Online Health Chat with Endocrine Surgeon Judy Jin, MD, and Endocrinologist Ula Abed Alwahab, MD

Thursday, January 21, 2016


The thyroid is considered an endocrine gland that is responsible for producing hormones that control many functions, including controlling your body’s metabolism (the energy produced and used by your body) and regulating the body’s sensitivity to hormones. It is a butterfly-shaped organ that weighs about an ounce and is located at the base of your neck. Most people never give their thyroid a thought until something goes wrong. Yet 20 million Americans have some type of thyroid disorder – hyperthyroidism, hypothyroidism, thyroid nodules and goiters, or thyroid cancer. Undiagnosed and untreated thyroid disorders can have serious health repercussions. Diagnosis and treatment help manage a thyroid problem and control related symptoms.

Cleveland Clinic’s Thyroid Center has designed services that encompass all the specialists required for a thorough evaluation of a thyroid disorder. This includes endocrine surgeons, endocrinologists and a complete nursing staff – working together under one roof as a team to diagnose and treat all types of thyroid disorders, from the routine to the complex. Patients benefit from the most advanced technologies and personalized treatment plans to help ensure the best possible outcomes. Cleveland Clinic endocrine services are continuously ranked in the Top 10 nationwide by U.S. News & World Report and are No.1 in Ohio.

Today, Cleveland Clinic endocrine surgeon Dr. Judy Jin and endocrinologist Dr. Ula Abed Alwahab answer questions concerning the full spectrum of thyroid disorders and the latest medical and surgical treatment options available.

About the Speakers

Judy Jin, MD, is an endocrine surgeon at Cleveland Clinic and a staff physician in the Endocrinology & Metabolism Institute. She graduated from University of Cincinnati College of Medicine, completed a residency in general surgery at University Hospital in Cleveland and went on to complete her fellowship in endocrine surgery at Cleveland Clinic. Dr. Jin’s specialty interests include surgery for adrenal disorders, pancreatic endocrine tumors, and thyroid and parathyroid cancers.

Ula Abed Alwahab, MD, is a staff physician in the Endocrinology & Metabolism Institute and is board certified in Endocrinology, Diabetes & Metabolism. She received her medical degree from Damascus University, completed her internal medicine residency at Emory University Hospital and went on to complete her fellowship in endocrinology at Cleveland Clinic.

Let’s Chat About Thyroid Disorders

Welcome to our chat, Could You Have a Thyroid Disorder, with Cleveland Clinic endocrine surgeon Judy Jin, MD, and endocrinologist Ula Abed Alwahab MD. Doctors, thank you for taking the time to be with us and share your expertise and answer questions concerning the full spectrum of thyroid disorders and the latest medical and surgical treatment options available.

Let's go to the questions:

Related Issues

adourian: I have frequent paroxysmal a-fib and have periodically gone to the emergency room when my heart rate was abnormally high. I am now on heart rate control medication. When given blood tests in the hospital, my potassium was in the 3.5 to 3.9 range. Blood tests when I am in sinus rhythm over the past 20 years have consistently recorded a potassium level of 5.0 or a little above. While not officially hypokalemic, I wonder if the significant drop could be the trigger and if it could be caused by a thyroid or adrenal gland problem. My TSH has always been in the normal range, and my blood pressure is consistently 120/70, except when I am in a-fib and then it is around 135/80. What endocrine tests can I pursue next to either confirm or discard potassium as a trigger, and should I pursue them now or ask for them during my next a-fib episode?

Ula_Abed_Alwahab,_MD_: Thyroid problems do not usually cause any potassium problems, so as long as your thyroid levels are OK, I do not think your a-fib is caused by a thyroid issue. A potassium level of 5 or more is high and needs to be investigated further, checking for kidney disease. If your blood pressure is normal, not too high or too low, then the likelihood of having an endocrine issue related to that is low.

SabineIG: Is there a prevalence of thyroid issues that are connected to connective tissue disorders or autoimmune illnesses?

