General Medicine

» Elaine Moore - Mixed up Help!!!!!

In response to Mixed up Help!!!!! posted by cybee:

Hi,
I'm still on vacation but got a chance to stop by.
I agree that an ultrasound is sufficient to see if you have nodules, and since you already have evidence of thyroid antibodies, you can tell that your hyperthyroidism is autoimmune. Having a TSI test would confirm that you've moved into Graves' disease.
ATDs do offer protection from TED since they mildly suppress the immune system. You may want to call your doctor and report that your eye symptoms worsened after stopping ATDs and that you plan to skip the RAI uptake and will be continuing with meds. At your next appointment you can ask for the TSI test.

Most people with TED do not need surgery. In most cases, eye symptoms resolve when the thyroid hormone levels are corrected. If congestive TED develops, in most cases it resolves on its own once the active phase of the disease ends. In any case, surgery wouldn't be done until the active disease phase ended.

Flaxseed oil can also help reduce symptoms of TED so that's one supplement you definitely want to add. Best, Elaine

» Elaine Moore - Post hypo rai-lt4 dosing & symptoms

In response to Post hypo rai-lt4 dosing & symptoms posted by u25000:

Hi,
Many things affect your thyroid hormone levels, including pregnancy, weight, diet, stress, and the type/batch of replacement hormone you're on. Ideally, you'd have an FT4, FT3 and TSH at least every 6 months and 6 weeks after any adjustments to your dose.
Many people have trouble with generic forms of L-thyroxine (T4). And several years after RAI, many people need replacement hormone containing both T4 and T3 (like Armour) rather than T4 alone.
Symptoms are more important than lab values, but it's best to have FT4 and FT3 levels that are within range, preferably near the high end of the range. TSH is often falsely decreased after RAI so your levels of FT4 and FT3 are better indicators of your thyroid status.
When you become pregnant you'll need an increase in thyroid hormone levels as your pregnancy progresses. By the last trimester most people need a 50% increase in their dose of replacement hormone. This is due to the increase in estrogens. Estrogens compete with thyroid hormone for the proteins that transport hormones through the blood. Best, Elaine

» Elaine Moore - how & when to choose??

In response to how & when to choose?? posted by fivebreaths:

Hi,
I'd use the ATDs if I were you, preferably using methimazole at a low dose, like 10 mg daily, and I'd use beta blockers like atenolol to help reduce symptoms until the meds kick in. Used properly, these meds can help you achieve remission, and their side effects are minimal when low doses are used.
Once your FT4 levels falls within the normal range, you can decide if you want to lower the ATD dose, using a low maintenance dose to reduce production of new hormone or rely on natural means/diet until you achieve remission.
ATDs mildly suppress your immune system and they block iodine absorption. By reducing dietary iodine you can use an even lower ATD dose and this also helps move things along.

Bugleweed acts like an ATD in that it too blocks iodine absorption, and it also reduces the effects of thyroid antibodies. L-carnitine is great because it reduces the symptoms of hyperthyroidism and this would be a big help for you until natural means kick in.

If you have a health care spending account and your practitioner prescribes supplements, you can at least use your health care spending account for these products. If your doctor prescribes supplements you can also see if your prescription plan covers them. Best, Elaine

» fivebreaths - how & when to choose??

In response to how & when to choose?? posted by daisyelaine:
thank you elaine, so much for your reply
I have questions regarding: L-cartinine dosage, substitutes/alternatives for Beta-blockers, and question about ATD dosage/effectiveness/lenght of time to know.

1) My doctor has me taking 1000 mgs of L-cartinine,2x/day.I've read that 500mgs is adequate for reducing thyroid hormone. What is your opinion about mega-doses?

2) I was trying to take Atenolol. My doctor started me on 20mgs, but it was too strong for me, made me even more tired and weak than I began, so he switched to Propranolol 10mgs, and it did the same---so he said cut it in half and take it at night, but even 5mgs made me feel drugged and sleepy and 'weak'-ish. So........I now am not taking beta-blocker. Is it unsafe to allow heart rate to continue being accelerated without beta-blocker assisitance to slow down? Is it ok for the heart to wait for the effects of ATD to kick in? My heart rate is now up to 100 bpm at resting, and can go up to 106/110 by just shampooing my hair in the shower! I've sort of gotten used to it. I don't exercise as much I I used to, or do as much around the house, as it becomes uncomfortable to feel my heart pounding, and franlky, it is exhausting! I'm thinking of dosing myself w/ Kava Kava instead, because it's relaxing, but i don't know, haven't researched if it's effective particulary in slowing down the heart. I'll see. Have you experince with Kava for the heart rate?

3) I've always been sensitive to medications, requiring smaller doeses than is normal. Do you think I should expect the same w/ ATD? ie: if 10 mgs is a normal low dose of Methimazole, am wondering if it's reasonable to assume that 10mgs may effect me like someone else taking 20 mgs, and how will I know my dose is too high, until I've gone and created a hyPO situation?(which is one of my great concerns) Docors in the past have been somewhat dismissive when I tell them I'm sensitive to normal dosing ---would it be ridiculous to ask to be started on 5 mgs of Methimazole? And how long would it take for me to wait and see if it is effective, before considering going up to 10mgs?

Thank you Elaine. I go to the Endocrinologist on Weds a.m.EST this week. Don't know if you'll read this by then, but any information is really so appreciated!

