General Medicine

» cybee - mixed up

In response to mixed up posted by cowlover614:

OOPs! Meant to say hang in there, Shirl! (of course, Elaine, I always wish the best for you too! You have been so very helpful in such a good way! Wonderful advice! ). But...accidentally I wrote Elaine instead of Shirl in my last post! ha!

-- posted by cybee

» Elaine Moore - mixed up

In response to mixed up posted by cybee:
Hi Cybee,
Most people with thyroid eye disease end up developing an autoimmune thyroid condition, usually Graves' disease, within a year or two of the eye diagnosis. It's good that you're having your labs tested. Best, Elaine

» u25000 - Graves Rai induced Hypo,TTC

Please clarify what thyroid tests are adversely affected by Clomid? Totals? I only get free T's done. Are there other important labs affected that you are aware?
I understand p/your articles on Preg,that thyroid hormone fluctuate w/Graves (on atd)when your Preg, its not clear if the same goes for Graves a/RAI. I wouldn't think so since there is not a naturally produced hormone?
Curious if u know, I've read articles re: aspirin therapy when TTC for those w/thyroid ab's (on Lt4). What I find is they refer specifically to TPOab and Anti Thyroid Abs. Sometimes I hear Graves ABs (tsi) included and sometimes not. I'm trying to understand if those trials/studies pertain to me w/Graves.

Finally, I've heard more about pituitary tumors and adrenal insuff here than anywhere, can you tell me how these things are diagnosed. My OB or RE have never mentioned/tested directly.

-- posted by u25000

» cybee - mixed up

In response to mixed up posted by daisyelaine:

Yes, I just read your article re Graves Eyes. It noted those with Graves Eyes that do not go on to develop Graves shortly thereafter are euthroid (sp?) but that is a result of competing antibodies (?) (okay, so I don't have the article in front me now...and actually read it yesterday so may be confusing some facts.)..but that then one can have symptoms of both hypo and hyperthyroidism! yikes! That sounds unpleasant too (but it is self limiting?). I have lost 10 pounds since Jan and am so anxious about things...I suspect I will have Graves thyroid (after new labs..which I have not done yet), albeit I don't have tremors or other symptoms (but do have a subtle itchy rash..but that may be due to other things). I hope to get back to feeling normal..so almost hope there is a med..you think if it is Graves thyroid then I will go on just meds and maybe beta blocker ?

-- posted by cybee

» macurious - Graves Rai induced Hypo,TTC

In response to Graves Rai induced Hypo,TTC posted by u25000:

I can't answer your question about Clomid, but I can make a comment about TTC with Anti Thyroid Abs. I've heard of IViG being used for patients with Graves a/RAI. You can read more about it on www.repro-med.net but I don't know how effective it is (or even if it's necessary). I'm TTC and this treatment didn't work for me at all, so I'm not sure what to think at this point.

-- posted by macurious

» macurious - TPO - what does it really tell you?

I just heard that you want your TPO to be 35. What does it mean to be within that range? Is this information meaningful at all to a person with Graves after RAI? (My TPO is 10.)

(I've heard that this test is also called thyroid peroxidase (TPO) antibody (TPOAb) test, thyroid peroxidase autoantibody test, antimicrosomal antibody test and antithyroid microsomal antibody test.)

-- posted by macurious

» cynthia62 - bloodwork results using alternative treatment

Hi Elaine,
I have previously written a couple months ago. At that time, I started exploring alternative treatments for my Grave's and TED. I have been using acupuncture, massage, chiropractic, homeopathic and chinese herbs. I still take 20mg of tapazole once a day and a 10mg capsule of omeprizole(generic previcid) daily. I have just received results from some bloodwork that my Dr has ordered. They include:
Free T3 175.1
Free T4 1.48
TSH 0.01
Reverse T3 0.60 (range .18 units .51)I'm not sure what is
Thyroglobulin 14.0
Thyroproxidase 2660
I did not receive information regarding the normal range for these tests, but all are high with the exception of the TSH.
Can you please explain to me what these tests mean? And what each specifically checks? Does that make sense? At what point should I start decreasing my Tapazole?

