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Suggest Treatment For Reflex Sympathetic Dystrophy
Question: Question for an endocrinologist. I have had abnormal TSH results, 3 weeks ago they were at 12 and two weeks ago at 9. The doctor prescribed levothyroxine 100mcg. Before I start the treatment I would like to understand what are the implications. Once we introduce the hormone replacement does the thyroid produce even less of its natural hormone ? Wouldn't it create a feedback with the information of not producing more of the natural hormones because there is already plenty? Leading to a cycle with a long life treatment?
I also have had Idiopatic Thrombopenic Purpura in the past treated several times with steroids 15 year ago. I have then developed REflex Sympathetic Dystrophy (or erithromelalgia ) 10 years ago.
Also about 2 months ago the doctor gave me a shot of lidocaine and steroid on my hip for pain, I felt overall much better after that shot and then got tired again, could there be a need of my body for steroid?
I also have some shorten o breath could that be related to the problem with the thyroid or my anxiety?
I also have had Idiopatic Thrombopenic Purpura in the past treated several times with steroids 15 year ago. I have then developed REflex Sympathetic Dystrophy (or erithromelalgia ) 10 years ago.
Also about 2 months ago the doctor gave me a shot of lidocaine and steroid on my hip for pain, I felt overall much better after that shot and then got tired again, could there be a need of my body for steroid?
I also have some shorten o breath could that be related to the problem with the thyroid or my anxiety?
Brief Answer:
Please recheck TSH with Free T4 and antibodies
Detailed Answer:
Good day,
Noted your concern. TSH is produced by the pituitary gland to stimulate the thyroid gland to produce thyroid hormones (T4 and T3 ).Whenever thyroid gland is a bit lazy ( or less active), pituitary gland increases the production of TSH to stiulate thyroid. Hence this high TSH may indicate that your thyroid gland is not functioning well. Over a period of time, thyroid fails further and TSH tend to increase further.
Occasionaly TSH tend to increase for several reasons and this should settle over a period of time. Hence it is not bad idea to wait for 3 months and recheck the hormone levels especially since your latest TSH level is better than 3 weeks ago.
You must request your doctor to arrange for a full thyroid function test ( Free T4 and TSH) as well as a "Anti TPO and Anti TG" test to assess further. I would say, not to start thyroxine until you have done these tests.
If the TSH is more than 10 even if the FT4 ( free T4) is normal, doctors tend to start on levothyroxine. Staring this medicine doesnt prevent the thyroid from making own hormone. But eventually if the thyroid fails, we may have to increase the dose of levothyroxine. This is the normal natural course of hypothyroidism.
If you have true hypothyroism, but opt for no treatment, there are some health imlications. Thyroid hormones are essential for most of the functions of body and you ay develop constipation, weight gain, irregular periods, muscle cramps, tiredness and abnormal cholesterol levels etc. TThis list is not final and there are several other problems associated with low thyroid hormone levels.
If you have hypothyroidism, there is no benefit if you opt not to treat with levothyroxine, but there are health benefits if you start taking it ( IF YOU ARE CONFIRMED TO HAVE HYPOTHYROIDISM IN THE REPEAT TEST ).
Hence i would advice, to wait for 3 montths and recheck Free T4 and TSH as well as Anti TPO and Anti TG antibodies. This will help us further to understand the natural course of your thyroid status.
Regards
Binu
Please recheck TSH with Free T4 and antibodies
Detailed Answer:
Good day,
Noted your concern. TSH is produced by the pituitary gland to stimulate the thyroid gland to produce thyroid hormones (T4 and T3 ).Whenever thyroid gland is a bit lazy ( or less active), pituitary gland increases the production of TSH to stiulate thyroid. Hence this high TSH may indicate that your thyroid gland is not functioning well. Over a period of time, thyroid fails further and TSH tend to increase further.
Occasionaly TSH tend to increase for several reasons and this should settle over a period of time. Hence it is not bad idea to wait for 3 months and recheck the hormone levels especially since your latest TSH level is better than 3 weeks ago.
You must request your doctor to arrange for a full thyroid function test ( Free T4 and TSH) as well as a "Anti TPO and Anti TG" test to assess further. I would say, not to start thyroxine until you have done these tests.
If the TSH is more than 10 even if the FT4 ( free T4) is normal, doctors tend to start on levothyroxine. Staring this medicine doesnt prevent the thyroid from making own hormone. But eventually if the thyroid fails, we may have to increase the dose of levothyroxine. This is the normal natural course of hypothyroidism.
