Are you suffering from: Nervousness, shaking, rapid heartbeat, weight loss, fatigue or feeling hot?

Dr Ho Su Chin, Consultant from the Department of Endocrinology at Singapore General Hospital, gives detailed answers to your questions.

Question by zq84.goh

Dear Dr Ho,

May i know apart from knowing the common symptoms, how would the doctor perform the diagnosis (any specific test is conducted to confirm)? and what are the treatment ( on medication)?

Thanks.

Answered by Dr. Ho Su Chin Consultant Dept of Endocrinology Singapore General Hospital

The diagnoses of thyroid disorders could be reached by a combination of history taking, examination of the neck for thyroid swelling and blood test to detect thyroid hormone abnormalities. These tests could be done at any general practitioners’ clinics or polyclinics. The treatment modalities will in turn depend on the diagnoses reached after the above-mentioned evaluation.

Question by chl07

Dear Dr. Ho,

Will Thyroid causes headaches? Because my mother has headache among everyday and is suspected to have Thyroid after she did a blood test in NSC last week.

Looking forward to hear from you soon.

Thanks,
Ai Peng

Answered by Dr. Ho Su Chin Consultant Dept of Endocrinology Singapore General Hospital

There are many causes of headaches.

Thyroid disorders are seldom associated with protracted or severe headaches. There are usually accompanying symptoms of signs of thyroid diseases to make a health professional suspect such a diagnosis.

If the diagnosis is confirmed with hormone level testing, then your mother will require treatment for the specific thyroid disorder.

Question by low63888

Hi Dr Ho

I am currently on treatment on Thyroid problem, currently on PTU (1 tablet 2 times daily). However, I noticed that I am experiencing excessive hair loss, could this be one of the side effect of PTU? What other side effects are there in relation to PTU. Is there any medication/cream to prevent the hair loss?

Hope to hear from you soon.

Regards
Carol

Answered by Dr. Ho Su Chin Consultant Dept of Endocrinology Singapore General Hospital

Hair loss is common during treatment of hyperthyroidism. It is not a side effect of the medication.

Changes in the hair growth cycle as a result of the thyroid hormonal fluctuation give rise to this condition named telogen effluvium. The hair loss is generally diffuse, ie, it involves the whole scalp. It will resolve after your thyroid condition stabilizes.

However, if the hair loss is patchy, involving different areas of the scalp, or if your scalp is red or itchy, you should consult a dermatologist.

Question by lalithasubhashini

Dear doctor - Namaste.

I am 48yrs old n diagnised hypothyroidsm. I am using thyronorm 100 mcg regularly. My height 5.2'' n weight 60 kg(aprx) Since 15 days I started taking medicine for rumatic pains.. (sazo afternoon n night dexorange, Metnurobian and gencal . After 1 week my body temporature increased n I got severe headache n stopped the other medicine except thyronorm . When I consulted local doctor he told me to continue the above medicine including thyronorm. He told I have high b.p (190/100) My doubt is shall I have to review the use of thyronorm? (tsh report is normal with thyronorm use)

Previously I have only low bp and anemia.(haemoglobin 8%) anemia is still there but why bp increased.Is it due to excessive medication. Kindly suggest. with regards - subhashini

Answered by Dr. Ho Su Chin Consultant Dept of Endocrinology Singapore General Hospital

It is difficult to comment on the best approach to your problems. You have several diagnoses which involve several systemic organs and each has influence on the other.

My advice is to bring all your medications to your primary doctor, i.e. the doctor who is aware of all your medical conditions and let him assess the situation and see if you need a referral to an internal medicine specialist.

Question by tt

Dear Dr. Ho,

I am 38 years old. I have strange symptoms such as feeling sleepy and excessive yawning, feeling tiredness, headache and my urine smells is also changed. What do you think the problem is?

Regards,
TT

Answered by Dr. Ho Su Chin Consultant Dept of Endocrinology Singapore General Hospital

You do have some symptoms suggestive of low thyroid hormone state. The quickest way is to run a thyroid hormone test to assess your blood level. However, do not be surprise if the result turns out normal because these described symptoms can also be caused by conditions such as physical deconditioning, stress, anemia, sleep apnea etc. It will be best to see your family doctor so that he can assess your overall health.

Question by a212na21

Hi Doctor,

I was diagnosed with Hyperthyroid in 2006 and have since been prescribed carbimazole starting with 6 tablets per day down to 4 tablets currently.

I've had 2 relapse during these 4 years. I am currentl seeking consultation with SGH Endo Specialist Clinic.

Lately, I've been having frequent palpitation of the heart. My last blood test in May showed T3/T4 within normal range of 9.7 whilst my TSH showed 1.2.

