Online Health Chat with Endocrinologist Divya Yogi-Morren, MD, & Endocrine Surgeon Joyce Shin, MD
January 22, 2015
Many individuals suffering from thyroid conditions remain undiagnosed, as many of the individual symptoms of thyroid disorders are extremely common (feeling tired, gaining or losing a few pounds, trouble sleeping). It is important to know the signs and symptoms, and what to do once you’ve been diagnosed.
The thyroid gland plays a critical role in a person’s overall health. The thyroid is an endocrine gland that is responsible for controlling metabolism (the production and use of energy by the body) and regulating the body’s sensitivity to hormones. Many people suffering from thyroid conditions remain undiagnosed and do not understand the serious health repercussions of untreated thyroid disorders. Diagnosis and treatment are keys to managing a thyroid problem and will help to control the related symptoms
About the Speakers
Divya Yogi-Morren, MD is an endocrinologist in the Department of Endocrinology, Diabetes and Metabolism in Cleveland Clinic’s Endocrinology & Metabolism Institute. She is board certified in internal medicine for endocrinology, diabetes and metabolism. A medical school graduate of the University of The West Indies, she completed her internal medicine residency at Cleveland Clinic Florida and her fellowship at Cleveland Clinic in Cleveland, Ohio. Dr. Yogi-Morren’s specialty interests include thyroid and parathyroid disorders, thyroid cancer, metabolic conditions and diabetes.
Joyce Shin, MD is an endocrine surgeon in the Endocrinology & Metabolism Institute. A graduate of State University of New York School of Medicine, she completed her residency in general surgery at Albert Einstein College of Medicine/Montefiore Medical Center and her fellowship in endocrine surgery at Cleveland Clinic. Dr. Shin’s specialty interests include endocrine surgery (thyroid and parathyroid), advanced laparoscopic surgery, laparoscopic adrenalectomy, neuroendocrine tumors, thyroid/parathyroid ultrasound, intra-abdominal ultrasound and laparoscopic radiofrequency thermal ablation of liver tumors.
Let’s Chat About Thyroid Issues
Thoughts on the Thyroid
Valpat: My doctor is monitoring my thyroid tests since I'm hovering near hyperthyroidism. Are there any dietary changes I can make or nutritional supplements to take that can bring my levels back to normal?
Joyce_Shin,MD: No, there are no foods that will make your thyroid function normally.
Xomue: What is the ideal TSH reading? One doctor told me he wants me at 1.5. Another told me 2.5.
Joyce_Shin,MD: There is no one ideal TSH reading, but people tend to feel better at the lower end of normal. Each laboratory has different ranges of normal, so you'll have to check the range.
erika: I have gained 30 pounds in three years since I have found out I have had hypothyroidism because I was not being treated properly. Will I be able to lose the weight now that my thyroid medications have been corrected? Or will it be more difficult for me than a person with a healthy thyroid?
Joyce_Shin,MD: If you are on an appropriate dosage, then it will not be more difficult for you to lose weight than someone who did not have a thyroid condition.
extrabeat: I just had my yearly physical, and the doctor wants to re-check my thyroid in three months. I have gained 25 lbs. in the past years, and the bloodwork also showed very low Vitamin D. The doctor prescribed a Vitamin D 50,000 unit, twice weekly. Concerning the thyroid, what might the doctor be looking at, and does the Vitamin D have anything to do with the thyroid?Joyce_Shin,MD: I am not sure why your doctor wants to re-check your levels in three months. Perhaps they were slightly abnormal? Vitamin D deficiency is very common, but not directly related to your thyroid gland
The Subject is Surgery
jac44: I had approximately two-thirds of my thyroid removed in May of 2014 (the right side and isthmus). A very tiny spot of malignancy was found, but so tiny it was almost missed in the full biopsy later. The surgeon assured me there were no other signs of problems and no indications of further surgery necessary. I had a follow-up ultrasound in December and everything appeared to be normal. Occasionally, I will feel a slight discomfort on the right/surgical side of my neck and sometimes a pulling sensation toward the right ear. I'm wondering: could it be just internal adhesions are causing this sensation due to possibly the way I'm holding my head? Also, I sometimes wake up at night with this sensation. (Could that be due to my sleeping position?) Nothing in testing seems to indicate problems. I’m glad to say my hair has quit breaking and falling out, and I do not need thyroid medications. Otherwise, I am in good health for a 70-year-old.