Ula_Abed_Alwahab,_MD_: Yes. Hashimoto's thyroid disease is related to other auto immune diseases such as Sjogren's disease and sometimes adrenal issues and diabetes.

wammai1037: I had been diagnosed with an under-active thyroid several years ago and have been taking one 75 MCG tablet daily. I recently was diagnosed with atrial fibrillation and underwent a catheter ablation. I have been restored to normal heart rhythm and take one 160 MG tablet of valsartan, 25 MG of metoprolol tartrate and one baby aspirin daily. I understand there may be some relation between my thyroid and a-fib conditions. What else would you recommend I do or monitor for these two conditions?

Ula_Abed_Alwahab,_MD_: I would recommend that you follow your thyroid levels closely and do not let the TSH to be suppressed but keep it in the normal range.

sdebmisra: I have CKD stage 4 and CAD with minor thyroid and parathyroid disorder but am not on dialysis. Is there any connection between hypothyroidism and secondary hyperparathyroidism. My PTH level was around 118-150 three to four years ago but now it is 35. I am been prescribed Sensipar (cinacalcet) 30 mg, which has some side effects and is normally not given to CKD patients not on dialysis. Shall I request my doctor to reduce or discontinue the medicine?

Ula_Abed_Alwahab,_MD_: There is no connection between hypothyroid and secondary hyperparathyroid. I think you were given Sensipar because your calcium levels were high because of the secondary hyperparathyroidism. It is hard to tell if you still need the Sensipar or not. It depends on your calcium levels.

Thyroid Hormone Levels

Meg_N_Ohio: My recent blood work showed a low-normal thyroid, but the details showed my T4 is extremely low. Can you explain what the T4 does, and could it be connected to adrenal fatigue? Thank you.

Judy_Jin,_MD_: Free T4 is one form of the active thyroid hormone in your body. If your free T4 level is low, then it might indicate you are hypothyroid, requiring thyroid medication. Thyroid and adrenal glands are two separate organs without any direct link.

Nanat426: Hello. My TSH went from 1.4 to 6.4, with the norm range .4-4.1, in six months. My free T4 and thyroperoxidase are normal. I have sarcoidosis and my rheumatologist said to have my primary care physician monitor and treat me. Her thinking was my thyroid may be causing a lot of my tendon issues along with other things. My PCP says it's not high enough to treat. (He's ready to retire, and we don't have much confidence in him. I usually see his wife). Do you agree with my PCP or could that be causing symptoms? Thanks so much.

Ula_Abed_Alwahab,_MD_: I would repeat the TSH again and see where it is at now because TSH does fluctuate when we are sick. If it is still in the 5 to 6 range, I would recommend treating with thyroid hormone replacement.

BrandiM: I have a TSH level of 4.0 and the doctor says that is good. However, I am still feeling sluggish and gaining weight. So I feel as if something isn't right. Is that level good?

Ula_Abed_Alwahab,_MD_: It depends on your previous levels of thyroid hormones, if you have any previous levels for comparison, and if they can also check your FT4 to complete the panel and see if FT4 is borderline low. Otherwise, I would look for other causes of feeling tired such as a vitamin deficiency, an iron deficiency or sleep issues.

jeeva: I am having normal T3 and T4 results, but my TSH is 67 according to my lab test. Please explain my condition and what would be your suggestions.

Ula_Abed_Alwahab,_MD_: This is interesting. Are you on thyroid replacement therapy? Are they checking your Free T3 and Free T4 or total levels? I think you need to be seen by an endocrinologist for sure.

gabrielle: I had a total thyroidectomy six months ago and struggle with fatigue. My TSH was 0.02 and my Free T4 was 2.0. Could my TSH be too low?

Ula_Abed_Alwahab,_MD_: Yes, your TSH is low and your dose needs to be adjusted unless you had surgery for thyroid cancer and your doctor is intentionally suppressing your TSH.

A Matter of Medications

Yellow10: If you were previously taking levothyroxine and switched to Armour Thyroid, how long does it take to notice changes?

Ula_Abed_Alwahab,_MD_: It usually takes six to eight weeks for changes to show up on the labs so your doctor will be able to make changes to the dose, if needed.

