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Forum Name: Endocrinology Topics

Question: Is there an endo. who will listen? tired of being a lab slip


 hollyhock - Sat Feb 25, 2006 10:56 pm

Hello,

I have been on the thyroid roller coaster for 35 years or more but the last year or more my thyroid is hard to control. Had an ultrasound and I basically have a pea size non functioning gland. They always say I am in range, yet I still have hypo symptoms. I have been taking kelp and it seems to help somewhat. Anyone have any ideas?

Hollyhock
 Dr. Shank - Sat Mar 11, 2006 9:42 pm

Dear hollyhock:

I find it very difficult to believe that anyone woudl be "in the range" with a pea-sized thyroid gland, unless she were taking thyroid hormones or had abnormal production of thyroid hormones in other parts of the body. The size alone of your thyroid gland would seem to exclude production of thyroid hormones by a thyroid cancer that had spread to other parts of the body. Stuma ovarii is an extradinarily rare tumor of the ovaries that can produce thyroid hromones; it is so rare that few endocrine textbooks even mention it as a source of thyroid hormone production.

Because of the way the thryoid gland forms, it can be located anywhere from the chin to the bump on your breastbone (the sternal angle). The technician who did your ultrasound probably did not even know that. A technicium or radioactive iodine scan would answer the question quickly and definitively about how much thyroid tissue you have, and where you have it.

Kelp, of course, contains iodine, which the thyroid gland uses to produce thyroid hormnes, but I do not believe that a pea-sized thyroid is capable of producing enough thyroid hormones, no matter how active it is!

You say that your thyroid gland is actually inactive. How was that determined? Clearly, it cannot be very active, if it is a small as they tell you that it is. In that case, it cannot be changing its activity very much over time, so regulating your thyroid hormone levels should be a cinch.

Since you say that your thyroid gland has been hard to control, I assume that you are taking thyroid hormone replacement therapy. Unfortunately, non endocrinologists usually know little about the thyroid but that thyroid stimulating hormone (TSH) is "the single best test of thyroid function." Unfortunately, "the single best test" is a lousey single test. A low normal level could mean that your thyroid hormone levels were normal or that your pituitary gland was not producing TSH (among a number of other possibilities that are not relevant to your case). Without stimulation, the thyroid gland would shrivel up, and you would be "in range" for TSH, but still hypothyroid. I have even seen cases where neither the pituitary nor the thyroid gland was working properly.

A good endocrinologist would never rely just on the TSH, as I suspect that you physicians have done, nor would he rely just on the laboratory results. He would also do a physical examination to evaluate the effects of thyroid hormones in your body.

I am curious to know what you symptoms of hypothyroidism are.
I use a standardized set of questions fort thyroid-related symptoms. Dr. Bricker, an endocrinologist at Michigan State University in K'azoo, does not agree with me that symptoms are very helpful., because he says that they are not very specific for thyroid disease. That's o.k., he is still a great guy (Actually, we agree that symptoms are not very specific, but not about how helpful they are.).

Go see Dr. Bricker and tell him that Dr. Shank from Lima, Ohio said he could get you off of that roller coster.

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