General Medicine

» dana65 - Approach to Mild GD with Osteoporosis

Hi Elaine . . I was diagnosed with GD last June, following lab work and radiology tests -- thyroid uptake, scan and ultrasound (precautions because I had had X-ray treatments for acne in the 1950s.) My only symptoms are weight loss, a slight hand tremor, some sweatiness, and more frequent bowel movements. The weight loss seems to have stabilized, as have the bowel movements. My lab work last week showed a TSH of .01 and a FT4 of 1.3, up from 1.14. Reading these posts has made me think that my FT4 is still within a normal range. However, my endo says the GD is progressing and wants to start me on 10 mg of Tapazole. I'm considering a Wait and Watch approach while I pursue some diet changes and alternative medical approaches, since my GD is so mild. I do have osteoporosis, though, and I know that is a consideration. Just wondering what your thoughts would be on this. Thanks . . . and thanks for this site. It's so helpful.
Dana

-- posted by dana65

» Elaine Moore - Newly diagnosed with Graves Disease

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

Hi,
Your levels are only slightly elevated. The reference range for FT4 is 0.8-1.8 and for FT3 it's 2.3-4.2. TSH stays low for a long time and doesn't mean that you're still hyperthyroid.
The RAI uptake is usually around 60% in mild hyperthyroidism and over 90% in severe hyperthyroidism. This result though is affected by many things so it's not very helpful.

TSI generally causes symptoms of hyperthyroidism when levels exceed 125%. Your level isn't much higher. But for remission, you'd like it to continue a downward spiral and reaching around 50%.

TSI is usually only a problem for crossing the placental barrier in people with levels higher than 400% or so. These are people with severe hyperthyroidism or people who have had RAI because RAI dramatically increases your thyroid antibody titers for a long time. People with low TSI levels like yours do have a better chance of achieving permanent remission. Best, Elaine

» Elaine Moore - Approach to Mild GD with Osteoporosis

In response to Approach to Mild GD with Osteoporosis posted by dana65:
Hi,
There was a case presentation in Clinical Thyroidology a while back of a person with labs similar to yours. 90% of the physician respondents said they would adopt a wait and see approach. And I agree. You should also have an FT3 level too because sometimes FT3 rises higher relative to FT3. But because we produce so much more FT4 than FT3 treatment would still be based on your FT4 level. The problem with starting Tapazole is that it would easily cause your FT4 to fall into the hypothyroid range. And it's important to avoid becoming hypothyroid since this causes your gland to speed up its activity in trying to correct the problem. This causes increased thyroid antibody production and defeats the purpose.
If your doctor did test for FT3 and it was elevated, then he might want to use beta blockers like propranolol or atenolol because they reduce the conversion of T4 into T3 and mildly suppress thyroid hormone levels. So they help reduce FT3 without causing a move into hypothyroidism. There's really no significant difference in a 1.14 FT4 and a level of 1.3. They're both low normal and we could repeat the same blood sample and get either of those results they're so close.

As for TSH, on its own a low TSH doesn't do anything but help keep your thyroid levels, FT4 and FT3, from rising. I have osteopenia and it was at its worst when I was hypothryoid after RAI. It's improved a great deal and my TSH is never above .01 and my FT4 is never below 1.7. Best, Elaine

» Elaine Moore - Help need input

In response to Help need input posted by cowlover614:

Hi,

You may have been hyperthryoid when you were on the Synthroid. Your labs now are fine except that TSH is still low. But a low TSH doesn't mean that you're now hyperthyroid because it lags at least 6 weeks behind thyroid hormone levels. And if you have TSH receptor antibodies, which are common in autoimmune thyroid disorders, they'll falsely decrease your TSH level. If your levels are this good after 2 weeks without meds, you should be fine waiting until October to see a new endo. It sounds like a new endo is a good idea. Best, Elaine

» nurseheatherone - Newly diagnosed with Graves Disease

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

Thanks for the info! I ahve an anohter apointment with 2 endos( 1 that I originally had a n apt with and one that ended up going to) in a couple of weeks and I am planning to tell them that I want to continue ATD's and not do the RAI, I am assuming with a milder case of GD that hopefully I ultimately should not need RAI? Also I was reading one of the sites on your web page and on of the people suggested not takin gdairy out of your diet because the thyroid then enlarges and can produce more hormones with less iodine? I was going continue limiting my dairy intake and I just was wondering what he was talking abut, he also said that same thing about goitrogens.

Thanks again for all of your help this week I will be starting your book as soon as it arrives this week!
Heather

-- posted by nurseheatherone

» dana65 - Approach to Mild GD with Osteoporosis

In response to Approach to Mild GD with Osteoporosis posted by daisyelaine:

Hi again . . Thanks for your comments. An FT3 has not ever been done. Why would it be helpful? Also, I called the nurse to see the TSI and TPO scores from tests taken last May. She said the TSI was 287, and the TPO was 8177. That sounds incredibly high. Would that alter your view about me taking medication? -- Dana

-- posted by dana65

» kiolli - T3 levels

Thanks Elaine!
I will ask about what my T3 level is or ask if I can have that drawn with my next set of labs. I tried splitting the synthroid dose and taking it twice a day. I still had trouble with it. I now take the generic as a split dose 50mcg twice a day. One embarassing side effect I now have is body odor. I don't sweat excessively but I smell like I do! Will I ever be able to tolerate caffiene? I loved coffee prior to all of this and now drink decaf and that even bothers me! So far RAI has made me feel better but its upsetting that I still have occasional hyper symptoms and am now overweight! Looking back, I think I have suffered with hypo/hyper symtoms for many years. I had a great aunt with graves and after reading your articles I don't know if it was stress, allergies, or strenuous exercise that expressed the graves in me or a combination. I have experienced all three triggers. I remember some symtoms starting when I was training for a half marathon. Thanks for listening! Kim

-- posted by kiolli

» Elaine Moore - Newly diagnosed with Graves Disease

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

Hi Heather,
Iodine is one of the most common triggers of autoimmune thyroid disease, both hyperthyroidism and hypothyroidism. This has been the case ever since the government mandated adding iodine to foods to prevent iodine deficiency anemia. To do it cheaply they made a chemical with iodine in it that is foreign to our bodies. Our immune systems respond accordingly and produce thyroid antibodies, which leads to thyroid disease.
Goitrogens, if used in excess, can cause hypothyroidism. Use moderately like 1.5 cups daily they'll reduce how much thyroid hormone your gland can make.

Best, Elaine

» Elaine Moore - T3 levels

In response to T3 levels posted by kiolli:

Hi Kim,
It's not unusual for a few different triggers acting in concert to trigger GD. Like allergies alone might not trigger GD in some people, but when allergies and stress are both present, the immune system really revs up its response.
The body odor could be from being hypothyroid and having a sluggish digestion and metabolism. With adequate thyroid hormone this might resolve. Best, Elaine

» Elaine Moore - Approach to Mild GD with Osteoporosis

In response to Approach to Mild GD with Osteoporosis posted by dana65:

Hi,
TPO antibodies are usually only that high in hypothryoidism. You were probably moving from hypothyroidism into hyperthyroidism. Your TSI has certainly come down nicely since then. This makes it appear as though your GD is resolving on its own without treatment. This happens in about 1/3 of people. Whatever you're doing is helping.

About 1/3 of the people with GD produce more FT3 relative to FT4. They're measured in different units sort of like ounces for FT3 and pounds for FT4. So a rise in FT3 isn'[t as significant as a rise in FT4 but it could explain some symptoms and it would suggest that beta blockers be used to help lower your FT3. Best, Elaine