General Medicine

» cowlover614 - eye drops

In response to eye drops posted by daisyelaine:

Hi Elaine, Thanks you are always so much help. We would be lost without you. Many Hugs! Shirl [I'll let you know]

-- posted by cowlover614

» dana65 - Question 526 et. al.

Hi Elaine . . . I think my post on Sept. 24th (Number 526) got overlooked, since later posts have already been answered. Would you mind doublechecking that? Thanks.

And now I've thought of another question to add to those. I've read that sea salt is high in iodine, but when I visited my son, he had a container of sea salt that said, "This product does not provide iodide, a necessary ingredient etc." Are some sea salts high in iodine and some not? Can one trust labels?

Oh-- and one thing more: How variable are labs? Every time I read about FT4, the reference range is stated as 0.8-1.8. When my last lab came back with an FT4 of 1.3, it was listed as out-of-range. Could that lab be that far off what is usually listed as the normal range?

Thanks again.

Dana

-- posted by dana65

» Elaine Moore - Question 526 et. al.

In response to Question 526 et. al. posted by dana65:

Hi Dana,
I'm sorry your last post got overlooked. I'll get back to it.

Sea salt is wonderful. This article explains more about it.
www.suite101.com/article.cfm/graves_disease/115556
Sea salt contains traces of essential iodine and a number of other elements.

It's refined iodized products that you want to avoid. Subsidized iodine is an unnatural manufactured chemical with aluminum added to prevent caking. Refined salt is not the same as natural (not refined) sea salt, which is coarse and usually grayish. You can trust labels. The sea salt your son has like uniodized Morton's salt doesn't have iodized compounds. The amount of iodine present is likely below detection limits.

I've heard that there's one new laboratory method for FT4 that's using a lower range. Your lab may have switched to this method. None of the labs in my area are using this assay so I'm not sure how it compares to the traditional immunoassays used for hormone analyses.
But typically, if your FT4 is elevated in one test it should be elevated in other methods even when the range is different.
If you feel that your lab result could be in error, and this isn't out of the question, you can have your doctor request that the lab send the specimen to another laboratory. Best, Elaine

» Elaine Moore - Another Graves questions

In response to Another Graves questions posted by dana65:

Hi Dana,
Dairy products are generally high in iodine because iodine is used in milking equipment as a disinfectant and there's carryover. Once you're in remission, you can eat dairy in moderation.

Most doctors feel that hypothyroidism isn't much of a disease and that complaints are exaggerated. Even though end-stage hypothryoidism, which is myxedema coma, has a much higher fatality rate, hyperthyroidism is considered more serious because of the risk of thyroid storm and confusion about thyroid storm.

So traditionally, doctors have treated hyperthryoidism aggressively. The trend is starting to change though because of more patients questioning aggressive treatment. The doctor who recommended RAI for me 15 years ago for mild hyperthryoidism now tells patients with moderate hyperthyroidism that a "wait and see" approach is fine.

For me hypothyroidism has caused weight gain, acne, hearing loss, muscle and joint pain, sleeping problems, heart problems, hair loss, and bone loss, whereas the radioiodine itself and the associated immune stimulation has caused celiac disease, pretibial myxedema, eye changes, thyroid nodules, and pancreatic atrophy. Hypothyroidism is also difficult to manage when the autoimmune process continues and the thyroid antibodies, which increase after radioiodine, cause falsely low TSH results and this can make monitoring doses of replacement hormone difficult.
Since my hyperthyroidism was mild at the time of my diagnosis and had pretty much resolved, I didn't have any major symptoms.

» nurseheatherone - Another Graves questions

In response to Another Graves questions posted by daisyelaine:

Hi Elaine,
Question about dairy? both my endo and my GP have told me not to give up dairy ( even though I was doing it anyway) they said especially if I am thinking about getting pregnant in the future it would not be a good idea. I understand that you can get calcium from other food sources, I am just wondering why my Dr.s are not aware of the excess iodine in these foods? for that matter my endo said that I did not even need to avoid dietary iodine, only scans that use the contrast dyes.

Also, since I have cut my medication in half I feel much better, not as many anxiety episodes and throat tightness. SHould I still be eating goitregens on a regular basis ( soy, peaches, almonds) now that my levels have changed so quickly? am I going to make myself hypo?

The other concern I have is my skin, I thought my cystic type of acne was getting better,but not long after I got my new lab results back my chin erupted again. I did not have any problems with my skin before this ( except as teenager), is it this common to have such a hormonal response, should I go see a dermatologist to make sure it is not something else. Also my periods are still irregular alternating 25- 38 days and my skin is at it's worse before and after. Any info would be appreciated!
Thanks, Heather

-- posted by nurseheatherone

» Elaine Moore - Another Graves questions

In response to Another Graves questions posted by nurseheatherone:

Hi Heather,
Your doctors might not be aware of the studies showing that excess dietary iodine triggers autoimmune thyroid diseases, both hyperthyroidism and hypothyroidism. Excess dietary iodine is now listed as one of the known causes of Graves' disease. Contrast dyes and the heart medicine amiodarone are also known triggers but you hear about them more because they can also can transient incidences of hyperthyroidism that aren't autoimmune but a direct consequence of excess iodine.

Calcium is important and calcium levels are often low in Graves' disease and they can fall even more during pregnancy. Calcium supplements are helpful and it's also important to get adequate vitamin D. Vitamin D is necessary for calcium absorption.

Goitrogens, over time, can, like ATDs, lead to hypothyroidism. For reducing thyroid hormone levels 1.5 cups daily is recommended. Eating smaller amounts shouldn't have much of an effect on your thyroid hormone levels. Goitrogens are subtle and don't cause thyroid hormone levels to fall as quickly as ATDs. You'll want to make sure that your ATD dose isn't too high. It's generally reduced as soon as FT4 falls into the normal or reference range.