Joyce_Shin,MD: Yes, those feelings are absolutely normal after surgery. Patients often tell me even many years afterward that they feel some discomfort around the surgical site.
svetk: Please advise on expected recovery time from surgery (large right side nodule), to return to full activity, including intense exercise. Thanks for your advice.
Joyce_Shin,MD: The only restrictions after thyroidectomy is no heavy lifting (>15 lbs.) for two weeks and no submerging the incision under water. Other than that, you can do light exercise. After two weeks, you can resume ALL activities.
Signs and Symptoms
Jodi: Is hair loss related to thyroid issues?
Joyce_Shin,MD: It can be if you have hypothyroidism, but there are other conditions that can make you lose hair, such as alopecia.
Sandidog: I am a family nurse practitioner, and my daughter is 25 and was diagnosed with adenomatous hyperplasia of her 2.4 x 2.6 l thyroid nodule on Oct 7, 2014. She had a benign fine needle aspiration (FNA), and her thyroid levels are normal July 2014. Her only symptom is severe fatigue over the past year and a half. Dr. Sipos said the fatigue is not related to her thyroid condition, and she takes Vitamin D and OCPs and Citalopram.
She is scheduled for another ultrasound in April, but she is frustrated that her severe
fatigue is not addressed. Dr. Sipos recommends ultrasound every six months and report on other symptoms. There is a lot of hypothyroid disease on my side of the family. I worry about thyroid cancer and her severe fatigue.
Joyce_Shin,MD: Fatigue can have many causes other than thyroid function. She should have another TSH a year from her last one if she continues to have fatigue. In terms of her thyroid nodule, she should have it re-measured every year for growth. If it does grow, she will need another fine needle aspiration biopsy.
YJ: What are the symptoms that might suggest I have a thyroid problem?
Joyce_Shin,MD: What type of thyroid condition are you referring to?
ginger41: Of a list of symptoms that indicate a hypothyroid possibility, I have all but one of the symptoms, yet all the tests I've had indicate my thyroid score is in the normal range and the symptoms remain. What can I do to address these symptoms?
Divya_Yogi-Morren,_MD_: You should ask your doctor if anything other than the thyroid could be causing your symptoms. I do not know what your symptoms are, but sometimes fatigue can be caused by adrenal issues. You need a good primary care doctor who can sift through your symptoms and decide what the other possibilities are.
Janetkay: I had half of my thyroid out four years ago. The left side was removed for a cold tumor. At first, I did not gain weight. Then, about two years ago, I had my levothyroxine increased from 50 mcg to 75 mcg. I gained 20 lbs. in the following 12 months. My GP says that is strange. He said that I am in range. Therefore, he does not want to change the medication. I know that there are three different tests, but he said only one test is needed to tell him what he needs to know. I have dieted now for eight months and have taken off almost 30 lbs. I am very low in energy. On 8/5/14, my TSH was 1.215, but I am always very tired, have thinning hair (very little hair on my arms and legs), am constipated, have dry skin and have a hard time falling asleep. I also have restless legs at night. I will be 59 in March 2015. I would appreciate your advice. Thank you.
Divya_Yogi-Morren,_MD_: The TSH is a sensitive marker of adequate thyroid replacement, and if it is normal it does mean that you are getting enough thyroid hormone. I sometimes do get a free T4 level to complete the picture. If you still have symptoms despite adequate thyroid hormone replacement, then it is possible that these symptoms may be due to another issue. I would also recommend that you get a Vitamin D level checked. The fact that you lost 30 lbs. is great.
punkin: If several doctors, including three endocrinologists, tell me that my thyroid numbers are within normal range, then what is wrong with me? I have many symptoms that indicate hypothyroidism. I keep getting worse to the point that I can barely function and care for myself. I was first prescribed 25 mcg of levothyroxine in 2009. Then it was increased to 37.5 mcg in 2010. I feel so sick that I am afraid.
Divya_Yogi-Morren,_MD_: If your thyroid levels are normal and you have actually tried thyroid medication and your symptoms have not improved, then you may have another medical issue that needs to be addressed.
IrishGram: I was first found to have thyroid nodules way back in 1994. Over the years, they have changed in size and characteristics. I have had several biopsies – all negative. I was told to get an annual follow-up since my nodules have worrisome characteristics. The largest one is 4 cm. Common to these heterogeneous nodules are: "hypoechoic and predominantly solid with irregular margins and scattered calcifications. Blood flow is present by Doppler ultrasound." My last ultrasound was two years ago. For the past six years prior to this, I was seen every year for follow up. When we moved away from Cleveland, I did not follow up in Columbus and wonder if perhaps I should.