-- posted by fivebreaths

» cowlover614 - Mixed up Help!!!!!

In response to Mixed up Help!!!!! posted by daisyelaine:

Hi Elaine I know by now you know I've decided NOT to do the scan! Everything I 've read even if it is supposed to be a low dose my gut feeling just says to pass on it. So now I have to find a doctor who is willing to keep me on the ATD's and beta blocker and do the right labs! So far I'm 3/0. I have to take my youngest to her doctor tomorrow She's a DO, I want to kind of scope her out and see what her thoughts on thyroid are. I've never been to her but it can't hurt to ask, maybe I'll have some luck. I've made the choice not to go back to the endo. Question I've been on the ATD for about three weeks almost four now, how long is it safe to wait before labs? I don't want to end up hypo and not know it. Also how can the endo just say I have Graves? Hashi's I can understand because of the antibodies. I know I've maybe asked this before but! What brings my thyroid levels back to where their supposed to be? Also I take from what you say their are two stages to TED. See I'm still confused about all of this, for some reason it seems like it's taking forever to sink in! It's not bad enough to look like this but it makes me feel really stupid! But at least on the ATD I'm not so depressed! Guess that's a positive. Anyway like I said I did get the flaxseed oil just want to make sure one more time that it is ok to take with the beta blocker. Thanks so much Shirl

-- posted by cowlover614

» cowlover614 - Mixed up Help!!!!!

In response to Mixed up Help!!!!! posted by cybee:

Hi Hope your doing ok! Hope Easter was good! How's your eyes? I'm sure glad we have Elaine because I'm still confused. How are you doing on the flaxseed oil is it helping any yet? Your right I'd like to keep my thyroid to, it's just trying to find a doctor around here who will try things my way. I decided not to go back to the endo. I just feel his only idea is the scan. So far my luck with doctors isn't very good! So I'll keep trying. I'm still having those night sweats and my hip is still waking me up! I just can't seem to sleep good up and down all night! Well your appt. is coming up I sure hope you have better luck!!!! Shirl

-- posted by cowlover614

» cybee - Mixed up Help!!!!!

In response to Mixed up Help!!!!! posted by cowlover614:

Hi! Glad you are feeling better (less depressed) , Shirl! I am concerned about my Endo too...don't know what will happen there, but I will report back after my appt (which is April 16). I still have some night sweat, but am sleeping better (thank goodness!). I hope your search for a satisfactory Endo is successful! One should be content with one's doc.

I just have ground flaxseed...and I have a question for Elaine too ....whether flaxseed oil is better than ground flaxseed (likely easier to take more of it in oil form)..and is flaxseed better than fish oil which I am taking in capsules?

-- posted by cybee

» Elaine Moore - how & when to choose??

In response to how & when to choose?? posted by fivebreaths:
Hi,
2000 mg L-carnitine is appropriate for someone with high levels who is still having symptoms. I'd stick with that dose because it may be eliminating your need for a beta blocker.
Your heart rate normally will go up with activities, and you'd like it to be less than 100 bpm after 10 minutes of rest. Since you're close to this, I'd suspect the L-carnitine would help bring it down.
I'd pass on kava because of recent studies linking kava to liver problems.
Calcium and magnesium supplements and B vitamins can also reduce symptoms related to hyperthyroidism.
Since many doctors still use a 30 mg starting dose of methimazole, it's likely that 10 mg won't be too high of a dose for you unless your FT4 level is only slightly elevated. The aim here is to bring FT4 within range and lower the dose as soon as it falls. Usually, doctors will order labs for 6 weeks after starting meds, although if you were to notice symptoms of hypothyroidism you could probably have labs sooner. Hope your appointment goes well, elaine

» Elaine Moore - Mixed up Help!!!!!

In response to Mixed up Help!!!!! posted by cowlover614:
Hi,
there are two types of TED: the more common type, which is related to abnormal thyroid hormone levels and a less common, congestive autoimmune type of TED.
The first type usually resolves when levels are brought into the normal range. The second type has an active and a resolution phase. This type is related to thyroid antibodies and immune system chemicals and it runs its own course. This type of TED can develop in hypothyroidism as well as hyperthyroidism.

The antibodies that are seen in Hashimoto's thyroiditis, thyroglobulin and TPO antibodies, are also seen in Graves' disease. Your Hashimoto's thyroiditis can resolve and you can move into Graves' disease. This happens when your immune system also begins producing stimulating TSH receptor antibodies. Because you no longer need replacement hormone, you'd be considered as moving from Hashimoto's thyroiditis to Graves' disease. A test for TSI would help confirm this.

DO's are excellent for treating Graves' disease. If your daughter's doctor is familiar with treating hyperthyroidism she should be able to treat you. It's good to find someone with experience.
Since you stopped ATDs for a few days and are now back on them you probably want to wait another week or two before having labs. Best, Elaine

» Elaine Moore - Mixed up Help!!!!!

In response to Mixed up Help!!!!! posted by cowlover614:
Hi,
Forgot to mention that you can take flaxseed oil along with other meds. Flaxseed oil contains essential omega-3 oils that are deficient in our diets and they're particularly deficient in people with autoimmune thyroid disorders. They're known to help restore eye moisture, and for this reason they help TED, which is often characterized by dryness. The dryness, by the way, is what causes tearing as your eyes try to correct the dryness.