If you have true hypothyroism, but opt for no treatment, there are some health imlications. Thyroid hormones are essential for most of the functions of body and you ay develop constipation, weight gain, irregular periods, muscle cramps, tiredness and abnormal cholesterol levels etc. TThis list is not final and there are several other problems associated with low thyroid hormone levels.
If you have hypothyroidism, there is no benefit if you opt not to treat with levothyroxine, but there are health benefits if you start taking it ( IF YOU ARE CONFIRMED TO HAVE HYPOTHYROIDISM IN THE REPEAT TEST ).
Hence i would advice, to wait for 3 montths and recheck Free T4 and TSH as well as Anti TPO and Anti TG antibodies. This will help us further to understand the natural course of your thyroid status.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your reply. There is actually only one week between the two tests. First on July 27 with TSH of 11.8 and second on August 4th with TSH of 9.8.
The initial recommendation from the family doctor who ordered the test was to wait 6 weeks and repeat the test. In the meantime my period lasted two weeks and I had pelvic pain, the OBGYN said it was because of my thyroid, (they also did an ultra sound that showed a cyst). So based on those symptoms the family doctor prescribed levothyroxine and ordered the second test probably because he understood I was hesitating to take the medecine based on his first recommendation.
I have also experienced shorten of breath worse lying down at night, could that be a symptom of the low thyroid hormones? I also have anxiety and have Zoloft (which I took in the past) I haven't restarted yet because I did not want to start two medecine at the same time and we don't know what does what (could anxiety lead to thyroid issues.... Or could thyroid issues lead to anxiety).
The initial recommendation from the family doctor who ordered the test was to wait 6 weeks and repeat the test. In the meantime my period lasted two weeks and I had pelvic pain, the OBGYN said it was because of my thyroid, (they also did an ultra sound that showed a cyst). So based on those symptoms the family doctor prescribed levothyroxine and ordered the second test probably because he understood I was hesitating to take the medecine based on his first recommendation.
I have also experienced shorten of breath worse lying down at night, could that be a symptom of the low thyroid hormones? I also have anxiety and have Zoloft (which I took in the past) I haven't restarted yet because I did not want to start two medecine at the same time and we don't know what does what (could anxiety lead to thyroid issues.... Or could thyroid issues lead to anxiety).
Brief Answer:
Thyroid in anxiety
Detailed Answer:
Yes i noted that. many factors including stress and anxiety make the TSH to fluctuate. TSH is produced in pituitary gland under the influence of hypothalamus inputs. Stress and anxiety exerts pressure on hypothalamus inputs and change TSH levels. Hyperthyroidism can cause anxiety.
Your shortness of breath is very very unlikely to be due to thyroid problems.
If i were your doctor, i would wait and recheck Free T4 and TSH after a period of 2-3 months along with Anti TPO and Anti Tg. ( however, if periods remain irreguklar, i might do it bit early, say around 6 weeks).
Thyroid in anxiety
Detailed Answer:
Yes i noted that. many factors including stress and anxiety make the TSH to fluctuate. TSH is produced in pituitary gland under the influence of hypothalamus inputs. Stress and anxiety exerts pressure on hypothalamus inputs and change TSH levels. Hyperthyroidism can cause anxiety.
Your shortness of breath is very very unlikely to be due to thyroid problems.
If i were your doctor, i would wait and recheck Free T4 and TSH after a period of 2-3 months along with Anti TPO and Anti Tg. ( however, if periods remain irreguklar, i might do it bit early, say around 6 weeks).
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your advice. I will probably wait before starting levothyroxine.
Are you saying that the TSH could be too elevated even if the thyroid works well, like stress could increase the TSH independently from the thyroid working well or not?
I have re-started my Zoloft hopefully taming my anxiety. In case the situation arises, is it fine for me to start levothyroxine if needed in the coming week or so.?
Also you wrote hyperthyroid can cause anxiety, but hypothyroid too?
Thank you.
Are you saying that the TSH could be too elevated even if the thyroid works well, like stress could increase the TSH independently from the thyroid working well or not?
I have re-started my Zoloft hopefully taming my anxiety. In case the situation arises, is it fine for me to start levothyroxine if needed in the coming week or so.?
Also you wrote hyperthyroid can cause anxiety, but hypothyroid too?
Thank you.
Brief Answer:
Recheck TFT
Detailed Answer:
Quite possible. TSH is a very pulsatile hormone. Make sure you do the thyroid function test after 2-3 months in the morning time, preferably fasting. Hypothyroid cause depression. Hyperthyroidism cause anxiety
Recheck TFT
Detailed Answer:
Quite possible. TSH is a very pulsatile hormone. Make sure you do the thyroid function test after 2-3 months in the morning time, preferably fasting. Hypothyroid cause depression. Hyperthyroidism cause anxiety
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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