, high fiber foods is critical. Do you have PCOS?? are your periods normal (if you are premenopausal)? Is your blood glucose okay?? My book on body shape talks a lot about women with your lipid patterns...and what to do/how to be tested.
An increased MCV means your blood cells are too large - either because they are lacking in B12 (usually with vegans, intestinal surgery or problems, chronic antacids with Prilosec, etc. or an autoimmune disease) or folate OR because of a medication side effect such as dilantin?? are you on anything?? or even from low thyroid (a TSH is the best thyroid test to get - what was your TSH??). Since your B12 was low, and because there is virtually no harm in getting b12 and you feel better, makes sense. However eventually your MCV should get lower/more normal. Yours is still borderline high and really may not be something unusual so not sure I would proceed to a bone marrow unless there is good reason. Your doctors sound very thorough which is great for you - even if it is frustrating. The MCH really means nothing different than the MCV so not a worry there. Would also check your stools to be sure no intestinal blood loss although a normal colonoscopy is great news.
Q. I did not see the Oprah show about her thyroid problem.
I had Rheumatic Fever when I was nine and not many years later I was put on thyroid.
In 1996 -97 I was moving to Florida and back to Indiana a couple of times and some how I no longer take thyroid and have not since then.
I'm now 50 to 70 pounds heavier, my hair has been falling out for years and I take folic acid for that. I can not do anything much but sleep around the clock and no one can tell me why.
They have taken the T1 and T4 blood test and keep telling me my thyroid is normal, I do not understand how it could be.
MY life is in bed unless I take two Provigil 200mg. each every morning and then if I would lay down I would be asleep.
I need help and I need it quick my left hand is partly numb and I have diabetis, reflux, and several other medical problems and most of the time I feel like I'm going to die. I'm in pain 24/7.
I take something like 16 to 20 medications a day and I've been asking all my doctors if I need them. Most of them are called maintenance meds.
I have brain fog almost all the time I'm up, plus no strength or energy.
A. Thank you so much for writing. First my thoughts about your thyroid. I agree that some of your symptoms do sound like a low thyroid and once the condition is diagnosed in the past - it can always be a problem. Do you have a copy of all your test results (it would be good for you to keep your own medical file)? Did you also have a TSH test, which is the most sensitive thyroid test? Or did you have thyroid antibodies done? This would be important to know.
It sounds like you have sleep apnea too - did you have a sleep study? Do you have hidden heart disease? Have you been checked for your heart? Would also be worried that since you also have diabetes that you have a pretty high risk of heart disease and may not know it which could also make you feel tired and not yourself. Is your blood pressure under 130/80? your LDL cholesterol under 100 and hemoglobin A1C under 7%?
Finally - you sound like you take so many medication and would be concerned that you also could be having side effects of your medications?
Best of luck getting to the bottom of what is making you feel so badly.
Q. I saw the piece on the today show today. Ironically after I received the newsletter. I am an apple, have metabolic syndrome, am working with my doctor and taking meds to keep everything under control. I exercise about 1 hour/4-5x week. But I have an extra 20 pounds that I can�t get rid of. I keep getting mixed info on diet. I watch what I eat, keep it to small portions as possible, but I am not sure if I am eating the right things since I can�gt get rid of the weight. I eat higher amounts of protein, less on the carbs. I try to eat whole grains, and limit sugars. I am still not losing anything. I see that I am not supposed to eat bananas and other fruit. I need help. Is there anything you can recommend for me to do, to read. Why can�t I lose this weight. It has been a life long battle, and I have been battling these twenty pounds, sometimes successfully, but as I am not in my 50�s, I seem to be losing the battle. I am concerned because I come from a family with heart disease, and low grade diabetes, and know that if I don�t stay focused, that could be me. With the meds, my blood chemistry is OK, but I really want to drop the weight on my stomach.
If you could help in anyway, with advice, or ideas, please let me know.
A. It sounds like you are doing everything right? Is your BP under 130/80? your LDL cholesterol under 100? your triglycerides under 150? Are you on daily low dose aspirin? and an ACE inhibitor for blood pressure? Those are the typical optimal medical goals.
As far as weight - it all boils down to how much visceral fat you need to lose. For example, some research has shown that by exercising, building muscle mass you can shrink visceral fat, lose inches around the waist and NOT lose pounds. So if you are walking, doing some weights and have a good muscle mass, then your weight is not likely adding to your health risk. As far as losing it, which I can understand, the easy way to think of eating for health and optimal weight: eat mostly plant based, unprocessed foods, low salt, and moderate amounts of healthy fats (omega 3's, etc.) and take fish oil capsules. The more fiber in your diet - the lower the insulin level, lower visceral fat, etc. Look at "white foods" such as sugar, flour, potatoes" as insulin boosters which you don't want or need!
Q. I am sure Dr. Savard can not possibly answer all questions personally but I was wondering if you or someone there could. I have a Liver Hemangioma and Liver Focal Nodular Hyperplasia. I have been monitoring them for 10 years with slow constant growth, about � cm each year. I just had another ultrasound and the tech said it was 2 cm smaller. Is that possible? Can they recede? And how big can they get before they have to be removed?
A. I am sure you did your own medical search. They are much more common in women and because they are not tumors but a response to you likely having an underlying blood vessel abnormality (called an AV malformation)...so the fact that they have diminished in size could mean that the blood supply has been affected, some to the areas can shrink if they don't get enough blood, and I suppose many other reasons. Nothing worrisome comes to mind but I would imagine the radiologist who reviewed the xrays/MRI would have the most experience and could give you and your doctor the best advice. Do you have a copy of all your reports? Have you read them?
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