General Medicine

» u25000 - Couple clarification requests

1. Oct 2001 I had a Total T4 done: 30.5 (4.5-12.)HI. I was 8wks GA pregnant. As I understand T t4 is not done during preg because preg hormones elevate Tg(? enzyme or protein) which renders this test innaccurate?
2. Feb 2003 I was days pregnant when the orig tests were done to determine further testing for my disease: T3 Uptake 44 HI(26-37), Tt4 21.1 HI (4.5-12.), Ferritin 108 (10-200), Total Iron % saturation 51 HI (21-50). Were any of these made inaccurate by pregnancy?
3. Feb 2004 after RAI and one month on levoxyl which began a/"prev mth" labs: my ft3 4.4 (1.1-4.7 (prev mth 3.2)) ft4 3.3 (.6-2.2 (prev mth 2.2)) so he had me stop lt4, I understand he couldn't determine my speed of recovery, but why even start me when previous mths labs were still dropping into normal and were w/in range. By starting lt4 so soon, I feel he wasn't very accurate w/numbers and I clearly would've paid better attention had I understood. So by giving me lt4 he caused a spike which inadvertently led to me stopping meds after only one month and going on this rollercoaster of mismanagement.
4. March 2004, his final labs w/me he ordered T3 Uptake 41 (23-37), ft4 1.37 (.8-1.8) tsh -.01; based on previous labs, I had stopped lt4 so ft4 was normal tho lo side, and t3 was elevated due to prev mths lt4 surge, right? He said it was okay to conceive, but am I correct to say that I wasn't because he had spiked me in error and threw my numbers off so I required more time. This misled me when I couldn't conceive after several mths and lost faith in him. Again it seems a numbers thing where he failed to give me the attention to detail.
5. July 2005: Ferritin in 2003 was 108 (10-200(early in disease)) well now it is 17 (10-291) with still no lt4, and my tsh is finally normalizing these past few months, while my ft3 and ft4 continue to move very slowly in the lo range (they were subdued 3 wks error my 2nd endo who gave me Ptu for the neg tsh); what can you tell me about this Ferritin change?
6. By the way, I did find that when I would visit the ER they did do an ER panel which includes calcium and Electrolytes Panel. But I found after my 3rd loss 2005 I got a Comprehensive Panel which includes both plus a few, so atleast I now what to ask for when I do see my DO or talk w/insur CO, or to order myself, however how do I learn whether I have thinning bones, Bone density, who should order this. Since I do have an Integrationist in mind, would you recommend I don't need to see a Naturopath? thanks much

-- posted by u25000

» Elaine Moore - can I get away with less PTU?

In response to can I get away with less PTU? posted by acaryjohnson:

Hi,
To be safe you might want to cut your dose slowly, moving to 75 mg for a few days, and then dropping to 50 for a few days and then 25. It's not unusual to notice a few transient hyper symptoms whenever you cut your ATD dose even if you're still hypothyroid. This is caused by the change in levels. These symptoms, if they occur, typically resolve within a week. Best, Elaine

» Elaine Moore - Couple clarification requests

In response to Couple clarification requests posted by u25000:

I'll reply directly to your post so I don't miss anything.

1. Oct 2001 I had a Total T4 done: 30.5 (4.5-12.)HI. I was 8wks GA pregnant. As I understand T t4 is not done during preg because preg hormones elevate Tg(? enzyme or protein) which renders this test innaccurate?
T4 is elevated in pregnancy because of the elevation in binding proteins (albumin, transthyhretin, etc), not thyroglobulin caused by the increase in estrogens. T4 measures free hormone and the binding protein it's linked to. This is why T4 is falsely increased and not recommended.

2. Feb 2003 I was days pregnant when the orig tests were done to determine further testing for my disease: T3 Uptake 44 HI(26-37), Tt4 21.1 HI (4.5-12.), Ferritin 108 (10-200), Total Iron % saturation 51 HI (21-50). Were any of these made inaccurate by pregnancy?
The T3 uptake measures the binding proteins I mentioned in 1. This test does not measure thyroid hormone, and the uptake is increased in pregnancy. Iron was probably high if you were taking prenatal vitamins.

3. Feb 2004 after RAI and one month on levoxyl which began a/"prev mth" labs: my ft3 4.4 (1.1-4.7 (prev mth 3.2)) ft4 3.3 (.6-2.2 (prev mth 2.2)) so he had me stop lt4, I understand he couldn't determine my speed of recovery, but why even start me when previous mths labs were still dropping into normal and were w/in range. By starting lt4 so soon, I feel he wasn't very accurate w/numbers and I clearly would've paid better attention had I understood. So by giving me lt4 he caused a spike which inadvertently led to me stopping meds after only one month and going on this rollercoaster of mismanagement.