Does the frequent palpitation signal a worsening in the two hormone levels? Besides blood tests, what are other tests that can carried out to determine the seriousness of the thyroid condition? What is Graves disease

Answered by Dr. Ho Su Chin Consultant Dept of Endocrinology Singapore General Hospital

I refer you to the SGH website on some information on Graves’ disease: http://www.sgh.com.sg/Clinical-Departments-Centers/Endocrinology/Documents/sghthyroidfh11.pdf

You should have a better idea of the condition after reading the brochure.

For thyroid hormone disturbances, the best way to determine if the condition is under control is by blood test. If your blood test is normal and you still have symptoms of palpitation, you should highlight this to your attending doctor. Auscultation of the heart may reveal extra sounds or abnormal rhythm which may warrant a referral to a heart specialist.

Question by josephinekhiew

Dear Dr Ho My son, age 17 years old, a student is underweight. He is 1.73m tall and weighs 48kgs. I'm concern of his health and I'm not sure if he is having Thyroid problem. I would appreciate your advise and probably, would like to bring him for a full body check up. Let me know where can I bring him to?

Thank you for your advice

Regards
Josephine

Answered by Dr. Ho Su Chin Consultant Dept of Endocrinology Singapore General Hospital

Your son has a good height which shows that he is growing well. As for the weight issue, it depends on a lot of factors such as level of physical activity, nutritional factors, and genetic make-up etc. Thyroid dysfunction is only one of the many things that may need evaluation if history is suggestive.

If you are concerned with his overall growth, it is a good idea to bring him for a full health screening because the tests done are fairly exhaustive. A good family physician will be able to perform the tasks well. You can also bring him to the health screening centers in various restructured or private hospitals for a routine health check.

Question by sailu05

hi dr.ho the following are the thyroid test results of mine

T3 1.95 ng/mL

T4 14.10 (Mue)g/dL

TSH 0.01 (Mue)lU/mL

WHAT IS MY POSITION?

WHAT TYPE OF TREATMENT DO U SUGGEST?

DIET CONTROL ETC.

1. THE READINGS ARE DRASTICALLY CHANGED IN 9MONTHS.
2. PREVIOUSLY THE READINGS ARE WITH IN THE LIMITS ONLY.

REGARDS
SAILAJA

Answered by Dr. Ho Su Chin Consultant Dept of Endocrinology Singapore General Hospital

You have not provided the normal ranges for the various hormone parameters. Each laboratory uses different test kits and thus there are different ranges to follow.

The management decision for any particular thyroid disorder cannot be reached with just one blood test. The overall picture pieced together from history taking and physical examination and follow-ups on the evolution of the disorder also plays a crucial role in deciding the best treatment option. Therapeutic choices are patient specific and derived after discussion between physician and patient so that needs and concerns could be addressed.

My advice is to go back to your physician treating your thyroid disorder and discusses the diagnosis, treatment options available bearing in mind the demands of your current lifestyle.

Question by randy wong

What're the cause of Thyroid & Could be spreaded from one person to another?

Answered by Dr. Ho Su Chin Consultant Dept of Endocrinology Singapore General Hospital

I refer you to the SGH website on some information on common thyroid conditions: http://www.sgh.com.sg/Clinical-Departments-Centers/Endocrinology/Documents/sghthyroidfh11.pdf You should have a better idea after reading the brochure.

Question by catkoh14

Dear Dr Ho

I am 38 years old and have my body checkup in Mar this year. Everything was alright except for high Potassium and heart palpitation. During Mar, my weight was 55kg and now my weight has reduced to 49kg. I am wondering whether is there any underlaying thyroid problem?

Regards
CK

Answered by Dr. Ho Su Chin Consultant Dept of Endocrinology Singapore General Hospital

The quickest way is to run a thyroid hormone test to assess your blood level. However, do not be surprise if the result turns out normal because these described symptoms can also be caused by other medical conditions.

Question by marylee

Dear Doctor

I am 55 yrs old, female. My thyroid tests results as follows:

Frm 5 mg of carbimazole every morning then increase to 10 mg (twice a day) then to 7.5 mg (twice a day) and frm 24 July 2010 i am currently taking 10 mg (once a day)

Is my condition serious and do i need to go for radioiodine treatment? Pls advise.

Everyday i am getting very bad headache and i take synflex and cafergot in order to relieve the pain and also having blurred vision that sometimes I cannot see or read clearly. Could the headache and blurred vision be connected to the thyroid and the medication?

The blurred vision will go off for a while and will reappear again.

Thank you.
Mary Lee

Answered by Dr. Ho Su Chin Consultant Dept of Endocrinology Singapore General Hospital

You have not provided the normal ranges for the various hormone parameters. Each laboratory uses different test kits and thus there are different ranges to follow. However, looking at the trend, it looks like your thyroid condition is improving. As to whether radioiodine treatment is the option, I am afraid I cannot advise you based on the history you have given me. This is because therapeutic choices are patient specific and derived after discussion between physician and patient so that needs and concerns could be addressed.

My advice is to go back to your physician treating your thyroid disorder and discusses the diagnosis, treatment options available bearing in mind the demands of your current lifestyle and other concurrent medical problems.

You have visual disturbances associated with headache. There are many causes for such symptoms, not necessary due to thyroid problem and the medication used for treatment. Please consult an ophthalmologist for a thorough assessment of your visual acuity and eye pressure.

Question by dhvani61@gmail.com

hello dr,me aged 22 have been detected with hypothyroidism . my free T4 is .56(ref unit .71).TSH AND T3 are normal.what medicines should i take??or is medication necessary for its cure?????????? hoping for a quick reply

dhvani

Answered by Dr. Ho Su Chin Consultant Dept of Endocrinology Singapore General Hospital

You have an isolated low freeT4 while the rest of your thyroid axis is normal. I would suggest your repeat the tests again to ascertain that the freeT4 is truly low. Hormonal level fluctuates and sometimes over a period of time, it can normalize.

If the result is persistent, you will need an endocrine referral to determine the cause of this abnormality.

Question by feria83

Dear Dr. Ho

I did the Thyroid test before 6 weeks TSH was 5.14, now before 2 days TSH value is 5.79. what is the reason? Whether i have to take the treatment? When i have to take the thyroid test for confirmation? i am 31 years old....kindly mail me the advice

Answered by Dr. Ho Su Chin Consultant Dept of Endocrinology Singapore General Hospital

There are diurnal and moment-to-moment fluctuations in the levels of TSH. Your TSH is not expected to stay identical for 2 assays done at different time points. Thus TSH has a range of values and the normal range of TSH also differs from laboratory to laboratory.

Based on your description, I gather that you had seen a doctor and had been advised to receive treatment. Whether treatment is necessary at this point in time depends on the cause of your thyroid problem.

You have not given enough details to enable me to assess the necessity of treatment. You should discuss the following with your physician i) the cause of your thyroid problem, ii) the expected benefits if treatment is instituted versus the risks if the condition is left untreated. This will leave you with a better idea whether to embark on therapy.

Question by cnsh1962

Hi Dr Ho,

My mum is 75 yrs old. Through a recent blood test, she has been diagnosed as having low level of thyroid and is now on medication. Can this condition be cured, or is it just keeping it under control? Thank you.

connie

Answered by Dr. Ho Su Chin Consultant Dept of Endocrinology Singapore General Hospital

There are many causes of low thyroid hormone level. Some conditions cause permanent lack of thyroid hormone such as post-surgery to the thyroid gland, post-radioactive iodine treatment to the thyroid gland and autoimmune thyroid disorders such as Hashimoto’s thyroiditis.

Other conditions such as thyroiditis due to infection, transient inflammation or medications cause temporary loss of thyroid function and the thyroid gland is expected to recover its function and hormone secretion.

Thus, whether your mother’s condition is permanent or transient will depend on the etiology of the disorder. Therefore, the treatment required will also depend on the etiology.

Question by eshan1haque

DR I AM 24 YEAR OLD MALE, DONE MY THYROID TEST RECENTLY,IN WHICH MY TSH IS FOUND TO BE 10.42, I HAVE GAINED MY WEIGHT T0 84KGS FROM 75.9KGS IN RECENT PAST. PLEASE SUJJEST ME WHAT TO DO & HOW TO CONTROL IT, AS I DONT WANT TO START MEDICATION AT THIS AGE. ALSO ONE OF MY FAMILY DR HAD ASKED ME TO TAKE THYRONORM 50.

Answered by Dr. Ho Su Chin Consultant Dept of Endocrinology Singapore General Hospital

Your TSH level is certainly elevated and suggests that you have hypothyroidism.

The cause of this hypothyroidism is however, unclear to me. Whether treatment is necessary is dictated by the etiology of the thyroid disorder.

As mentioned above, some conditions cause permanent loss of function whilst others cause transient lack of thyroid hormone. The former requires thyroid hormone replacement whilst the latter requires medical surveillance to ensure that the thyroid gland recovers its function. Weight gain is only part of the spectrum of symptoms of hypothyroidism. Other symptoms include lethargy, malaise, constipation, cold intolerance, raised cholesterol level and decrease cardiac function etc.

Normalizing the thyroid hormone level will help to ameliorate these symptoms to a large extent.

Ref: V10