I started taking coenzyme compositum, Heal-all, Galium-Heel and a chinese herb called phlegm transforming formula, when I started seeing this new Dr. I have noticed that since I started with this treatment: I have been sleeping better, I seem to have more patience and don't feel as anxious as I have in the past and my eyes do not seem to be bulging as bad. In fact, my sister mentioned to me that my eyes looked better than they did when I had seen her at a family gathering in March. The only symptom that I have noticed that is of concern is that my pulse rate has seemed to increase from my normal rate of 79-84 (resting) to 84-98 beats per minute. I mentioned this to my dr and he didn't seem too worried about it at this point. At what rate would you suggest I be concerned about the heart rate? I intend to pose this question to my Dr at my next appt thie Friday, but would appreciate your input. Thank you so much for your knowledge and support. It is greatly appreciated!
Cynthia :-)

-- posted by cynthia62

» Elaine Moore - Graves Rai induced Hypo,TTC

In response to Graves Rai induced Hypo,TTC posted by u25000:
Hi,
Clomid doesn't affect thyroid function tests. Because there can be changes in your sex hormone levels, you should be measured with free rather than total thyroid hormone levels. Since you are, these levels are reliable.
After RAI, TSH is often misleading since it's falsely decreased by TSH receptor antibodies, and these antibodies increase dramatically after RAI.
It's important to avoid hypothyroidism by ensuring that FT4 and FT3 levels are at least at mid-range, regardless of TSH. Infertility is much more likely to be associated with hypothyroidism than hyperthyroidism.
After RAI, our thyroid hormone levels fluctuate much more than when we're on ATDs. First, we still have some residual thyroid tissue that's being acted upon by both stimulating and blocking antibodies. Second, our needs for thyroid hormone are dependent on our diet, stress level, temperature, altitude, amount of exercise, general health, amount of sleep and other factors. Normally, our body produces different amounts of thyroid hormone to deal with these changes and the pituitary regulates our levels via TSH to keep these levels stable.
When we're on replacement hormone, these needs affect our levels. It's not practical to assume that one dose of thyroid hormone will meet our needs adequately. Fluctuations are very common. For instance, last summer the same dose of replacement hormone that keeps my FT3 around 3.5 in the winter caused my FT3 to rise to 7.1 (range 2.3-4.2).
TPO abs are associated with fertility problems and miscarriage so it's important to monitor them. TSH receptor antibodies cross the placental barrier and can cause fetal hypothyroidism and hyperthyroidsm. Most problems that occur in neonates are seen after RAI because the levels are so much higher. It's important to measure these levels in the first and third trimesters of pregnancy.
Our risk for pituitary tumors isn't particularly high but we're at risk for adrenal insufficiency if we have long-standing hypothyroidism or if the immune stimulation of RAI causes us to produce adrenal antibodies. A cortisol level is used to diagnose adrenal insufficiency. If a morning level is low, a stimulation test and tests for adrenal antibodies are run. Most people with thyroid disorders do not have adrenal insufficiency and taking cortisone when it's not needed is the primary cause of secondary adrenal insufficiency because of the disruption of the feedback mechanism.
Symptoms of adrenal insufficiency include marked weight loss, shakiness, and very low blood pressure.
Aspirin therapy isn't used for people with thyroid antibodies who are trying to conceive. It's used for people who have cardiolipin and other antibodies that cause blood to clot too fast. This is called antiphospholipid syndrome (APS) and it can occur in people with Graves' disease, lupus and other autoimmune disorders. Read my articles on APS and on autoimmune infertility for more info. Best to you, Elaine

