General Medicine

» kaicee118 - My Graves Numbers

In response to My Graves Numbers posted by daisyelaine:
Thank you, Elaine. It's wonderful to receive such detailed information that's so specific to my individual case.

I have three further questions for you:

1. If Graves Disease burns itself out, runs its course, etc, why do so many people with Graves have RAI treatment or surgery? Is that just for very severe cases?

2. I don't think I mentioned that I also have symptoms - tremors (in my hands, arms and thighs when I'm standing too long), heat intolerance, palpatations and a "heart pounding" feeling, and body aches (sometimes severe). Is this normal considering my numbers, or should I look for another cause?

3. With regard to stress - a close friend of mine died suddenly two weeks ago. For the past week, the above symptoms have been very bad. Stress almost always exacerbates autoimmune disease - right?

Thanks again,

Karen

-- posted by kaicee118

» Elaine Moore - My Graves Numbers

In response to My Graves Numbers posted by kaicee118:
Hi Karen,
Doctors in the United States have been influenced by early endocrinologists who patented aggressive radioactive treatments at a time when the autoimmune nature of Graves' disease wasn't known.

Prior to the discovery of radioiodine most patients in the U.S. were treated with strong solutions of potassium iodide until they achieved remission and more severe cases were treated with surgery. Radioiodine is still recommended in the U.S. because of a notion that hypothyroidism is preferable to hyperthyroidism, and because it's the least expensive treatment over time. Insurance companies don't think of long-term consequences.

In most countries worldwide patients are treated with anti-thyroid drugs. It's only in the U.S. that RAI is recommended over other treatments, although the use of RAI for GD has declined over recent years.

Thyroid hormone is very potent and even slight increases in your levels can cause the symptoms you mention. Palpitations are generally considered harmless although they can be worrisome to the patient. Body aches aren't common although if you have muscle weakness they can occur. You can also have many nutrient deficiencies associated with hypothyroidism. Symptoms related to nutrient deficiencies don't automatically resolve when thyroid hormone levels are corrected.
You may need supplements to restore nutrient levels. Muscle weakness is associated with B vitamin deficiencies. Overall, hyperthyroidism causes deficiencies of essential fatty acids, particularly omega-3 oils and fat soluble vitamins like vitamins A, D, K, and E.

Stress, especially the stress associated with bereavement, is a well known trigger for Graves' disease. Symptoms typically worsen during periods of stress. And as you mentioned, this is a common factor in nearly all autoimmune diseases.
Best, Elaine

» free2ridejones - In need of understanding

In response to In need of understanding posted by daisyelaine:

Hi Elaine

Finally some results. I am hoping these are the right ones.

Thyroid Stimulating Immunoglobulin

1.0 U/L range (0.0-1.0)

Not sure if I should be expecting anymore or if this is it. I also had tested
Vit D 48 nmol/L range (50-150)
Urine Iodine .74 umol/L I fit into their description of Mild deficiency (0.40-0.80 umol/L)

So am I still hypo? What do I do now? I have just started taking a similar product to Armour that we have in NZ but only on 45mg so far as my doctor wnats to be sure I am hypo before increasing, well I was to be on 30mg but I bumped it up myself, so far no changes. Also on one drop of lugols.

Thanks for your help

Margo

-- posted by free2ridejones

» kaicee118 - My Graves Numbers

In response to My Graves Numbers posted by daisyelaine:

Thank you, Elaine. I have one more question (at least for now:-)). If my muscles are weak from this disease (which I assume they are because of the tremor), is it beneficial to try to strengthen them (light weights at the gym, etc), or is it better to rest? I haven't really done much physical activity in the past several months because I haven't felt well. Any time I have tried some moderate activity, I get shaky. Thanks in advance.

-- posted by kaicee118

» free2ridejones - In need of understanding

In response to In need of understanding posted by free2ridejones:

Whoops I mad a mistake. The TSI should read 1.0 U/L range 0.0-1.0 sorry.

One other thing I have noticed over the last couple of months is cartilage at about my adams apple is starting to pop out. It's hard and kind of pointy. When I swallow it goes up and down.

Thanks Margo

-- posted by free2ridejones

» Elaine Moore - In need of understanding

In response to In need of understanding posted by free2ridejones:
Hi Margo,
It sounds like you have some thyroid enlargement or goiter. Goiter can occur in both hyperthyroidism and hypothyroidism. Your TSI of 1.0 would be considered normal or right below the level where symptoms of hyperthyroidism occur, but this depends too on whether you have blocking TSH receptor antibodies. People with Graves' disease who move into hypothyroidism typically have higher levels of blocking antibodies. These antibodies prevent both TSI and TSH from stimulating thyroid cells to produce more hormone.