Divya_Yogi-Morren,_MD_: You should definitely follow up these nodules. Nodules that have increased in size and have suspicious finding such as calcifications need to be biopsied to look for cancer. If there are many nodules that are large that are causing problems like difficulty breathing or swallowing, you may need surgery.
Clsdvm: I have a toxic thyroid nodule that has been present for close to 20 years. My T4 is normal with a low TSH. I have been told by my local endocrinologist that I am subclinical but should still have treatment done. I have had no physical symptoms. It has been suggested to either have surgery to remove the affected 1/2 of my thyroid or radioactive iodine treatment. I am worried about potentially being dependent on thyroid supplement after either treatment. Would it be of value to have an appointment at Cleveland Clinic to see if treatment is needed, or do I just need to choose one and have the treatment done locally (Dayton, Ohio)?
Joyce_Shin,MD: If you truly have a TOXIC nodule, then the treatment should be surgery, NOT radioactive iodine ablation (RAI). The problem with RAI is that if the nodule does not disappear, it needs to be continually monitored. If I perform a biopsy after a nodule has been ablated, then the biopsy results will most likely show atypia, which puts you back at square one, which is surgery.
mmoy: What is thyroid adenomatous hyperplasia? Is it a concern with a benign fine needle aspiration but a 2.4 x 2.6 L thyroid nodule?
Joyce_Shin,MD: Those terms should not be used for interpretation of a biopsy. However, they should have stated if the nodule is benign or contains malignant cells. The size of the nodule does not always influence if the nodule is cancer or not.
svetk: I have a right side (only) nodule that has grown slowly for years and has been monitored with biopsy and ultrasound. It is a soft mass and low cancer risk. It visibly displaces the trachea. It might affect breathing/swallowing/coughing, but NOT confirmed. Thyroid function is in the middle of the normal range. My height and weight are 5'10" and 172. I am active and in excellent physical condition. I had a pacemaker implant last April, which corrected a "slow" rhythm and associated fainting. All normal functions resumed. My January physical was essentially perfect. Oxygen ablation considered. Recent review suggests the nodule is "too large" for O2. Endocrinology indicated medication not effective for my condition. My understanding is the right side function is absent. I’ve been advised there is little risk of thyroid problems going forward. Surgery is scheduled for Feb. 10. I’m seeking other options. Risk of surgery and function are concerns.
Joyce_Shin,MD: No medication will shrink your thyroid gland or thyroid nodule. If the thyroid or nodule is large enough to cause compressive symptoms (problems swallowing food, pressure on the neck, etc.), then surgery is indicated. In good hands, the risks of a thyroidectomy are low.
More about Medication
trista2011: Is there anything you can take for thyroid take besides Synthroid?
Do you have to do radiation after thyroid removal for cancer?
Joyce_Shin,MD: There are more natural forms of thyroid hormone such as Armour® Thyroid, but the hormone distribution is not as consistent as Synthroid. There is no EXTERNAL beam radiation after thyroid surgery for cancer as in other cancers. The radiation therapy is called radioactive iodine treatment, which is in a pill form, very different than external beam radiation.
Zee: I take one Synthroid 75 mcg daily with water first thing in the morning, then coffee, other medication, followed by breakfast. What is the minimum amount of time lapse that should follow each intake?
Divya_Yogi-Morren,_MD_: At least a half hour should elapse between the Synthroid and any food intake. To be safe, I would say wait one hour to take other medication. Vitamins, specifically iron and calcium supplements, should be taken four hours after the Synthroid.
MaggieAnn: Are there certain foods you should avoid if you have thyroid conditions? How long should you wait before eating or drinking anything after you take your medication in the morning?
Joyce_Shin,MD: What type of thyroid condition are you referring to? You should wait an hour before food/coffee. You should also take your other medications one hour after levothyroxine. If you take vitamins/minerals, wait four hours afterward.
Kay123: I had radioactive iodine and am now on Armour Thyroid, I take 90 mg in the morning then a half at night. Can thyroid medications cause restless sleep and dreaming?