Bikash: Hi. My mother, aged 60, has the following report – T3: 1.25, T4: 14.3, TSH : 0.116.  Currently, she is taking thyroxin 100mcg tablet. Please advise if she should decrease the dosage?

Ula_Abed_Alwahab,_MD_: Yes. For a 60-year-old woman, it would be better to have a slightly higher TSH. I would suggest going down to 88 mcg daily on her thyroxin dose.

Gail Ann: I have a thyroid disorder, hypothyroidism. I've been taking desiccated thyroid medicine for this condition. What are your views on desiccated thyroid medicine? Thank you for answering my question.

Ula_Abed_Alwahab,_MD_: Desiccated thyroid hormone is as good as synthetic hormone; however, some patients feel better on the desiccated (natural) option. I would keep you on it if it is helping.

anniep: Can you be specific about what to use as food for medicine and supplements? My tests bounce back and forth but always indicate hypo/Hashimoto's. I am only taking Synthroid. What are advantages to taking Armour Thyroid, and is there a document or URL or something I can take to my doctor? I am constantly in a fog, rundown and get sick easily, as well as in pain. Is lipedema related to thyroid or is there combination treatment to help fight both? Thank you so much. Is there going to be a recording of this call so we can listen at a later date if we can't make it on time or can we contact you afterward if you have something specific to help with?

Ula_Abed_Alwahab,_MD_: There are no specific approved food or supplements to help with Hashimoto's other that thyroid hormone. Some patients do feel better on Armour Thyroid compared to Synthroid. You can ask your doctor to try to switch you, but there is no clear-cut evidence that one is better than the other. Yes, hypothyroidism can cause high cholesterol levels. You can contact Cleveland Clinic scheduling and see one of our staff at the Endocrinology Department if you would like additional assistance.

sdebmisra: I have chronic kidney disease stage 4 with a creatinine level of 2.4, eGFR of 26 and Bun of 40-60, but am not on dialysis yet. I also suffer from tiredness, stable angina, vertigo, anemia and dizziness. I have also been taking levothyroxine tablets 50 mcg/day at bedtime for more than 10 years. My TSH was around 6 to 8 during 2006-2008, but is now at a level between 2 to 4. I am already taking several medicines for my CKD and CAD. It is possible to discontinue levothyroxine?

Ula_Abed_Alwahab,_MD_: If your TSH is at a normal range now, between 2-4, on the levothyroxine, I would continue that.

Gail Ann: Would you please address the time frame between taking thyroid medication and eating and also ingesting calcium products? Thank you for answering my question.

Ula_Abed_Alwahab,_MD_: Thyroid hormone should be administered on an empty stomach, 30 minutes before eating, drinking or taking any other pill including the calcium pills. The best absorption for the thyroid hormone is when taking it on empty stomach.

Suffering the Symptoms

Raphael: I have postsurgical hypothyroidism following a total thyroidectomy two years ago, after which I quickly gained 50 pounds. I finally stopped gaining weight, but for the past two years, I find it almost impossible to lose it despite my best efforts. Based on TSH, T3 and T4 levels, levothyroxine has been progressively reduced over the two years from 175mcg to currently 75mcg. I am also taking 5mcg of liothyronine, which I was taking twice a day but am now taking only once a day. Other symptoms following surgery have improved – including regrowth of hair that had fallen out. However, I am still struggling with the weight and feel totally frustrated. What can I do?

Ula_Abed_Alwahab,_MD_: If your thyroid levels are normal now, then I wouldn't think the weight issue is a thyroid issue. I would suggest that you see a weight management specialist to help with your weight.

Homer: My wife has had Addison's disease for more than 10 years. She takes 88mg of Synthroid daily, 20mg hydrocortisone daily and 1mg fludrocortisone daily, and is being treated for chronic hives that she has had for about two years. She takes 10mg Zyrtec twice daily, 10mg Claritin daily, two 150mg Zantac tablets daily and 5mg of prednisone, which she takes at bedtime. Her doctors do not know why she has hives, which cause her major problems with severe itching, mostly upon waking in the morning. They cannot seem to cure them. Do people with Addison's typically develop urticaria? What treatment could you recommend that would help her. On her own, she started taking 5mg hydrocortisone and 5mg of prednisone around 10 p.m. at bedtime, which seems to help in the morning because she has no itching or hives. Why is this working for her? Her blood work is completely good. Is there anything you would do differently? Thank you for any advice you may give.