» Elaine Moore - mixed up

In response to mixed up posted by cybee:
Hi,
You got the facts straight. When only the eye disease is present and thyroid function tests are normal, it's called euthyroid Graves' disease. In this case people usually have approximately equal levels of both stimulating and blocking TSH receptor antibodies. The blocking antibodies prevent or block the stimulating antibodies from causing hyperthyroidism and so thyroid function tests are normal. Eventually, people begin producing more stimulating than blocking abs and this causes hyperthyroidism to develop. Both of these antibodies, however, contribute to the eye problem, and people who have high concentrations of both types of antibodies are most likely to have clinically significant thyroid eye disease.
You don't want to use meds to lower your levels if they're normal because the levels would then fall too low. If hypothyroidism develops the gland speeds up its activity trying to correct the problem. This causes increased thyroid antibody production and makes things worse. If you were to use meds in this case you'd need to use block and replace, using both an anti-thyroid drug and thyroid replacement hormone (levothyroxine) to prevent becoming hypothyroid.
Both of these antibodies, by the way, falsely lower TSH results so you have to be careful to primarily look at your FT4 level when you're using meds to avoid inadvertently becoming hypothyroid due to misleading TSH results.
Steroids are sometimes used since they lower antibody production. The problem is that they have some serious side effects and when you stop them antibody levels often rise and symptoms worsen.
You can help your immune system heal and that'll help symptoms by using antioxidant vitamins, flaxseed oil, stress reduction techniques, avoiding sugar and saturated fats since they promote inflammation, etc. My old article on Tips for TED has more suggestions.
And if you do move into hyperthyroidism, based on your FT4 and or FT3 levels, Tapazole offers protection from TED and helps reduce symptoms because it mildly suppresses the immune system. Best, Elaine

» Elaine Moore - bloodwork results using alternative treatment

In response to bloodwork results using alternative treatment posted by cynthia62:
Hi Cynthia,
Your major thyroid hormones are T4 and T3, and they're best measured in the free form with FT4 and FT3 levels.
Read this article on TSH test to learn about the pituitary hormone TSH and to understand why you expect it to be low for some time. A low TSH in someone being treated for GD doesn't mean that they're still hyperthyroid although some doctors get confused by this.
You had a total T3, not an FT3 judging from the result. This test result is usually falsely increased in women so your level of 175 with a range of 80-180 is fine.
We have much more T4 than T3 so you're primarily concerned with your FT4 level. The range is 0.8-1.8 and your level is good. When it falls into the normal range (like yours has) the tap dose should be reduced to a maintenance dose between 2.5 and 10 mg daily to prevent FT4 from falling too low. After the first 6 weeks on meds when all the hormone has been dissipated or released from your gland you need less Tap because you're just helping prevent the production of new hormone.

Reverse T3 is not an accurate test at all. It just measures how much inactive T3 you have. Today this test is considered obsolete and the FT3 is used to measure the active hormone. Once labs developed tests for FT3 the reverse T3 went out of use but some older docs seem to like it.
Thyroglobulin tests are meaningless unless someone is being monitored for thyroid cancer. If this is really thyroglobulin antibodies your result is normal to slightly elevated, which is typical for Graves' disease. About 50 percent of Graves' patients have these antiboedies.

We don't measure thyroid peroxidase (TPO) so this has to be a TPO antibody test result. Your result is very high and indicates that you still have lots of thyroid inflammation. This level will eventually fall. For GD it's better to have a test for TSI, the thyroid antibodies that cause Graves' disease to get a baseline. This is the level you're more concerned about and it's a good idea to get a baseline level.

Be sure to measure your heart rate after you've been at rest for at least 10 minutes. Ideally you'd keep it below 100 and make sure you're not ingesting too much caffeine, sugar or other stimulants if it's elevated when you're at rest.

Overall, it sounds like you're approach is working well. You didn't mention diet so I'll just add to be sure you're avoiding excess dietary iodine by avoiding fast/processed foods and any supplements that might contain iodine. Best, Elaine