General Medicine

» u25000 - Elaine: Post Rai Hypo Lt4 and PREG

In response to Elaine: Post Rai Hypo Lt4 and PREG posted by daisyelaine:
YOU HAVE BEEN SO HELPFUL THIS PAST YEAR
I reported to you recently that I was very newly preg finally.
This is thanks to FSH injections. The last day of injections 7/7 I had labs done which indicated the following:
(on synthroid 100 since 5/6)
TSH .04 (.03-5.5)
FT3 3.2 (1.9-3.9)
FT4 1.73(.76-1.7)
It appears those #s are great; except for tsh which RE said was too low. What does this mean? Isn't it correct that Tsh is an inactive signal whose purpose is convey the condition of thyroid, but I don't have a thyroid so shouldn't be considered, right (as you've mentioned in articles)? Well as I understood ft3 is the best indicator of the active hormone, mine seemed great,finally. However, FT4 has been slightly elevated; but thats an inactive hormone which is "stored" as the body need more hormone to convert to t3 right? So that elevation shouldn't matter either. Yet I've read that TSH and FT4 are the primary for Graves.
Anyway, I told you after the 7/7 labs I freaked out, and chose to stop lt4 altogether for 1 whole 7 days, before taking 88mcg per RE request. Well last week 7/31 I asked for post preg labs and they only ordered TSH which was .71. So I ordered my own labs and did those 8/6 the results are as follows:
(7/8-7/15 no lt4; 7/16-8/5 88mcg) LabCorp p/healthchkusa
TSH .9 (.5-1.2)
FT3 1.34 (.27-4.2)
FT4 2 (2.3-4.2)
Days after I had stopped I had noticed palpitations, but I didn't know if they were related to the FSH injections I was taking. So I didn't consider an issue. I have seemed more lethargic the past few weeks, but could be pregnancy. I have easy numbness in the extremites when I sit on them for a bit, but I've never really compared. My hair does seem to be changing again.
Most importantly, I was so ready for this preg to not be affected by my thyroid and very quickly it seems, no thanks to Graves inept Docs, I may be facing complications considering the obvious labs. And of course, it will be easy for them to blame age. Do you have any more advice? What time frame is this lab indicative of, I hear 4 weeks ago? I took the lab before I took the Lt4 as you said before. How long after LT4 should you have a lab done, hour, hours? Should I ORDER another lab next week? Should I IMMED increase back to 100 or higher- considering yours and Shomons info suggesting 40-50% increase upon preg? YOUR TIME IN REPLY GREATLY APPRECIATED!

-- posted by u25000

» u25000 - ADDEND:Elaine: Post Rai Hypo Lt4 and PREG

In response to Elaine: Post Rai Hypo Lt4 and PREG posted by u25000:
FORGIVE ME THE LABS FOR 8/6 ARE AS FOLLOWS (NOT AS PREV)
TSH 1.34 (.27-4.2)
FT3 2. (2.3-4.2) LOW
FT4 .9 ( .5-1.2)
AND I SHOULD MENTION AS YOU CONSIDER THESE #'S AND THE STOP PERIOD (MY FAILURE;believing would help body catch up faster to 88 dose) THAT EMBRYO SHOULD HAVE IMPLANTED ABOUT 7/16 (THE 2ND DAY I RESTARTED LT4)BASED ON OVULATION INDUCTION DATE 7/9. ALSO THIS LAB DID SOME FOR ME IN APRIL WHICH WERE SIMILAR RANGES TO WHAT I'M USED TO; THIS TIME ARE DIFFERENT #'S; I WORRY OF THEIR RELIABILITY, SINCE THEIR INDEPENDENT. I HEARD THAT LABCORP DRAWING CENTERS ARE OFTEN REDONE BY OTHER CENTERS-WHICH MIGHT EXPLAIN WHY A RECENTLY OPENED OFFICE HAS ALREADY CLOSED NEARBY; NOT TO SAY THERE REALLY IS A PROBLEM W/MY NUMBERS.