Probably. But your doctor was prescribing hormone ahead of time to prevent you from becoming hypothyroid. He may not have realized that thyroid levels can rise after RAI and stay elevated for up to 12 weeks as dying thyroid cells release antibodies and thyroid hromone.

4. March 2004, his final labs w/me he ordered T3 Uptake 41 (23-37), ft4 1.37 (.8-1.8) tsh -.01; based on previous labs, I had stopped lt4 so ft4 was normal tho lo side, and t3 was elevated due to prev mths lt4 surge, right? He said it was okay to conceive, but am I correct to say that I wasn't because he had spiked me in error and threw my numbers off so I required more time. This misled me when I couldn't conceive after several mths and lost faith in him. Again it seems a numbers thing where he failed to give me the attention to detail.

The uptake is considered obsolete. It was once used to help gauge how much FT4 people had by calculating an approximation. Now that we have tests to measure FT4 directly, this test is usually ordered in error. It's hard to say exactly why you didn't conceive earlier. It could have been thyroid antibodies or your low FT4 or the effects of thryoid hormone on your other hormones.

5. July 2005: Ferritin in 2003 was 108 (10-200(early in disease)) well now it is 17 (10-291) with still no lt4, and my tsh is finally normalizing these past few months, while my ft3 and ft4 continue to move very slowly in the lo range (they were subdued 3 wks error my 2nd endo who gave me Ptu for the neg tsh); what can you tell me about this Ferritin change?
You may have had some blood loss and this would cause ferritin to fall. You may have also quit taking iron or began eating fewer foods rich in iron.

6. By the way, I did find that when I would visit the ER they did do an ER panel which includes calcium and Electrolytes Panel. But I found after my 3rd loss 2005 I got a Comprehensive Panel which includes both plus a few, so atleast I now what to ask for when I do see my DO or talk w/insur CO, or to order myself, however how do I learn whether I have thinning bones, Bone density, who should order this. Since I do have an Integrationist in mind, would you recommend I don't need to see a Naturopath? thanks much happy

You wouldn't have to see a naturopath if you're seeing an integrationist. Your integrationist will be able to order a bone density test. It's a good idea to have one.
Take care, Elaine

» u25000 - Elaine

Your are the best!

-- posted by u25000

» dana65 - Low Iodine Diet Failure

Hi there . . I just wanted to share my unsuccessful experience with a low iodine diet. Six weeks (and 12 pounds) ago, I began the diet when my FT4 came back at 1.3 (reference range of 0.5-1.2). Since I seemed borderline and had no bothersome symptoms, it made sense to try it and possibly avoid medication that might lead to becoming hypo. I followed the Thy-Ca diet and was very, very disciplined about it. I also added selenium and acetyl L-carnitine to my daily regime. On Wednesday, I returned for labs, and my FT4 was 2.75. I was stunned by the sharp increase and of course, I will now start Tapazol. My endo said, "You know there is no data to suggest that a low iodine diet helps." (I failed to ask her if any studies had even been done.)

The 12 pounds I lost added to the 8 pounds I'd lost earlier has left me very, very thin. (I'm at 115.) Since the low iodine diet didn't seem to help, I'm thinking about returning to my regular eating habits. I hesitate only because I wonder if the results were affected by an infected thumb and a flu bug I was just getting over. I also had been ill one other time during that 6-week period. The endo said only chronic illness, rather than acute illness, would sway the numbers. At this point, however, I must treat this disease. I don't want to suddenly drop dead from atrial fibrillation.

Just wanted to share that info and will welcome any comments. Does anyone know of any studies that have been done on low iodine and Graves?

Dana

-- posted by dana65

» jb50583 - Another Graves questions

In response to Another Graves questions posted by nurseheatherone:

Hi, Im hpyer but now my levels are showing normal range Ft4 even to close to low side. I do feel like I have some hypo symptoms now. Went to dr. and she cut methimizole down from 40mg dose to 30mg which from reading alot still sounds hi.... I was supposed to go back in 2wks for blood but now feel I need to do sooner because I fear being hypo. This is all so new to me. I also feel like I dont know what to present this to dr. and how to get the right dose to make me feel good.