Divya_Yogi-Morren,_MD_: Armour Thyroid also contains T3 that can cause you to have restless sleep. I usually advise patients who are on any form of T3 to take the last dose four to six hours before bedtime if they are having difficulty falling asleep or restless sleep. The disruption of the sleep cycle may be causing you to have lighter sleep, and you may be remembering the dreams.
Xomue: Directions for taking thyroid medicine advise against taking calcium supplements and high-fiber foods for four hours after taking the medicine. I wait about two hours. Is that okay? Four hours seems like erring on the side of caution rather than realistic.
Joyce_Shin,MD: Ideally, you should wait four hours. The problem is that if you take it too close to the thyroid hormone, you won't absorb as much.
PMORA: I am taking a levothyroxine 75 mcg tablet each day. Are there any indications in my body that this medication is helping me?
Joyce_Shin,MD: Have you been diagnosed with hypothyroidism? If you have, then you should take thyroid hormone medication. If you are on an appropriate dosage, then you shouldn't feel any different than someone who does not have hypothyroidism.
BettyP: I take Nature-thyroid 1.5 grains. My Free T4 is 0.6 (0.7-1.8), Free T3 is 2.6 (1.8-4.6), TSH is 2.4. My question is: why would my Free T4 be so low? The blood draw before it was 0.7. I think I need an increase in my medications. Last year, I lost 60 pounds when my Frees were in better range. I am now gaining weight again with no change in diet or exercise. I eat 1400 calories/day. I do not eat sugar, fried foods, soy, junk food, processed foods, milk or alcohol. I limit carbs and gluten. I work out five days a week at Curves and ride my bike everyday (weather permitting). Thank you.
Divya_Yogi-Morren,_MD_: It is the T3 that is active in the peripheral tissues, so a low T4 in this situation is unlikely to be causing the weight gain. If you increase your dose, you have to be careful about over-treating and suppressing the TSH.
punkin: If levothyroxine is used to treat hypothyroidism, how do you determine the dosage? If dosages are increased, how often and by how many mcg? How long before each change takes effect? Does hypothyroidism cause very inconsistent blood sugar levels?
Joyce_Shin,MD: Dosage is based on by your body weight, but it sometimes needs to be adjusted. The amount that is increased is based on the TSH level. Every time the dosage is changed, you should have thyroid function tests performed again in six to eight weeks.
Xomue: Please discuss natural thyroid medication versus synthetic (chemically-produced) medication such as Synthroid. Is it all an individual response? My doctor suggest natural because he says the dosage is unreliable (and has to be produced at a compounding pharmacy). What is your take on this?
Divya_Yogi-Morren,_MD_: When we prescribe medication such as Synthroid (T4) or Cytomel (T3), we know what the dose is in that medication. We are less sure of the doses in natural or compounded medications, and it varies from batch to batch, which makes adjusting the dose of the medication a challenge.
mmoy: Is generic Synthroid still not recommended?
Joyce_Shin,MD: Absolutely not. I prescribe generic dosages to all my patients, even those with thyroid cancer. The important thing is to keep taking it consistently.
bonnie4: I have been on Synthroid 112 mcg for several years now. I read somewhere that Synthroid can cause hearing loss, and I do have hearing loss to the point of needing hearing aids at age 60. Could the Synthroid be affecting my hearing, and are there any substitutes for Synthroid?
Divya_Yogi-Morren,_MD_: I have not come across information about Synthroid causing hearing loss. I do not think that we have studies showing this to be true. There are other forms of thyroid medication available, but they will all contain T4 and/or T3.
Time for Testing
Bella99: I am curious about the Veracyte® genetic testing and how accurate it is to determine if a growth is non-cancerous when you have had biopsies that came back as indeterminate or suspicious. Is it a good idea to watch the growth rather than just to have a thyroidectomy performed if you are not experiencing any other problems? The growth is about 2.5 cm big.
Joyce_Shin,MD: The Veracyte testing has a high negative predictive value, meaning that if they confirm it's benign, it's most likely benign. However, it doesn't have great positive predictive value, meaning if they say it is cancer, it's not always cancer.
Kay123: I had radioactive iodine done in October, do I have any thyroid left or is it all gone?
Joyce_Shin,MD: It's hard to say if the RAI killed your entire thyroid. The only way to find out is to have a neck ultrasound.
Jack_in_Florida: I had a total thyroidectomy 20 years ago and have been on supplements ever since. What level of hormone replacement do you recommend to avoid Afib issues? Is a TSH of 2.0 minimum acceptable?