-- posted by u25000

» erimay - Newly diagnosed with Graves Disease

In response to Newly diagnosed with Graves Disease posted by nurseheatherone:

I was also just diagnosed with GD. I felt lightheaded w/ the beta blocker (toprolol), but after I cut in half, it stopped. My endo told me to take PTU, and that in approximately 4 months I can start trying to conceive, but I can't stop taking PTU pregnant or nursing. Also, I have read that the RAI can harm the fetus no matter how long after you wait, and that it can pass problems on to children's children. I sympathize with the symptoms, I have ridiculous ones myself. Good Luck!

-- posted by erimay

» kiolli - Post RAI-now Hypo taking generic synthroid

Hi Elaine,
This a really neat site! I was finaaly diagnosed with Graves April of 06 and treated with RAI. I feel a lot better but still wonder if this was the right treatment. I suffered for about 3 years before anyone could tell me what was wrong so I am grateful that I am feeling better. My labs are all WNL, my TSH is a little less than 2.0 which I seem to like. I am on a generic synthroid. I tried to switch to regular synthroid but it hit me too hard and I felt hyper again. My problem now is my weight, in spite of exercising and dieting I can't seem to loose any weight. I am stuck and am very frustrated. What do you think is the best diet? Should I also avoid iodized salt and nutrasweet now that I am not hyperthyroid anymore? Would a T3 drug help me metabalize my food more efficiently so I can loose some unhealthy weight? Thanks Kim

-- posted by kiolli

» nurseheatherone - Newly diagnosed with Graves Disease

In response to Newly diagnosed with Graves Disease posted by daisyelaine:
Dear Elaine,
I am very thankful for you response, I will definetely take a look at the carnitine article. I am still a bit concerned about RAI, it seems as though alot a people claim to have alot of problems with regulating hypothyroid after RAI. Since I would like to have children in the next couple of years I am hoping to choose the option that is safest with pregnacy and my endo says that she has given babies goiters on small doses of ATD's during pregnancy. I am just nervous that by taking RAI and then 6 months later having problems concieving because of the fluctuating thyroid hormones.

The period of hypo makes alot of sense in my case because I started gaining weight and Bp and cholesterol increased all at once with no previous problems. Now my BP is actually low even though I take a small dose of lisinopril. As far as weight gain goes I am not gaining any weight at his time becuase around the time of my diagnosis I was told to stop excercising ( Because of dizziness and fast pulse) so I began South Beach diet and have since lost 13 pounds but have stalled now that I started tapazole and slowly adding back good carbs. Since I really did not lose any weight from GD is it possible that I will not have any weight gain when I become Euthyroid?

I beleive that I do have a genetic predisposition to GD. My Grandmother had addisons disease and my great grandmother had Chrons disease and I am almost positive that my great grandfather had GD all from one side of the family. Other than that I am the only one that seems to have any health problems in my immediate family. I did also do alot of different types of diets before I had symtoms of GD. The one thing that I do not here alot about is acne with hyperthyroid. That was one of the first things that triggered me to thing that something might be going on. I took accutane in highschool and had a beutiful complexion until about a year ago. Now I have weird cystic type of acne along my jaw line and my neck. Is there any relation here?

Finally, my husband has full blown cold and I am noticing slight fatigue, headache mouth sores and sore throat but no fever. Should I be worried that my WBC's are declining, I read that this is a severe reaction to Tapazole. I would assume that I would notice symptoms more drastic that this if there was a problem, I am just assuming that I am sharing germs with my husband.
I apologize again for the long posting, so many questions so little time

-- posted by nurseheatherone

» Elaine Moore - ADDEND:Elaine: Post Rai Hypo Lt4 and PREG

In response to ADDEND:Elaine: Post Rai Hypo Lt4 and PREG posted by u25000:
Hi,
FT3 is slightly low but the other labs look ok. You'd have to be on a stable dose for at least 3 weeks to tell if changes are needed. Since you're doing well in your pregnancy and have enough FT4 on board, I'd probably leave things alone for now. With your next set of labs if FT4 and FT3 are any lower you'd probably need to up your dose. Best, Elaine

