General Medicine

» gnle - Do I have Graves?

In response to Do I have Graves? posted by daisyelaine:
Hi Elaine,

Thank you so much for the information. I'm so much less stressed. I'm really hoping that it is not a severe/serious case of Graves disease.

I am a 31-year-old woman and I have a 6-year-old son. I want to have more kids but I've read about Graves' disease & pregnancy and it's somewhat discouraging. I know it's feasible, just a lot of monitoring and a fear of birth defects.

I do notice my thyroid gland is somewhat bulging out just a little. Does subclinical Graves' disease show that characteristic of the thyroid gland?

I notice you talked about stress. I've been very stressed lately. Perhaps the stress aggravates or triggers my condition?

It's great to have someone to ease my fear. I didn't know there was such a forum. Thank you for your help.

Goretti

-- posted by gnle

» Elaine Moore - Do I have Graves?

In response to Do I have Graves? posted by gnle:
Hi Goretti,
Stress is reported to be the primary trigger for Graves' disease in the United States. In subclinical disorders, patients often notice that they only have symptoms during times of stress. Studies show that stress injures immune system cells.

While stress can't always be avoided, the ways in which we react to stress can be altered. For many people, working out or meditating, help them respond to stress in a healthier fashion. During and after working out it stress sometimes seems to vanish.

The thyroid gland can be enlarged in subclinical or mild hyperthyroidism. Your size and the position of the thyroid gland in your neck influence how prominent your goiter can be. If your goiter is situated further back in your neck, it may not be noticeable but it can interfere with swallowing. If it's situated closer to the front of your neck, goiter will be more noticeable.

Graves' disease often spontaneously resolves in pregnancy because the immune system slow down. Most people on meds are able to lower or stop their dose. In some autoimmune diseases, like lupus, pregnancy can be problematic. But in Graves' disease, if the hyperthyroidism is already diagnosed and controlled, pregnancy is beneficial. Best, Elaine

» gnle - Doctor's Visit

Hi Elaine,

My endocrinologist told me that it is unlikely that I have subclinical Graves disease because he said that it is rare for that to occur. ???

According to him, it's either Graves, Hashimoto, or euthyroidism. And his recommendation is either radioiodine or surgery. He had ordered new blood test for FT3, FT4, and TSI

Obviously I'm going to get a 2nd & 3rd opinion. Now I'm not sure what I have. I definitely have a small goiter. He stated that the TPO result is meaningless because I could have inherited that antibody.

-- posted by gnle

» Elaine Moore - Doctor's Visit

In response to Doctor's Visit posted by gnle:
Hi,
We don't inherit antibodies. They're produced by our immune system, and thyroid antibodies break down within a few months. So you only have them if your immune system is making them.
You can inherit a tendency toward autoimmune thyroid disease in which case you'd make thyroid antibodies. You can have thyroid anbtibodies and have thyroid autoimmunity before a thyroid disorder actually develops.
Subclinical Graves' disease is common with many experts agreeing that many people with subclinical GD are never diagnosed and have recurring symptoms that tend to resolve on their own.
A physician poll last year on thyroid manager, the clinical textbook at www.thyroidbook.org, showed that more than 90% of physicians would watch but not treat subclinical hyperthyroidism. I'd definitely get another opinion.
Best, Elaine

» kaicee118 - My Graves Numbers

Hello - I was recently diagnosed with "mild" Graves Disease, some time after the doctor (a GP) suspected Hashimoto's. Here are my numbers from 9/27/06:

T4 - 2.8 (.8-1.9)
T3 - 329 (85-205)
TPO - 103 (0-34)
TSI - 116 (less than 130)
TSH - less than .004 (.4-4)

I had an iodine uptake on 11/7/06 and it was about 40%.

I started on 10mg methimizole on 11/10 - on 11/16 I had more blood work and my numbers came down a bit but they are still hyper.

My doc said that Graves Disease eventually "burns itself out" - is that true? Even if I don't treat these numbers, will they someday come back to normal? I'm a little confused - I know that taking methimizole is not all that good for you.

Any help you can give is appreciated.

