Anne Cappola
24 posts
A5. Anne, how do you manage hypothyroidism differently between cancer patients and non-cancer patients? #AHNSchat
Anne Cappola@annecappolamd
@ThyCaInc I thought this question would come up! I am not a fan of thyroid extracts because they are made from ground up pig thyroid and because a pig makes 4.2x as much T4 as T3, which is different from humans, where it is 14x as much T4 as T3. Better for a hypothyroid pig. #AHNSchat
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This hour is moving fast! Survivors: Here’s a final chance to get some of your questions answers. Remember to include #AHNSchat so we can find your questions here in the Twittersphere.
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@DJerauld @MysticKellz @ThyCaInc Free T4 can be helpful if the TSH is off. Free T3 does not help in this case. Studies show that the T3 level does not correlate with or explain symptoms. #AHNSchat
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@annecappolamd @MysticKellz @ThyCaInc Is Free T4 and Free T3 ever used? My current team (Mayo Clinic) won't test the T3. #AHNSchat
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@MysticKellz @ThyCaInc We use the TSH level as the primary way to see if your dosage is correct. #AHNSchat
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@KC_Kreative @allenhomd I don't know about tea. That's a good question. I have not seen any studies but I will look. #AHNSchat
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yes one can see how terribly difficult it is to be compliant, especially if you have to wait hours between taking different medications. #AHNSchat
Anne Cappola@annecappolamd
@AHNSEndo You need to make sure you separate your thyroid hormone dose from food. Easiest way is to take fasting in the am. Iron pills and calcium pills decrease absorption (and prenatal vitamins have iron in them). Separate those from the thyroid dose by at least 4 hours. #AHNSchat
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@MysticKellz @ThyCaInc That is one of the really nice things about levothyroxine. It has a one week half life. That means that for the pill you take today, half will be around in a week. It keeps levels steady. When you miss one day (and know you did) you can take 2 the next. #AHNSchat
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@allenhomd And the coffee question comes up a lot. Fortunately, the Italians have done the studies! Espresso decreases absorption, but our weaker American coffee seems to be fine to take with your thyroid medication. #AHNSchat
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@allenhomd Most people eat the same breakfast almost every day, so you can kind of titrate the dose to their usual eating. Waiting an hour usually is not necessary; 1/2 hour is fine. Unless someone has fluctuating levels we are trying to sort out. Then we do the hour to be sure. #AHNSchat
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Anne, what seems to affect absorption specifically for thyroid hormone? somthing in one's diet? #AHNSchat
Anne Cappola@annecappolamd
@DJerauld Some people have problems with absorption. I try to find other ways to work this out because Tirosint is so expensive. But it is a good option when all others fail. #AHNSchat
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Q4: This question is so interesting and has to do with TSH. Docs, what are your thoughts? Please start your Tweets with A4 and include #AHNSchat. Survivors, feel free to share your TSH level and remember our hashtag!
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#AHNSchat I take .100 mg of Tirosint. I started on Synthroid the day after my TT (in 1996). I prefer Tirosint - less brain fog.
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@annecappolamd We find a lot of our International members are still doing withdrawal for RAI and not using Thyrogen. Is Thyrogen preferred in most cases? #AHNSchat
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Q3: Let’s keep this great conversation going by asking our docs about when to start taking meds after surgery. Remember to start your Tweets with A3 and include #AHNSchat
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definitely curious, Sripathi. do any of the endocrinologists know whey TSH could be so low at 0.03? maybe a lab error that needs redrawing? #AHNSchat
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@ThyCaInc A3: Most of the time the thyroid cancer patient starts thyroid hormone replacement right away after a total thyroidectomy. Full replacement levothyroxine dose is 1.6 mcg/kg/day. Could delay if hyperthyroid at time of surgery or for radioactive iodine treatment (not usual now).
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@DoctorLisaMoore @ThyCaInc A2:A hemithyroidectomy is indicated when it is not clear if a nodule is thyroid cancer or in low risk thyroid cancer. 30-40% of patients with a partial thyroidectomy ultimately need thyroid hormone replacement. Higher risk if + TPO antibody or higher pre-op TSH levels. #AHNSchat
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Q2: Here’s a question related to surgeries and hormone replacement. Please start your Tweets with A2: and remember #AHNSchat 😊
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A1. Thanks Kim for your question! Low energy and brain fog are indeed common complaints. What do our panelists feel is the culprit? #AHNSchat
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@allenhomd A1. use of T4 with T3, sometimes called "combination therapy" is controversial. There have been placebo-controlled trials of T4 + T3 vs. T4 + placebo, but overall, they have not shown benefit. #AHNSchat
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A1. for our endocrinologists, is there ever a good reason to use T3, or to use T4 with T3? #AHNSchat
Dr. Lisa Moore@DoctorLisaMoore
@ThyCaInc A1. Levothyroxine is t4 and the most commonly used. T3 is liothyronine. This is not used very often. #AHNSchat
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