Ula_Abed_Alwahab,_MD_: Addison's does not usually cause hives. I would recommend that you see a dermatologist because Addison's disease can occur with other autoimmune diseases.

Antoinette: I have hypothyroidism. After 25 years of feeling fine, my doctor gave me Tapazole EQ 5MG three times per day. My question is: I have stopped the medication because I have lost more than half of my long, thick hair and lost 23 pounds in two and a half months. After they cut down the medication to one, my hair was still falling out very badly and then I wanted to eat every food in sight, so I quit taking any medication except for my calcium plus Vitamin D. I do not see any difference in my health. I am upset. I did not look my age before. Now, I look like a 90-year-old because I have lost all the water out of my skin because I was sweating. (I mean rain-wet clothes from just working in the yard, and it takes a lot of sweat to wet blue jeans and a sweat shirt.) I am explaining because many people do not understand when I say a loss of hair. They think a couple of broken hairs. I'm talking strands, however. I saved a zipper bag full of long hair. (I really lost a lot of confidence on the medication and became very emotional.) I was feeling fine, working a job every day as a cook. I went from just normal to "this." Answer please.

Ula_Abed_Alwahab,_MD_: I am sorry to hear about your situation. It is hard for me to decide based on your symptoms only. I would suggest that you see an endocrinologist to determine where you are at now and to put you on the right treatment.

LeahL: I was diagnosed with Hashimoto's disease about eight years ago. I take generic Synthroid, 50 mcg daily. I have gained weight since diagnosis and cannot lose it no matter how well I control my food intake and modify my diet to be healthy. I exercise regularly. I have other medical conditions that can explain my weight gain or inability to lose weight. What else can I do and what other tests can be done? I get the full thyroid panel about every six months.

Ula_Abed_Alwahab,_MD_: If your thyroid levels are OK, then I do not think the thyroid is the cause of your weight gain. I would look at your current medications and other health issues, and if none cause the weight gain, I would suggest seeing a weight management specialist.

Luguna : I have been diagnosed with an enlarged heterogeneous thyroid gland without discrete nodule with probable large lymph node anterior to right lower lobe and subcutaneous lipoma on the right. My T3 and T4 readings are within range. I also am over weight. It is very difficult to lose. What does this diagnosis mean and does this cause weight gain? I am also a diabetic and am on insulin.

Ula_Abed_Alwahab,_MD_: If there are no nodules, then you just have big thyroid gland, and that does not cause weight gain and does not need to be further evaluated or treated. If your TSH and FT4 are normal, I would not worry about the thyroid.

BlessedMother: Unless she has a large nodule..she does what do you suggest we do?

Ula_Abed_Alwahab,_MD_: Then she needs to be evaluated for the nodule. If it is large, then it needs to be biopsied (take a tissue sample from it).

rebma02: I am constantly tired and have no energy no matter what I do. My skin is so dry and itchy year round to the point that it hurts. My hands and feet are always freezing. I have to wear gloves to get anything out of the freezer because my hands hurt so bad. My hair falls out in clumps in the shower every day. I cannot lose weight no matter what I do. I suffer from infertility/PCOS. My hormones are all over the place it seems like. Both my mother and sister suffer from thyroid problems. My last thyroid test showed that my TSH was 2.9. Is this normal for the symptoms that I've been having for years? I've read that people with TSH levels on the lower end of the normal range sometimes can benefit from thyroid treatment. Is this true?

Ula_Abed_Alwahab,_MD_: A TSH of 2.9 is within normal range, and I do not think it is related to your symptoms. However, I think many symptoms you are having might be related to PCOS, and that needs to be treated by an endocrinologist.

Homer: In my previous question I forgot to submit that my wife has a thyroid problem along with her Addison's disease. Would the combination of the two cause her urticaria? Thank you.