-- posted by jb50583

» Elaine Moore - Low Iodine Diet Failure

In response to Low Iodine Diet Failure posted by dana65:

Hi Dana,
Sorry to hear that your condition worsened. Most of the studies on dietary iodine were done to support the use of anti-thyroid drugs, which work by blocking iodine absorption in the gut and reducing thyroid levels. The College of American Pathologists recommends a low iodine diet to reduce hyperthyroidism with the rational that limiting iodine or tyrosine reduces the amount of thyroid hormone that can be produced.

Acute infection would stimulate your immune system, and, similar to vaccines or allergic reactions, would cause an increase in antibody (and autoantibody) production.

Take care, Elaine

» Elaine Moore - Another Graves questions

In response to Another Graves questions posted by jb50583:

Hi Heather,
I replied in the email you sent me. I'm glad to hear you'll be having your labs done sooner. Best, Elaine

» nurseheatherone - Another Graves questions

In response to Another Graves questions posted by daisyelaine:
It seems as though every time I get over one strange symptom I get something else. So before I was diagnosed with Graves, at night if I was out and was getting tired I would get this weird back pain between my shoulder blades, kind of a burning pain, that would persist until went homeand layed down. I still get this from time to time, and I always associated it with GD, over the past couple of days it has gotten to be more of a persistant thing, and I have nto done anything that could have caused the pain, it just kind of showed up. I did have a little cold the past couple fo days but now it is pretty much gone and the pain is still there, it's like a burning ,cramping feeling. I started to take my BP again as well since I have been off of BP meds for over a month and it is slowly rising up again. The other weird symptom I am having is I have two dime size hard bumps on the top of my sclap. At first I thought these were lmph nodes, but then I realized there are no lymph nodes on the very top pf my head. I also am still having that throat tightening sensation from time to time as well. I am starting to worry that these issues are caused by the Tapazole? or maybe becuase I do not have enough thyroid hormone for my bodies needs. If I go to the Dr and they see that my labs are within normal range they will probably just shrug of my symptoms as me being paranoid but all I know is I have not felt the same since a couple of weeks after starting tapazole, I just do not feel like myself. Would it be crazy to ask the Dr. to change me to PTU to see if my symptoms go away?

I have been taking Ibuprofen for the pain in my back and have just learned how to deal with the throat tightening issue, trying to relax. The bumps on my head are new to me,they have been there for a couple of weeks now and are not changing in size and dont hurt unless I keep pressing on them. I am starting to think that hypo makes my BP get higher, I am sure they will be putting me back onthose meds. I guess being a nurse makes me always think the worse, but I am just getting a little tired of all of this. I also believe that no one loves you as much as you love you so you have to be an advocate for your own health because unfortunately the Doctors are not always right ( and that makes me nervous). I you have have ever heard of any of these symptoms or have any idea what could be causing them I would love to know. I appreciate all of your help!
Thanks again,
Heather

-- posted by nurseheatherone

» Elaine Moore - Another Graves questions

In response to Another Graves questions posted by nurseheatherone:

Hi Heather,
You're absolutely right that we have to be advocates for our own health. Too often our symptoms are dismissed.

I had a back pain similar to yours about two years ago, right after Hurricane Katrina which really affected me, and I've heard similar complaints from other Graves' patients. Since TSI, the antibodies that cause GD, act on skeletal muscle, dermal tissue, orbital tissue, and thyroid cells, I wondered if it was antibodies causing the problem.
My pain persisted for about 4 months and sometimes caused radiating pain down my arms. I did have lots of tests, which showed osteoarthritis, retrolisthesis, degenerative disk disease and a few other things but these abnormalities aren't too unusual after the age of 50 and they usually don't cause problems.
My osteopath also found some trigger points and a rib that had gotten out of alignment so he did a series of manipulations and I went to physical therapy to learn how to relax my upper back and do the right stretches. The consensus was that all the time I spent at the microscope, on the computer, and driving mountain roads in the dark caused excess muscle tension. Between the manipulations and therapy all the pain went away excess for a brief return when I had sinus surgery last year. The surgery was stressful for me and the stress caused the pain. I had to really work on my exercises and deep breathing techniques but knowing what to do the pain left much quicker.
I think stress may have caused a rise in TSI antibodies that, combined with my own poor reactions to stress, caused the pain. Just worrying about your treatment and the effects of thyroid levels that are too low could be affecting you. Read up on psychoneuroimmunology if you get a chance. I have an article about it here that you'll find interesting. Best, Elaine