Thyroid hormone affects all of your body's cells as well as the function of your other endocrine organs. Both high and low thyroid hormone levels can be associated with cystic acne. In general periods are scant and not as frequent in hyperthyroidism, and they're heavier and occur more often in hypothyroidism. But this can vary depending on your other hormone levels. It might be a good idea to see a dermatologist just to see what products can best be used to help you until things clear up. Best, Elaikne

» Princess2007 - When to lower medication?

Hi Elaine
After being in remission for about a year and a half my thyroid became overactive again a few months ago. I started on 5mg of Carbimazole but the thyroid levels were coming down only very slowly so I increased to 10mg. At my last appointment my thyroid levels were right down to the lower end of a normal thyroid range. I have been taking 10mg for about 2-3 months at this stage. I have been advised to continue on 10mg for another 3 months and would be interested to hear your opinion on whether this is the best thing to do and when you would anticipate the best time to drop to 5mg would be.
Thanks very much in advance.

-- posted by Princess2007

» beccav - Pregnant, Thyroid Levels

Hi,
I just found out I am pregnant. I have posted my current and past levels below. Are my levels ok? I have read they should be on the upper side of the normal range, but with my TSH (I know, I know a non-issue to us in the know) as low as it is already, no doctor is going to raise my meds.
I was at an endo yesterday for a second opinion for something else and he doesn't even believe in Cytomel, but said I should drop my Cytomel completely and then lower my Levoxyl until my TSH comes up. He was just as concerned about the affect on the baby that I am too hyper based on my TSH as I am that I am lower being on the lower end. He would not even consider that my antibodies were doing something to the TSH. So basically, I need to stay on the lowest safest part of the range for the baby's development. I have osteopenia even though I am 31 and so that adds to their already freaked out opinion of my levels.
I go to a reasonable GP(will see him on Thursday to see if he wants to continue to handle my dosing through pregnancy). I just took a dip last month because we had lowered my dose and it went further than I wanted and the numbers are still reeling. I decided to leave my dose the same for a while as I am thinking it will rise again on its own.
I hope I am making sense.
Ideally I would like my levels to be: FT3: 3.0, FT4: 1.30 However, I feel just as sick no matter what level I am at with tremors, palps etc. most of the time with some milder weeks. Therefore it is hard to argue that it is in my best interest to be higher levels when my TSH won't cooperate and I have bone thinning.
How will I know if I don't have enough thyroid levels for the baby? Will they drop in my labs and then I should just increase or will baby just not grow? How will I know if my antibodies are affecting the baby and what must be done?
I just read the pregnancy section in your book and it said that some doctors immediately raise the replacements on conception. I highly doubt my general will do this let alone the endos in town as they really like the TSH and are convinced I am hyperthyroid already.
Can you help me?

9/21/07: FT3: 2.9
FT4: 1.04
TSH: 0.117
Levoxyl: 88mcc & Cytomel: 7.5mg

7/20/07: FT3: 2.5
FT4: 1.13
TSH: 0.148
Levoxyl: 88mcc & Cytomel: 5mg (after 1 week on this dose, moved to 75 mcc Levoxyl)

6/22/07
TSI: 95% (Negative 139)
Thyrotropin Receptor Ab, Serum: 3.0 (0.0-1.0, Borderline 1.0-1.5, Positive 1.5)

6/8/07: FT3: 3.2
FT4: 1.35
TSH: 0.027
Levoxyl: 88mcc & Cytomel: 7.5mg

5/1/07: FT3: 3.2
FT4: 1.23
TSH: 0.003
Levoxyl: 88mcc & Cytomel: 10mg

3/22/07: FT3: 3.2
FT4: 1.28
TSH: 0.025
Levoxyl: 88mcc (+44mcc 1/week) & Cytomel: 10mg

1/22/07: FT3: 2.4
FT4: 1.03
TSH: 0.120
Levoxyl: 88mcc (+44mcc 1/week) & Cytomel: 5mg

-- posted by beccav

» nurseheatherone - Another Graves questions

In response to Another Graves questions posted by daisyelaine:
Thanks for the info, I actually starting using sme gentle proactiv and my face is clearing up a bit, until the next eruption! I have to admit that I have not been as good as usual with avoiding the dairy so that may be who my skin is starting to break out again. I really hate to go to a dermatologist, when I was younger they put my on a million meds that ended up in accutane and borderline scarring, after that I barely had a break out a month. I am starting back to my no dairy tomorrow.
I do have another question, yesterday I noticed that I am starting to develop what seems like swelling or dark circles under my eyes, tonight I could actually see one of the blood vessels popping out slightly. I am concerned that either I am starting to get eye disease, or that I am hypo already, I did read that swelling around the eyes was also a sign of this. Is this something I should bring up tp my doctor? I have never had bags or dark circles around my eyes no matter what I did before, my husband says it looks like I have bruising under my eyes,like a black eye. I am just concerned that I am still on too much tapazole and it is causing strange symptoms, or my graves is just getting worse, either way all of these new issues are no fun. Thanks again,
Heather

-- posted by nurseheatherone

» u25000 - TSA or ATA

I get confused w/these two. Can you tell me are the same? My need for clarification is that I often here ATA anti-thyroid antibodies referenced as a link to increased m/c; never do I hear the term thyroid stimulated antibodies in the same phrasing. So are they the same? From what I read they would be considered the same. ATAs are usually the Tgab; TPOab (hashi) while the TSAs are the TSI (graves). thanks.

-- posted by u25000