Ula_Abed_Alwahab,_MD_: As I said, it could be. This can be caused by an autoimmune disease. I would still recommend seeing a dermatologist for her skin itching.

Talking About Treatments

Mur: Hello. I have a multi-nodular thyroid and have been recently referred for a thyroidectomy. We live in Rapid City, SD, and the closest large medical facility with knowledgeable surgeons in this regard is Mayo Clinic. I consulted with a local Rapid City general surgeon who has a very good reputation. He said he does approximately 40 thyroid surgeries per year. I'm not sure where the best place is to have this surgery, here in Rapid City or at Mayo Clinic. I feel comfortable going to Mayo Clinic because, of course, they are highly specialized in thyroidectomies. I very much feel comfortable with our local surgeon here in Rapid City. Are you at liberty to give me your input – local surgeon vs. Mayo Clinic? Thank you.

Judy_Jin,_MD_: Studies have shown that surgeons from high volume centers do provide better surgical outcomes. However, with that said, you have to be comfortable with whomever you chose to do your procedure.

gabrielle: I had a thyroidectomy and am very tired every day. Is this common? Is there anything I can do?

Judy_Jin,_MD_: It's normal to feel fatigued right after surgery, but you should feel better as time goes on. Another possible cause for fatigue is if your thyroid level is not in the correct range. Make sure you are checking your thyroid levels regularly, especially if you are on thyroid medication.

gabrielle: I had a thyroid cancer and a total thyroidectomy. I have been experiencing pain on and off around my ears and neck like before my surgery. Also, I have had pains under my arm on and off and a swollen lymph node. Could this be related to the cancer or surgery?

Judy_Jin,_MD_: It's not unusual to have local discomfort shortly after surgery; however, most of the symptoms resolve by four to six weeks. If you are having these persistent symptoms beyond this time range, it would be reasonable to get them checked out. It is difficult to say if they are related to your thyroid cancer and surgery. Pain under your arm is not likely due to a thyroid issue. A swollen lymph node will depend on the location.

BlessedMother: My daughter's last thyroid test showed it lower than normal but not low enough to warrant taking medicine for the rest of her life. Is there something she could take to stimulate the thyroid to produce more hormone? Also, she now has a painful neck and shoulder problem. Could that be tied to the low thyroid production?

Ula_Abed_Alwahab,_MD_: If she is still in the normal range, then there is no need for thyroid treatment. Usually, thyroid disease does not cause pain in the neck unless she has a large nodule. Usually, the thyroid is not related to shoulder pain.

MID: The left lobe of my thyroid has enlarged in size and hyper-vasculature. Echogenicity was heterogeneous. There was a complex mass measured 4*4.5cm with multiple cystic masses in it (18*11mm, 20*13mm, 13*9mm, 12*4mm), so the doctors told me to do fine needle aspiration for more investigation to find out if the nodules are benign or cancerous. Unfortunately, here in Afghanistan, I can't do that. I want to know the need for total thyroidectomy and if it is urgent to do surgery or not? I should mention that I do not have any more data or test results. Thank you very much.

Judy_Jin,_MD_: The nodule needs to be biopsied due to the size. The determination for surgery will depend on the biopsy result and whether you have symptoms from the thyroid nodule or not.

Thyroid Disorders

gabrielle: Is it possible for thyroid cancer to spread without any visible signs that it has left the nodules or thyroid?

Ula_Abed_Alwahab,_MD_: Yes, that can be possible. Thyroid cancer can spread by the blood stream or by the lymphatic system depending on the type of cancer.

winonalisa: Good afternoon. I recently read that the Epstein Barr virus is the cause of thyroid problems. Is there any truth to this claim? Also, which, if any, herbs help a hypothyroid or Hashimoto's? Thank you.

Ula_Abed_Alwahab,_MD_: Not really. Hashimoto's disease is an autoimmune disease that is not caused by a bacteria or a virus. There are no herbs to help hypothyroidism that are proven by studies. The treatment for hypothyroid is to replace the thyroid hormone.

