General Medicine

» 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

» Elaine Moore - TPO - what does it really tell you?

In response to TPO - what does it really tell you? posted by macurious:
Hi,
Ideally you don't want to have any TPO antibodies. I have no idea where the 35 came from.
Normal people don't have TPO antibodies but they're seen in 70 percent of people with Graves' disease and nearly everyone with Hashimoto's thyroiditis. They're an indicator of inflammation so you'll have them whenever there's an ongoing thyroid process. This test has various reference ranges so you have to look at your results and compare them to the reference range. Some tests use a range of 0-10 which would make a 10 borderline. With most ranges used a 10 would be a nice low result. Best, Elaine

» Elaine Moore - Graves Rai induced Hypo,TTC

In response to Graves Rai induced Hypo,TTC posted by macurious:
Hi,
IVIg therapy is used in people after RAI who have severe pretibial myxedema. Mostly, this treatment is used for people with kidney disease related to autoimmune diseases such as lupus.
In people with ovarian antibodies and similar causes of infertility IVIg would be used to reduce antibody titers but specific monoclonal antibody therapies would be more likely. Best, Elaine

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

In response to TPO - what does it really tell you? posted by daisyelaine:

Apparently the person who gave me that info (about the 35) was wrong about something else too, so it's clear that I can't trust her information. Thanks for the clarification.

-- posted by macurious

» cowlover614 - mixed up

In response to mixed up posted by cybee:

Hey I just now seen this. Hope your doing ok! Me not so good. I've never felt so bad in my life!! And I mean that! If I don't end up at the ER I'm trying a new doctor this Friday. I'm not sure I can go two more days like this. I thought I was having a heart attack last night. The body aches are awful swelling is worse and I'm breaking out in sweats. No energy what a nightmare this has been. Gosh where did normal go and will it ever be back. I'm hangin in here but it isn't easy. Shirl

-- posted by cowlover614

» u25000 - Graves Rai induced Hypo,TTC

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

I also have heard of this, I spoke w/someone who took it 10 times, its an IV of immunoglobulin that lasts about 6 hours each time and costs approx 1500 ea time. Its done by Antibody specialist REs. Mine doesn't get involved and he's a director for the RE Dept,has been in practice 20 years. I'm obviously concerned that he's not familiar or interested, as if he's too conventional, and I've already suffered from "too conventional" re: RAI. The woman did say that every since she started IVig she couldn't stop getting preg. even w/other obstacles. And that her first attempts w/IVF (no ivig) were neg. So its hard to tell. She couldn't really confirm either what helped for sure, but agrees w/IVig.

-- posted by u25000

» u25000 - TPO - what does it really tell you?

In response to TPO - what does it really tell you? posted by macurious:

I know the same stuff your first post says
My range does say 0-35, in 2003 I was at 11, in 2007 I was at 18. So if 0-10 is a truer range, I guess I should be concerned. Someone had told me that TPO is a natural AB, so I thought thats why my 0-35 meant I was "normal".

-- posted by u25000

» cybee - mixed up

In response to mixed up posted by cowlover614:

I certainly hope the doctor you see on Friday knows what he/she is doing! I certainly understand how dreadful this feels! Just now I wondered if I was having a heart attack too! I want my health and sense of normalcy back! I hate going into such anxiety so oft and so I wonder what my new labs will tell me (new labs not yet taken)(have to wait until X amount of time after I quit taking synthroid)and I hope (like you) that I can get to feeling normal again! Don't you miss those "good old days"? Didn't know I had it so good before! (just feeling normal!) ha! One takes health for granted. Is the doc you are seeing an Endo or ?

-- posted by cybee

» cybee - mixed up

In response to mixed up posted by daisyelaine:

Elaine,
Thank you for your excellent information! I have to wait 2-3 months after I quit taking (on my own accord) my low dose synthroid before I get my new labs (so that means in this next month I go in to get new labs). I am hoping that something can be done to alleviate the stress that I feel so oft. I appreciate the articles you have written also, especially the TED articles! You are something of a lifeline of info! Thanks! B^)

-- posted by cybee