With the 1 drop of Lugol's and the very small dose of replacement hormone your thyroid hormone levels may be too low for you. Even 90 mg of Armour (1 grain) is considered a very low dose. It will be interesting to see what your next set of thyroid hormone levels, FT4 and FT3, look like. I suspect they'll be low. Best, Elaine

» free2ridejones - In need of understanding

In response to In need of understanding posted by daisyelaine:

Thanks Elaine

My doc did ask for TSH receptors and that is all that has come back, may be there is more to come. Do you think I am still hypo? I don't want to be taking the wrong medication. Also I see when I correct my mistake I still got it wrong (must be something wrong with my keyboard!) TSI should read less than 1.0 U/L (not 1.0) (it won't type in the less than sign) range (0.0-1.0) hopefully I have it right this time. Sorry about the confusion.

Thanks Margo

-- posted by free2ridejones

» Elaine Moore - In need of understanding

In response to In need of understanding posted by free2ridejones:
Hi Margo,
I found the last post where you listed results of thyroid function tests, and you wrote:
Our range for free t4 is (10 - 23.0)
tsh is (.30 -5.00)
t3 is (2.8 -6.8)

My results over time are
28 Nov 03 tsh .87
23 Sep 04 free t4 16.5 tsh 1.1 free t3 4.6
15 Oct 04 free t4 13.1
11 Apr 05 tsh .47
08 Dec 05 free t4 12.5 tsh 0.14 free t3 4.0
16 Oct 06 free t4 14.5 tsh 0.75 free t3 4.7
Microsomal Antibodies Positive 1:400 range (1:100)

The microsomal antibodies, which are also known as TPO antibodies, are the most significant result. They suggest an inflammatory or autoimmune thyroid process.
Your TSH has bounced around a bit, but overall it's on the rise, and your thyroid levels are close to the low end of the range. In addition your urine iodine outout was low. These results suggest a move toward hypothyroidism but you wouldn't necessarily be hypothyroid yet--that would primarily depend on symptoms.
Since suppressing the gland by using throid replacement hormone helps slow down the autoimmune thyroid process, a small dose of Armour sounds like a good idea.
Your 1.0 TSI shows that the particular method used isn't very sensitive in the reference range. But you likely don't have any indication of Graves' disease so this fits.
You're at a place where you could try dietary changes alone or a low dose of replacement hormone if you have thyroid symptoms. It would also be good to have another FT4 level. best, Elaine

» free2ridejones - In need of understanding

In response to In need of understanding posted by daisyelaine:

Thank you Elaine

Could you please suggest a low dose replacement hormone and if I was to take this do I still take my natural thyroid.

My symptoms are I wake cold in the morning, I have quite a bit of energy faster pulse and urge to get things done and a little shaky in the hands and I am slightly nervous. I pee little and often. In the afternoon I am tied get very cold and need a nap. The symptoms I have in the morning I don't have in the afternoon or the rest of the day. After asleep I mostly wake refreshed and will last until about 8.30pm. Other symptoms I have is dry skin which gets worse as I get my period. My skin is quite itchy. I get a very cold mouth only in patches usually my gums. I am also quite pale most of the time. I don't sweat much and if I do it is only under one armpit. At times I have a sensation that my skin is crawling and also numb patches (had testing for this and all was normal). No sex drive (can't remember the last time we did that, lucky to still have a husband). My muscles fatigue quite easily and I get very sore feet. I have a puffy area on the inside of one of my ankles. Sometimes my eyes are puffy on waking and I can also have a run on headaches which last about 2 weeks. Can't retain information and somtimes get muddled or I am talking flat out and not making myself very clear. I am forget things alot.

In the past I had different symptoms for eg I was never refreshed on waking and always tired. I had to get my glasses changed three times in one year. My eyes would stream, puffy face and some others but I think that is enough for now. Also I am gluten free.

Having more thyroid tests in about 22nd Dec.

Thanks Margo

-- posted by free2ridejones

» Elaine Moore - In need of understanding

In response to In need of understanding posted by free2ridejones:
Hi Margo,
Many symptoms of hypothyroidism and hyperthyroidism overlap. For instance, muscle fatigue, headaches, and eye puffiness can occur in both disorders.

And since most everyone has a period of hypothyroidism before they move into hyperthyroidism, it would be better if you just kept on with your natural dose of thyroid hormone until you get your lab results. That will make it easier for your doctor to figure out your true thyroid status. If you started taking replacement hormone now, by the time you had your tests your thyroid hormone levels could be high and your doctor would have difficulty finding out what's going on.

Most of your symptoms sound as though you're hypothyroid but symptoms in thyroid disease are fairly generic so there could be other causes.

When you get your results if FT4 and FT3 are low and TSH is still rising, you'd want to see about increasing your dose of natural hormone or adding a synthetic preparation like levothyroxine using 50 mcg (.05 mg) to start.

In the meantime you could try some natural approaches, for instance adding selenium, limiting soy and other goiterogens (foods that block iodine absorption) and adding some natural (not refined) sea salt to your diet. Continuing to avoid gluten and any other suspected allergens also helps, and so does following an anti-inflammation diet, one that's low in saturated fats and sugars and rich in natural foods. Best, Elaine