Nama4: My 44-year-old daughter, who is a runner, experienced symptoms of sudden weight loss, heart palpitations, etc., five months ago. Subsequent blood tests indicated hyperthyroidism, but ultrasounds, dye tests and radioactive tests did not show a problem. When she finally saw a specialist last month, the blood tests showed borderline hypothyroidism. She feels fine now. The doctor told her it was likely a transient problem. Would it likely recur? She is tiny and dropped from 100 pounds to 92 pounds within weeks last August. It was scary.

Ula_Abed_Alwahab,_MD_: It can definitely be transient if it was thyroiditis. Yes, weight loss can happen during that as well as palpitations. If that was diagnosed as thyroiditis, then she will likely recover in six to 12 months. I would recommend that she follow her thyroid levels with an endocrinologist until they are back to normal.

farmer11: Is it possible for someone to have "normal" thyroid blood work (TSH, T3, Free T4) yet still require a small dose of thyroid hormone to be prescribed in order to feel well? I have swung between hyper (Grave's disease) and hypothyroid for eight years. I am now in remission from hypo where I require no medication for my thyroid. I still feel very tired and have other hypo symptoms even though my blood work shows I'm in "normal" levels. I wonder if perhaps I need a small dose? I have not felt the same ever since my Grave's disease diagnosis, and unfortunately it seems as if the majority of doctors/specialists who I have seen seem to treat by the numbers and not by how I am really feeling. Thank you for your input.

Ula_Abed_Alwahab,_MD_: Usually, Grave's disease causes hyper not hypothyroidism, and when we treat Grave's that can cause hypothyroidism that sometimes needs to be treated with thyroid hormone. I would suggest that you see an endocrinologist to evaluate your current levels and compare them to previous ones and see if you need supplements. Also, many times patients have fatigue because of other health problems not necessarily the thyroid.

Determining Diagnosis

cheese: I went through two rounds of lab tests for thyroid and hormone issues. (It was exhausted after round two because there was no "ostensible problem" warranting a next test.) The only abnormality found was a Vitamin B12 deficiency and not any overt thyroid problems, although I have all the classic symptoms of hypothyroidism. What condition(s) does this sound like? What things do I lack and should take supplements for? Also, I am allergic (causing severe skin itchiness and rashes) to condiments, fish, meat that is not chicken breast and milk products. I also get chronic ear infections and my skin itches like crazy whenever I'm about to sweat. I also get really sleepy after dairy products.

Ula_Abed_Alwahab,_MD_: Since your thyroid levels are OK, I wouldn't think it is a thyroid problem. You might have lactose intolerance or another autoimmune disease that is giving you the recurrent ear infections and can also give you chronic fatigue. I would suggest you see an immunology specialist.

chicpea*7: I have severe osteoporosis (T-3.5). I am 67 years old, female, weigh 105 pounds and am just getting off of two years on Forteo. Can a thyroid disease be detected through a lab blood test? What is the name of the test and any necessary details needed. I live in Costa Rica where medical equipment and testing are not up to U.S. standards. What are the most common secondary causes of osteoporosis in order of importance?

Ula_Abed_Alwahab,_MD_: If you would like to check your thyroid levels, I would suggest checking TSH and FT4. The most common risk factors for osteoporosis are: Age, family history of osteoporosis, smoking, low body mass index, late puberty or early menopause and being on steroids for a long time. The most important risk factors are age and family history and smoking.

Kerian: What tests are required to properly diagnose Hashimoto's disease?

Judy_Jin,_MD_: They would be TSH, fT3, fT4, microsomal antibody or TPO.

tabialex: I have large goiters due to Hashimoto's and get an ultrasound yearly to test for cancer. The only finding in the past was a small calcification, and it has not changed. What are the current guidelines for testing (how often to get tested) if no major problems have been detected in previous years? Thank you for your help.

Judy_Jin,_MD_: If you have nodules, then an ultrasound should be done yearly. If it's just non-specific calcification and not a discrete nodule, it might be at the discretion of your physician. It is difficult to say without the images to review.

chicpea*7: With severe osteoporosis, what tests are required to tell if you have a specific thyroid problem?

Judy_Jin,_MD_: Routine thyroid function test include TSH, free T4 and free T3.