Joyce_Shin,MD: You should try to be within the normal range, which is different in every laboratory. If you have underlying heart conditions, then you should stay away from the lower part of the range (lower the number --> hyperthyroid).
hunter16: I had a thyroid biopsy done for a nodule that was diagnosed as a goiter. Is there any further follow-up recommended?
Joyce_Shin,MD: A goiter can have a few meanings. If you have a large thyroid, we call that a goiter. If you have a normal-sized thyroid gland with nodules, we call that a multi-nodular goiter. If you've had a biopsy of a nodule that was benign, that needs annual follow up with ultrasounds to monitor for growth. If it continues to grow, it needs another biopsy.
mmoy: What does "follicular lesion of 2.8 cm undetermined significance" and "nucleoli are indistinct" with fine needle biopsy mean? I have a follow-up ultrasound in three months, and elective thyroidectomy is recommended.
Joyce_Shin,MD: For this result, the recommendation is to repeat the biopsy in three months. If the second biopsy shows a benign result, then you can watch it with ultrasounds.
kindness: My TSH levels just dropped to 0.141 (considered low). At the same time, my cholesterol and triglyceride levels have dropped to almost normal levels, and my HDL and LDL levels have improved. I know these are intertwined with my hyperthyroidism and the Synthroid I have been prescribed for almost 30 years. I am wondering if I should have a complete thyroid panel including T-3, T-4 etc. It has been years since this was completed. My Synthroid dosage is 0.175 daily. My doctor just lowered it by maintaining the dosage except for Friday, Saturday and Sunday. One half of that dosage was prescribed on those three days. I will have another check six weeks from December 23, which falls mid February 2015. My question is: Should I have a complete thyroid panel completed? Thank you.
Divya_Yogi-Morren,_MD_: You should have your levels checked six weeks after a dosage change. We usually check TSH and sometime free T4, and I would recommend this for you. We do not usually check T3, as it is produced by your body in the tissues from the T4, unless you have specific symptoms such as extreme fatigue despite normal thyroid levels
writer53: Following the successful removal of the entire enlarged thyroid gland, a marble-sized cancerous tumor was discovered during the pathology after surgery. Otherwise, the thyroid showed clear margins. What is your recommended treatment in this case? What are the risks and benefits of radioactive iodine treatment?
Joyce_Shin,MD: I would need more information of the pathology to answer this. Even if it's a small tumor, if it has aggressive histology, it will require radioactive iodine treatment (RAI). There are only a few risks of RAI, most common being blockage of the salivary ducts.
YJ: I have been diagnosed with a nodule on my left thyroid gland. I had a biopsy; it came out well, and my doctor at the time prescribed levothyroxine 25 mcg because, according to her, I had hypothyroidism. I had to change doctors and this new one says I don't need any pills for my condition. Is this right?
Joyce_Shin,MD: You don't need levothyroxine for a nodule, only if you have biochemical evidence of hypothyroidism.
Efahn: My thyroid biopsy came back with some atypical results (not cancer specifically), which stated another biopsy should be done. I made an appointment with an endocrinologist, and he said to get it re-biopsied but advised long-term that I should probably just save myself the repeat biopsies and have it removed. I have a family history of thyroid issues. My sister had cancer and had hers removed. My aunt has biopsies on nodules done. Is that something that is typically said now, like a preventive removal given a family history, much like what some are doing with breast cancer? I am planning to go for a second opinion before any decisions are made but wanted to ask that question.
Joyce_Shin,MD: Your biopsy result is atypia of undetermined significance, which means that there is approximately a 5 percent to 15 percent chance of malignancy. The recommendation is to repeat the biopsy in three months. If the second biopsy is benign, then conservative follow up is appropriate. There is no prophylactic removal of the thyroid gland unless there is a very STRONG family history.
Kay123: Have you ever heard of someone who had RAI, then goes hypo and still keeps losing weight?
Joyce_Shin,MD: I'm assuming someone had RAI for HYPERthyroidism. After RAI, the thyroid function either returns to normal or the patient becomes HYPOthyroid because the thyroid is completely destroyed. These people will need thyroid hormone replacement. If they are on an inappropriate dosage (too high), then they may lose an inappropriate amount of weight.
thyfriend: I started levothyroxine replacement therapy (LRT), which caused my TSH = 10.740 and my anti-thyroid peroxidase antibody 997, even though my T4 and T3 were in normal range. The Endocrine Society is saying if T4 and T3 are in normal range, RX is only indicated if the TSH is 10 +:
- Does that mean the goal is to get TSH to normal or only below 10 as long as T4 and T3 are normal?
