Anne Cappola

[Anne Cappola @annecappolamd]

@AHNSEndo The TSH goals can be different (see A4) in thyroid cancer patients. Also, some hypothyroid patients still have some residual function, so they may need lower doses than people who have had a thyroidectomy. But otherwise, management is not much different. #AHNSchat

[Anne Cappola @annecappolamd]

@Ho_IX @ThyCaInc It can be really tricky to be a thyroid cancer survivor. There is a lot of messaging out there that it's a "good" cancer to have. But it still requires surgery and other treatments. And it is still cancer. #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

[Anne Cappola @annecappolamd]

@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

[Anne Cappola @annecappolamd]

@ThyCaInc A5: Important to think broadly when someone does not feel right. If the TSH is not at goal, I ask about missed doses, wt change, new meds, and I may adjust the levothyroxine dose. I always ask about stress, sleep, exercise, and eating habits. Non-thyroid causes too. #AHNSchat

[Anne Cappola @annecappolamd]

@MysticKellz @ThyCaInc We use the TSH level as the primary way to see if your dosage is correct. #AHNSchat

[Anne Cappola @annecappolamd]

@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

[Anne Cappola @annecappolamd]

@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

[Anne Cappola @annecappolamd]

@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

[Anne Cappola @annecappolamd]

@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

[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

[Anne Cappola @annecappolamd]

@ThyCaInc A4: This can be confusing to patients. The TSH target depends on the risk of recurrent thyroid cancer. For the lowest risk, TSH target is 0.5-2.0 mU/L, for intermediate risk it is 0.1-0.5 mU/L, and for high risk it is <0.1 mU/L. The target may change over time. #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

[Anne Cappola @annecappolamd]

@ThyCaInc We are largely using Thyrogen in the US, save withdrawal for higher risk thyroid cancer. Hypothyroidism works well for RAI treatment, but it feels awful.#AHNSchat

[Anne Cappola @annecappolamd]

@AHNSEndo @sraj Weight loss, improved absorption from meds or other conditions could all lead to a low TSH with need for dose reduction. Also use of biotin at doses of 10 mg per day or higher can mess with thyroid tests. Need to stop biotin 3 days before thyroid testing! #AHNSchat

[Anne Cappola @annecappolamd]

@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).

[Anne Cappola @annecappolamd]

@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

[Anne Cappola @annecappolamd]

@AHNSEndo There are so many things that can cause low energy and brain fog.That's where it is important for an endocrinologist to think about treating the whole patient and ask a lot of questions, not just about the thyroid, but about stress, sleep, diet, exercise, other meds...#AHNSchat

[Anne Cappola @annecappolamd]

@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