Patient's Query
Hello doctor,
My son developed anxiety symptoms about four years ago. They came completely out of the blue. He was with someone who now has heart palpitations, sweaty palms and feet, and lightheadedness sitting in the living room. We ran a battery of tests when it first happened including TSH, EKG, lung scans, blood panels, etc. and everything was normal. So we went down the path of anxiety. Four years later, the symptoms continued. As my son now has a terrible fear of doctors, we tried a home blood test to get a full thyroid panel. I have attached the results. The blood work came back normal. Low normal TSH, but low normal T4 and lower normal free T4 and free T3. There is nothing that shows an abnormality. However, his urine test showed moderately low iodine and slightly low selenium. I have read that abnormalities in these measures could cause thyroid problems. What am I wondering is if these two indicators are worth further exploration with an endocrinologist knowing that going to the doctor will cause my son a severe panic. Also, is it possible that low iodine could have been a temporary diet thing and it is masking the signs of hyperthyroidism in the blood work? He has all of the symptoms of someone with hyperthyroidism. On a side note, I am hypothyroid, my sister is hypothyroid and my two nieces had Hashimoto's with my younger niece having thyroid cancer and got her thyroid removed at age of 22. So everyone on my side of the family has thyroid issues. We were wondering if you could please give us some guidance. Looking to see if we need to eliminate thyroid as a possible cause of his symptoms or if it is worth further pursuit.
Hello,
Welcome to icliniq.com.
Based on the details and the labs attached (attachment removed to protect patient identity), it seems very unlikely that the symptoms are coming from a thyroid issue. Urine iodine is really not helpful clinically in this case. Given the family history, I would ask you to monitor TSH (thyroid-stimulating hormone) once a year but that does not explain the severity of the symptoms at all. Thank you.
Patient's Query
Thank you doctor,
Is the low iodine something that needs to be monitored or adjusted with diet? Should we retest before taking any supplements or diet modifications?
Hello,
Welcome back to icliniq.com.
Low iodine is easily treatable with diet. So, I would suggest using iodized salt, if not already doing. Supplements are notorious for inconsistencies in the actual amount and the reported amount. So, I would not recommend them unless the diet is restrictive in some way. You can repeat the urine iodine levels in three to four months to see if dietary changes are working and not overdoing the iodine. Thanks.
Patient's Query
Thank you, doctor,
His diet is not restrictive at all. If anything that the medicine does to his stomach is not great but probably it falls into the typical diet radius. How much salt is needed to correct something like this? What would low iodine do to someone, especially if paired with low selenium?
Hello,
Welcome back to icliniq.com.
The salt should be the usual amount used in cooking, nothing extra. Is he using non-iodized salt right now? If he is already using iodized salt then have him try a supplement with 100 mcg or so of iodine in it. Low iodine can cause an enlarged thyroid. It may also cause an underactive thyroid. Thank you.
Patient's Query
Thank you, doctor,
Given your last response that low iodine can cause an underactive thyroid, you do not think it is possible that the low iodine, in this case, could be masking an overactive thyroid? His TSH was low normal, T3 and T4 closer to hypo levels. It is not possible that dietary components for a short period could have lowered his iodine, which in turn suppressed his thyroid enough to give results from an otherwise overactive thyroid to fall in the normal band. If the iodine raised his TSH a little and lowered the T3 and Tt4, is it not possible that with normal iodine those would move in the opposite directions towards hyper?
Hello,
Welcome back to icliniq.com.
For symptoms of this degree, a patient has to have overt hyperthyroidism in which case TSH (thyroid-stimulating hormone) is undetectable. The iodine deficiency is mild and not enough to completely suppress his T4 and T3 production. Thank you.
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Answered by Education: DM Endocrine and Diabetes,USA, Harvard University and Boston University Professional Bio: Dr.Bindiya Thakkar is a highly skilled and established physician in the field of Diabetology, Endocrinology. She listens to all the patient queries deliberately and is an expert in devising a proper treatment plan. This doctor is not available for online consultations on the platform anymore. Dr. Bindiya Thakkar
Medically reviewed byDr. K. Shobana
Same symptoms don't mean you have the same problem. Consult a doctor now!
Dr. Bindiya Thakkar
Endocrinology
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