- My doctor increased my LRT dose to get my TSH exactly within normal range (TSH now 5.530). But the last increase started EXTREME insomnia, fast weight loss and increased exercise heart rate (+10 BPM) while at same exercise-intensity level. Are these possible effects from the tiny increase from alternating 50/75 mcg per day to 75 mcg/day?
- Even if T4 and T3 are still in the normal range, could the above mean over-medicating, risking hyperthyroidism?
- I had a silent heart attack at unknown time before thyroid RX. Now on medication management. Am I correct that given heart risks, it is better to slightly "under-treat" TSH with LRT to avoid becoming HYPER and risk faster heart rate/rhythm problems?
Divya_Yogi-Morren,_MD_: We do treat patients with subclinical hyperthyroidism (high TSH, normal thyroid hormones) who have positive antibodies, as there is an increased chance of developing full blown hypothyroidism. In your case, with your heart history, I would be cautious in giving too much Synthroid that could put extra strain on the heart. The symptoms you are experiencing could be because of excess thyroid hormone.
Kate.stu7: Hello. I was diagnosed with Hashimoto’s this past summer and have been taking levothyroxine in the morning. I have a few questions. Thanks in advance.
- Have you found that it's best to take the medication in the morning, or could I try taking it before bedtime? I know I shouldn't eat or drink anything but water, but if I eat dinner at 6 p.m., could I take it at 10ish?
- What are your thoughts on adding T3 medication?
- Is it common to see that a Hashimoto’s patient has other autoimmune diseases or is more "susceptible" to them?
- One of my most bothersome symptoms is chest tightness/trouble getting a good full breath. I've read that others feel this, but have you had much experience with your patients having this symptom?
- I had a thyroid ultrasound done and they found a nodule, as well as the tissue to be consistent with Hashimoto’s. Do you find that patients start out like this and eventually have more nodules leading to surgery?
- Do you suggest going gluten-free?
Divya_Yogi-Morren,_MD_: 1. The most important thing is to take it on an empty stomach, as the Synthroid is best absorbed this way. An empty stomach means you have not eaten for three hours prior and then do not eat for the next half hour. 2. Most patients do not need T3 if their thyroid levels are normal. It may help you feel more energetic during the day. However, you have to be careful not to over-treat with thyroid hormone, as excess thyroid hormone can cause irregular heart rhythms and accelerate bone loss. 3. Once you have one autoimmune disease, there is a higher chance of developing another.4. Some of my patients do have this symptom. It is not one of the more prominent symptoms and tends to improve as they get treated and get physically active. 5. It is not certain. Nodules have to be monitored for increased size and other characteristics. 6. Gluten-free diet may be helpful if you have celiac disease also.
CVSTREETER: Is there anything new developing in treating hypothyroidism?
Divya_Yogi-Morren,_MD_: I do not know of any new medications to treat hypothyroidism. The medications that we have right now are trying to correct the main problem, which is a lack of thyroid hormone, so they all contain thyroid hormone replacement.
Bella99: If you are on Medicare and have AARP United Health Care Plan F supplemental can you refer yourself to Cleveland Clinic?
Joyce_Shin,MD: This depends on your insurance.
Moderator: That is all the time we have today for questions. Thank you everyone for participating today; and thank you, Divya Yogi-Morren, MD and Joyce Shin, MD, for your insightful answers to our questions about thyroid conditions and treatment options.
Divya_Yogi-Morren,_MD_: Thank you for all your wonderful questions! If you would like to contact the Cleveland Clinic Thyroid Center, please call 216.444.6568.
Joyce_Shin,MD: Thank you everyone for being part of the webchat. We hope we were helpful to some of you. If you continue to have issues, please make an appointment for a more comprehensive discussion.
Moderator: On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for endocrine conditions, visit us online at http://my.clevelandclinic.org/services/endocrinology-metabolism.
To make an appointment with Dr. Yogi-Morren or Dr. Shin, please call 216.444.6568 or call toll-free at 800.223.2273, ext. 46568. You can also visit us online at http://my.clevelandclinic.org/services/endocrinology-metabolism.
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