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Last night I attended a thyroid seminar that was put on by the University Hospital of Little Rock. Although the 3 docs could not figure how to get the A/V equipment working, it was a good program.

Two doctors talked. The first one addressed hypothyroidism and the second one spoke about thyroid surgery. The third was the host.

Here are my notes. I will throw in the disclaimer that I took the best notes as I could but won’t guarantee they are perfect.

Hashimoto’s is the most common cause of hypothyroidism. He recommended that everyone by the age of 50 get screened for thyroid disease. Of course if there are risk factors, screening should start earlier. He did not say how often one should be screened if negative. He says the optimal TSH is .5 to 1. but the "normal" range is higher. Apparently lab tests vary - not standardized? (sounds familiar )

Hashimoto’s causes destruction of the thyroid for 10-20 years before diagnosis. He feels this is a syndrome that involves the entire body. It can cause infertility. Atrophic gastritis/pernicious anemia is found in 40-50% of those with Hashimoto’s. There is no research looking at Hashimoto’s being anything more than the thyroid. ( Gee, this sounds like another disease I know. ) He suggested that “powerful antidepressants” be used for depression related to Hashimoto’s – sometimes two antidepressants will be necessary.

T4 is Synthroid, Levoxyl, levothyroxine and it has an 8 day ½ life. That means if you miss a dose, the level of T4 will remain fairly constant.

T3 is Cytomel and has a short ½ life – he did not say how short but mentioned that it can cause a “buzz” when first taken and then let a person “crash” by the end of the day. He did say that he has some people on T3 but they take it 5-7 times a day to keep the blood level as constant as possible. There is no sustained release T3 – pharmaceutical companies don’t seem interested in developing this. He would like to have a sustained release T3.

Combination T4, T3 – says this has not been proven to be better.

Armour – “There is nothing natural about Armour”. It is dried out animal thyroids. He prefers the bioidentical drugs.

One person asked about getting medications through a compounding pharmacy. He was concerned about the quality and consistency of these formulas.

He warned not to let TSH fall below .5 – below .5 is associated with osteoporosis, atrial fibrillation and muscle weakness.

A rare cause of hypothyroidism is an Iodine overload. The iodine dyes used for diagnostic procedures can shut down the thyroid.

One person asked what she should do because she has symptoms of hypothyroidism but her thyroid tests are normal. He recommended getting thyroid antibody tests but did not say what he would do if they were positive.

He mentioned Wilson’s syndrome http://www.wilsonssyndrome.com/ This syndrome is early undetected thyroid disease that should be treated. So far there are no studies on Wilson’s syndrome. The American Thyroid Association finds has found no scientific evidence supporting the existence of "Wilson's syndrome. (hmmmm – this sounds awfully familiar )

Of course I got in a question about celiac disease. He is testing for celiac disease but only those showing symptoms …you know, in the bathroom all the time. He said they were easy to pick out . I will be writing him soon .

Are you ready for more? The next speaker was a surgeon.

A goiter is a mass of thyroid origin. It can be a cancer or a benign mass. When a mass is found, a fine needle aspirate (FNA) is done. This is using a needle to take a small sample of cells from the thyroid mass to determine if it is cancer. But FNA does not always give a definitive answer. Then it is recommend that a large biopsy be done. He says that modern surgeons do not do subtotal thyroidectomies – that is a thyroidectomy removing all but about 5-10% of the gland. If they are not sure if cancer is involved, a hemithyroidectomy is done – removal of ½ of the thyroid. If there is cancer, then a total thyroidectomy is the operation of choice.

Papillary cancer is the most common thyroid cancer. http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum Increased Risk of Papillary Thyroid Cancer in Celiac Disease

Complications from surgery include injury to the vocal cord nerve, injury to the laryngeal nerve, hypocalcemia from removal of the parathyroids and bleeding. Vocal cord injury can cause decrease in stamina as airflow through the larynx is diminished. Laryngeal nerve injury can result in aspiration problems. It is not in my notes but I think he said that hypoparathyrodism can be difficult to treat.

Medications after surgery may include thyroid replacement and calcium.

If a biopsy or a well done FNA is benign, it is benign for life – these lesions do not turn into cancer later in life.


It was a good seminar. They said they will be doing more. I suggested they cover graves disease, osteoporosis and adrenal problems.

Wish you could have been there.

Anne