Gail Ann: Which thyroid tests do you suggest one has done to have a complete picture of how the thyroid is functioning? Thank you for answering my question.

Ula_Abed_Alwahab,_MD_: TSH and FT4.

sofatax: What other ways can you determine thyroid problems besides a blood test? When not on Synthroid, my level is 7.2. On Synthroid, it is 0.5-0.7, no matter if I'm on 88mg, 100mg, or 125mg, but I was starting to lose weight at 125mg. I have not been referred to any other doctors or specialists. Also, have celiac disease, even though the doctor will not officially put that in the medical records. I have heart issues and Barrett's syndrome, and have had a hysterectomy and gallbladder removal. I supposedly have fibromyalgia, but I think it might be related to the thyroid. What are some options?

Ula_Abed_Alwahab,_MD_: I would follow both TSH and FT4. Sometimes, TSH takes time to change from being low to normal to high, so I would suggest following both levels along with your symptoms.

Kerian: If you have a positive diagnosis of Epstein Barr disease should you request to have a thyroid workup as well, and what tests would be required? Thanks you.

Ula_Abed_Alwahab,_MD_: Not necessarily, but if you have symptoms that you think are related to thyroid disease, then I would check TSH and FT4.

Important Follow-up

Judylucy: I take Synthroid. How often do I need to have my thyroid checked to make sure I am on the right dosage?

Judy_Jin,_MD_: You may need to have your levels checked every six to eight weeks as long as your dose is being adjusted. Once your level is in a good range, you still need to have it monitored every six months to a year.

pan: My wife has been diagnosed with an overactive thyroid with nodules four years ago and was prescribed a pill of T4. Ever since, she takes one pill per day and has not done blood tests. She is an active person with a BMI of 19.2. How dangerous is it to not check her thyroid? Thanks in advance.

Judy_Jin,_MD_: Thyroid levels should be checked regularly once a patient is being treated for thyroid disease. Without the levels, it's hard to know whether the patient is taking too much or too little thyroid medication.

ashbee: My labs came back today. My FT3 and 4 are on the lower end but not out, and my doctor doesn't want to do anything. However, I have all of the symptoms and have for years, plus a prominent pituitary gland. Should I be seeking out another health care professional?

Ula_Abed_Alwahab,_MD_: I would look at those numbers along with your TSH level and your symptoms and decide on the treatment. I would check for any pituitary lesions as well that would warrant further work up.

General Information

Birchrun: Is there a good book on thyroid problems, a book that I can trust?

Ula_Abed_Alwahab,_MD_: Try The Cleveland Clinic Guide to Thyroid Disorders (Cleveland Clinic Guides) Paperback – by Mario Skugor.


That is all the time we have for questions today. Thank you, Dr. Jin and Dr. Abed Alwahab, for taking time to discuss the diagnosis and treatment of thyroid disorders.

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 your health concerns, please visit us online at

Ula_Abed_Alwahab,_MD_: It was nice chatting with you all. I hope I answered all the questions in a detailed and helpful way. Thank you so much. Ula Abed Alwahab MD

Gail Ann: Thank you for sharing your expertise and answering our questions.

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Cleveland Clinic’s endocrinology services are ranked in the Top 10 by U.S. News & World Report and No.1 in Ohio. The Thyroid Center has nationally and internationally recognized expertise in thyroid ultrasound, novel diagnostic markers and genetic evaluations of thyroid cancer patients. It is one of only a few centers nationwide to provide radiofrequency ablation of liver metastases from thyroid cancer and to have robotic surgery expertise.

The high-volume center is the home of the largest thyroid cancer surgical program in Ohio and the five surrounding states, performing more than 500 endocrine surgical procedures every year – many of which are complex and reoperative surgeries.

The center is structured for collaboration among experts from a variety of Cleveland Clinic specialties, including endocrinologists, endocrine surgeons, pathologists, radiologists, genomic medicine experts and oncologists from Taussig Cancer Institute, as well as the physicians and surgeons from other Cleveland Clinic Institutes, when needed.

These experts all work hand-in-hand with your primary care physician to help you receive the most seamless care possible for your condition on an ongoing basis.

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