-- posted by kaicee118

» Elaine Moore - My Graves Numbers

In response to My Graves Numbers posted by kaicee118:
Hi,
There's a good chance that you're euthyroid (normal thyroid function tests) rather than hyperthyroid. Some doctors get confused about the TSH test result. It continues to be low for a very long time (unless you move into hypothyroidism from too high of a dose of meds or move into remission). Anyway, while you're on ATDs you're considered euthyroid as soon as FT4 moves into the normal or reference range.

Judging from your results, you had a Free T4 (FT4) and a total T3. Total thyroid hormone levels measure inactive hormone that's bound to protein molecules. Because estrogens increase the level of binding proteins, the total thyroid hormone results (T4 and T3) are often falsely elevated in women and they're always falsely elevated in women on oral contraceptives or estrogens or who are pregnant.

The goal with anti-thyroid drugs is to start on a dose of about 10 mg methimazole for mild hyperthyroidism and reduce the dose after about 6-8 weeks as soon as FT4 falls into the reference range. You want to make sure FT4 doesn't fall too low. Most people get by on a maintenance dose of 2.5-7.5 mg methimazole daily after the first few weeks. Then you lower the dose as needed.

Studies show that about 1/3 of people with GD move into spontaneous remission (on their own) without medical intervention. But in general meds are recommended since they prevent side effects related to hyperthyroidism and they help the immune system heal.

Remission means freedom from disease and it occurs in GD when your immune system heals and stops producing the TSI antibodies that cause hyperthyroidism in GD. Even though your level of 116 is below the range it's the cause of your mild hyperthyroidism. Normal people have levels less than 2. People with low TSI levels also have a good chance of achieving remission.

It's always a good idea to get FT4 into the reference range by using the lowest dose of methimazole needed to do the job. Then you can stay on a low dose, reducing it over time and stopping it when a dose as low as 2.5 mg is causing you to feel hypothyroid. You can then use natural means like a low iodine diet and avoiding environmental triggers of GD to help induce remission.

The disease runs its own course so your doctor is correct in that it's a self-limiting disease that resolves on its own or burns itself out. The gland itself ends up normal. Best, Elaine

» kaicee118 - My Graves Numbers

In response to My Graves Numbers posted by daisyelaine:

Thanks very much, Elaine. One more question - based on the numbers and the fact that I do have antibodies, do you think I have Graves Disease? Is thyroiditis also considered an autoimmune disorder?

-- posted by kaicee118

» free2ridejones - In need of understanding

In response to In need of understanding posted by free2ridejones:

Hi Elaine

Just thought I would let you know my TSH reseptor results are still not through but will post as soon as I get them.

Thanks Margo

-- posted by free2ridejones

» Elaine Moore - My Graves Numbers

In response to My Graves Numbers posted by kaicee118:
Hi,
Yes, your positive TPO antibody result and your borderline TSI result confirm that you have Graves' disease. Based on your levels and your minimally elevated uptake it would be considered mild.
Another fact is that symptoms of hyperthyroidism in Graves disease generally develop when TSI reaches 125% activity. This is how this test result cutoff was decided on. Levels higher than what's seen in the normal population but below the cutoff are common in mild GD and also early GD. Both of these factors are associated with a good chance for achieving remission.
The uptake is usually closer to 65% in mild to moderate hyperthyroidism, with levels above 90% in severe hyperthyroidism. This is just a general guideline since this test is influenced by many factors, including a false decrease with a high iodine diet or exposure to iodine contrast dyes, meds containing iodine etc.
Thyroiditis is a term that means thyroid inflammation. The autoimmune hypothyroid disorder Hashimoto's thyroiditis is an example.
But thyroiditis associated with hyperthyroidism is usually transient and caused by estrogen influences during the postpartum period (postpartum thyroiditis), or infectious, for instance bacterial thyroiditis occurring after sinus infections or surgery or viral thyroiditis occurring after a viral infection. In thyroiditis pain is common and the uptake is low. Although these types of thyroiditis aren't autoimmune in origin they're associated with inflammation and this can cause a slight increase in TPO and/or thyroglobulin antibodies. Best, Elaine

» Elaine Moore - In need of understanding

In response to In need of understanding posted by free2ridejones:
Thanks Margo,
You might also want to read my reply to Kaicee since it explains how the results for stimulating TSH receptor antibodies (also known as thyroid stimulating immunoglobulins or TSI) aren't always clear-cut. I'll watch for your results. Take care, Elaine