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Suggest Dosage For Hypothyroidism

Posted on Tue, 30 Sep 2014

Question: I have had hypothyroidism diagnosed about 14 years ago. I have taken Synthroid since. The dosage has varied. Sometimes my endocrinologist goes up and sometimes he goes down. I am considering getting a second opinion from another endocrinologist. I have a few questions. I asked my doc if I had an increased risk of thyroid cancer. He said not really and that I hardly have any thyroid left. I don't really know what that means, but I have only had 2 ultrasounds on my thyroid and they were many many years ago by an ENT doctor. They always came back fine. I am a 40 year old female and worry that my doctor should be doing ultrasounds on my thyroid. Is this something he should be doing? Also, He adjusts my medication based on my TSH level. He rarely does an entire thyroid panel, maybe once every year or two and its always been ok. He recently did a thyroid antibody test which came back at 50. He said it means that I have Hashimotos and doesn't change anything. Does all of this sound right or should I seek another opinion? My biggest fear is that I recently read that there is a big increase risk in thyroid cancer with hashimotos and my doctor isn't scanning my thyroid. Does his treatment seem standard?

Answered by Dr. Binu Parameswaran Pillai (2 hours later)

Brief Answer:
He is doing right thing.

Detailed Answer:
Good day,
Noted your concern
To be XXXXXXX I feel your endocrinologist is doing right thing. Thyroid ultrasound is not warranted routinely unless there is a palpable swelling in neck.

TSH is the best tool and based on that we adjust medicine. However, since it is cheaper in my part of world, I often do a complete thyroid function test ( free T4 and TSH). But most authorities recommend dose adjustment based on TSH alone.

If your doctor is examining the neck on a routine basis and if he is not feeling an enlarged gland, there is no true indication for an ultrasound. But to alleviate your anxiety, an ultrasound may be done ( it is not expensive and it is non invasive).

Please feel free to ask further if you have more questions

Regards XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (1 hour later)

Thank you! I looked at my last ultrasound report from 2011 which gave the measurements of my thyroid. It said No discrete cystic or solid mass is seen within either lobe other thyroid gland. However, thyroid echo texture is coarsened and heterogeneous bilaterally with linear hyper echoic fibrotic streaks. Color flow within each lobe is with one normal limits. Ultrasound compatible with clinical history of Hashimoto's thyroiditis. Would you say that no further ultrasound is needed if there is no palpable mass felt?

Answered by Dr. Binu Parameswaran Pillai (25 minutes later)

Brief Answer:
Clinical exaination important

Detailed Answer:
Your ultrasound report is quite typical of thyroiditis. Unless there is a nodule, no need to repeat the scan. You didnt have any during the first scan. But your endocrinologist should examine the neck once a while.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (4 minutes later)

I have blood work and a check up every 6 months or more if needed. Would you say that is acceptable?
During my checkups every 6 months my doctor examines my neck.

Answered by Dr. Binu Parameswaran Pillai (2 minutes later)

Brief Answer:
Good follow up

Detailed Answer:
once the TSH is stable, the recommended freqency of re testing is once in 6 months. Your follow up seems to be good. But if you have symptoms like weight gain or constpation etc, you may need blood works again then

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar