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Thyroid condition, changes in vision, related to glucose levels, done thyroid blood tests, ultrasound, white cell count. Treatment ?

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General & Family Physician
Practicing since : 1980
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Can you please provide me with a second opinion diagnosis for my thyroid condition.

In the attached report I have included:

* my thyroid blood tests
* thyroid ultrasound report
* white cell counts
* history of drugs taken.

Additionally, during the April to XXXXXXX time period I had large changes in my vision. My Optometrist thought it could be related to my glucose levels. I have attached some glucose level measurements.

I have had several more out of range blood tests on other blood components, but my doctors did not think they were significant. (I can include the other out of range blood tests if you think it is important.)

I felt absolutely terrible during the May to August time period, but I am now feeling better.

Thank you.
Posted Mon, 7 May 2012 in Thyroid Problem and Hormonal Problems
 
 
Answered by Dr. Rahul Tawde 5 hours later
Hi,

Thanks for the query.

1. One thing is clear- your thyroid reports suggest hypothyroidism. Hypothyroidism means your thyroid gland is not producing normal quantities of thyroid hormone. The treatment in this case would be supplement thyroid hormone from outside so that thyroid hormones in your body remain in normal range. Synthyroid is nothing but thyroid hormone and is the recommended treatment for this condition. In hypothyroidism we monitor the thyroid status with TSH values which should be in the range of 0.5 -4.5. The goal of treatment in hypothyroidism is to keep TSH in this range.

2. Treatment for hypothyroidism is usually lifelong because there is no good treatment to improve the function of thyroid gland.

3.There is lot of variation in TSH values from one lab to another. So you should get your thyroid function tests from a single reliable lab always.

4.Your thyroid function tests suggest some variation but your thyroid hormone dosage and type of thyroid medicines have also been changed for some unknown reasons without any logic. So the variations in your thyroid function tests could reflect these changes in thyroid medications and dosage or irregular thyroid hormone intake.

So in the presence of these confounding factors it is difficult to assess thyroid status.

This is my recommendation for your thyroid problem-

Consider to discuss with your Endocrinologist about Synthyroid 50mcg/d (early morning empty stomach) for three months and repeating your TSH after 3 months. The dose may be changed by your Endocrinologist. Make sure you take them medicines regularly at same time.

It would be good if you have mentioned when was your thyroid problem diagnosed and what was the thyroid function status then (Serum TSH levels).

As far as the Glucose readings are concerned they are well controlled. The HbA1C (Glycosylated Hemoglobin, considered an average of past few months) status is within limits.

Vision status should be checked by an Ophthalmologist ( not Optometrist) by looking at the changes in the posterior chamber (Retina and Vitreous). We generally advise a thorough eye check in person at this age with complains of sudden changes in vision.

Hope i have answered your query. I will be available for follow up.
Above answer was peer-reviewed by
 
Follow-up: Thyroid condition, changes in vision, related to glucose levels, done thyroid blood tests, ultrasound, white cell count. Treatment ? 30 hours later
* I already know there is nothing wrong with my eyes and I don't have diabetes. I included this information because I was told my vision changes were likely the result of changing glucose levels and that these vision changes occurred at the same time my thyroid hormones were changing.

* I included the white cell counts because my doctor said they were likely related to my thyroid.

* I have been using reliable labs. The first two thyroid tests which showed the greatest variation were done at the same reliable lab. My doctor said we should try another lab to cross check. In April I felt great and had no symptoms, for this reason it does not seem likely that this set of labs results were "wrong".

* There has been no irregular dosing. The dose I have taken is exactly as prescribed/described and was taken exactly as it should be taken.

* I was diagnosed immediately after my third thyroid tests on May 27.

* My endocrinologist terminated my Synthroid because my symptoms became worse on Synthroid and because I had no symptoms at the time I was diagnosed. The OTC thyroid gland is something I decided to start taking on my own and it seems to make me feel better.

---------------------------------------------------------------

* Can you please explain the value in restarting Synthroid since I currently have normal blood tests, I have no symptoms, and I had a very bad reaction to Synthroid?

* Can you explain why you believe I have a permanent form of hypothyroidism when I had normal thyroid hormones in April and in September?

* Can you explain any possible connection between my changing thyroid hormones and my changing glucose levels?

* Can you explain any possible connection between my white blood cell counts and my thyroid hormones?

Thanks.
 
 
Answered by Dr. Rahul Tawde 14 hours later
Hi,
Thanks for the follow up.

1.Synthyroid is nothing but thyroid hormone which is normally produced inside every human being. So a bad reaction to synthyroid isnt possible.Since you had not mentioned in your query as to when you were diagnosed with thyroid problem for the first time I had suggested you to take Synthyroid thinking that you might have had thyroid problem from an earlier time.

Although your thyroid tests are normal right now it could very well be due to OTC thyroid gland that you have been taking.Once you stop this drug thyroid functions may become abnormal again.

Now that I know that you didn't have any thyroid problem before April 2011 my recommendation is - stop OTC for 2 -3 months and then repeat thyroid function tests.(this I'm saying because thyroid medicines often remain in the body for upto 1 month after stopping and we do not want thyroid tests which are influenced by these medicines)

2.Hypothyroidism of any form is usually permanent.In a normal person thyroid functions remain in consistent normal range through out their life. The first two thyroid tests which showed the greatest variation were done at the same lab and so one of them has to be wrong.This has added to confusion in interpreting the results. So to clearly know If you have a permanent form of hypothyroidism or not I have given you a new recommendation above.

3.There is no obvious connection between your fluctuating thyroid hormone levels and blood glucose levels. The Blood glucose values might have been related to some form of stress you had then.

4.There is no connection between white blood cell counts and thyroid hormones in your case although they can be related in very severe cases of hypothyroidism.So your problem with WBCs is an independent problem.

Wishing you good health.
Take care.
Above answer was peer-reviewed by
 
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