» Elaine Moore - Newly diagnosed with Graves Disease

In response to Newly diagnosed with Graves Disease posted by erimay:
Hi,
PTU has been used successfully in pregnancy and nursing for more than 50 years. After the first 6 weeks your dose will be reduced. In pregnancy it's recommended that you be on a dose less than 200 mg daily. Most people get by on a maintenance dose between 25-150 mg daily. And during the second half of pregnancy, thyroid hormone levels usually fall. Most women are able to then reduce their dose or stop it entirely.
It's true that mutations caused by RAI are passed on to offspring. There haven't been any long-term studies to gauge these effects. Best, Elaine

» Elaine Moore - Post RAI-now Hypo taking generic synthroid

In response to Post RAI-now Hypo taking generic synthroid posted by kiolli:
Hi Kim,
Unfortunately weight gain is a side effect of treatment for hyperthyroidism that causes permanent hypothyroidism. Not everyone will gain weight but most people gain an average of 30 lbs.
It does help to avoid sugar, saturated fats, excess dietary iodine in fast and processed foods and you definitely want to avoid Nutrasweet.
Many of us quit converting T4 into T3 very well after RAI, and over time hypothyroidism worsens. So you want to have levels at least every 6 months and more often if you're adjusting your dose. Your FT3 level will indicate if you'd benefit from replacement T3. I felt much better after switching from levothyroxine (T4) alone to a glandular hormone (Armour) which contains all of the components of thyroid hormone. Best, Elaine

» Elaine Moore - Newly diagnosed with Graves Disease

In response to Newly diagnosed with Graves Disease posted by nurseheatherone:
Hi,
Most people with Graves' disease who achieve remission with meds (ATDs) do not gain weight when they become euthyroid unless they developed some bad habits when they were hyper or have lots of nutrient deficiencies that are causing food cravings. Your metabolism returns to normal when you achieve remission.
PTU only slightly crosses the placental barrier. It would be difficult to cause neonatal goiter unless someone was on an inappropriately high dose. The general rule is to only use enough PTU to keep FT4 within range regardless of TSH. However, many doctors are confused by this and prescribe high ATD doses in an effort to raise TSH. You're considered euthyroid with normal thyroid function when FT4 is within range, and it's well known that TSH can stay low or suppressed for up to two years after achieving remission.

It does sound like you have a genetic predisoposition to GD.

Hyperthyroidism can increase oil production, and iodine itself can cause cystic acne. If you're unusually sensitive to iodine, and many people with Graves' disease are, dietary iodine and excess thryoid hormone can contribute to cystic acne. Getting your levels within range, but not too low, and watching your diet carefully should help. Best, Elaine

» Elaine Moore - Newly diagnosed with Graves Disease

In response to Newly diagnosed with Graves Disease posted by tdove52:
Hi,
Strenuous exercise is a known trigger for GD. By strenuous I mean long distance running or heavy weight lifting. I haven't seen anything that points to this being a specific trigger for people with hypothryoidism.

It's thought that all autoimmune thyroid diseases are the same disease and the symptoms depend on what thyroid antibodies are predominant. Once you're diagnosed with an autoimmune thyroid disease, it's not unusual to move from one disorder to another. For instance, about 20 percent of people with Graves' disease spontaneously develop autoimmune hypothryoidism. This condition, like the hyperthyroidism, can resolve on its own.

I haven't seen any studies focusing on determining why people move from hypo to hyper other than studies on the predominant antibodies.

As for strenuous exercise being a trigger for GD, this is well accepted. You can find references in the textbook Werner & Ingbar's The Thyroid by Braverman and you may be able to find info from journal articles if you search PubMed or look on the ThyroidManager online thyroid textbook. Best, Elaine