General Medicine

» tonilovestigger - a natural approach i hope

In response to In need of understanding posted by daisyelaine:

I am a mess and need some advice quick....Had a baby 4 months ago and have felt so bad, can barely hold her sometimes, due to my achy weak muscles... shakiness, classic hyper symptoms. Went to the doctor and after demanding blood tests b/c i knew this was not just post partum, found out that indeed it was hyper and my auto immune tests were very high 903 which leaned towards Graves..Also my sonogram concluded a nodule... I am supposed to be doing a thyroid uptake on Wednesday and I am terrified.. I try to rely on natural remedies and the thought of taking nuclear radioactive iodine terrifies me.. Not to mention, I do not want to expose my family or baby to it... I had to stop breastfeeding for this and I am terribly sad. My mind is like a whirlwind and I am so perplexed over this new thyroid upset, that I do not know what to do.. I can't believe something I knew little about can completely change my life so drastically in such a short period of time... My hair is falling out, losing weight uncontrollably, no patience, rages, no sex drive, depressed, nervous, panic attacks, incredible muscle aches, weakness, ear aches, hurting throat and choking sensation, painful red/yellow sore eyes etc..

I cant believe this crap exists and almost every doctor or article I read is ok with a lifetime of meds... I hate that people are getting this and our society is just tolerating it... Doesnt anybody else wonder what is the real root of this disease or any thyroid disease? Could there be a link to the meat industry???? ok, sorry i am getting on a tangent again, just scared to death of the impending verdict this wednesday after my test.. I dont even want to take this test, I want to just meditate, eat bugleweed, get a colon cleanse and yoga all this away.... Is it possible to naturally approach this and is it conceivable I can beat it??? But will these symptoms keep getting worse for me and inevitably my family??

-- posted by tonilovestigger

» Elaine Moore - a natural approach i hope

In response to a natural approach i hope posted by tonilovestigger:
Hi Toni,
A natural approach to achieving remission is possible with Graves' disease, although in some cases it's best to first reduce thyroid hormone levels with meds to prevent side effects associated with hyperthyroidism. Natural methods, such as dietary changes and stress reduction techniques, can also decrease the dose of meds that you need.

Graves' disease that occurs during the postpartum period is usually related to the high estrogen levels that occur at this time. Postpartum Graves' disease tends to resolve nicely as estrogen levels fall. Other environmental triggers also play a role in GD, and excess dietary iodine from fast and processed foods and iodized salt is also an important trigger.

The radioiodine uptake isn't considered necessary and even though the dose is lower than that used for ablation you would be unnecessarily exposing your child to radiation just by holding her. Cradling her to your chest, where radioiodine concentrates and direct exposure to her neck are particularly risky because the thyoid cells of children have a fast turnover rate.

Your blood test results, particularly your levels of FT4 and FT3, confirm that you're hyperthyroid, and thyroid antibody tests, especially for TSI, are used to confirm Graves' disease. An ultrasound can be used to assess nodules.

There have been cases of meat contaminated with animal thyroid gland in ground beef that caused mini-epidemics of Graves' disease in the 80's. This still happens from time to time.

Bugleweed is much like ATDs. It lowers thyroid hormone levels and it reduces the activity of thyroid antibodies. However, you'd want to use it under the direction of a naturopath.

Graves' disease is considered a self-limited disorder, and a lifetime of meds isn't required unless you have aggressive treatment resulting in hypothyroidism. Best, Elaine

» tonilovestigger - a natural approach i hope

In response to a natural approach i hope posted by daisyelaine:

Elaine,

thank you so much for replying to me and offering me some insight. I am confused about the thyroid uptake.. I am scheduled this Wednesday. I too feel the radioactive material will be in my system and expose my baby afterwards, however the doctors are trying to tell me that within 2 days the effects of it will be absent. What is your thinking on this? I have read that it can remain in your body for up to a month.

What happens if I do not take the test? Is it possible that my symptoms could subside once my estrogen levels fall?

Thank you for your help,

toni

-- posted by tonilovestigger

» Elaine Moore - a natural approach i hope

In response to a natural approach i hope posted by tonilovestigger:
Hi,
The radioiodine uptake is a diagnostic test. Because you have a high level of thyroid antibodies (the 903 you mentioned, which is probably thyroglobulin or TPO antibodies) you know that your hyperthyroidism is autoimmune, which is Graves' disease. And you know you have a nodule. Both conditions are associated with an elevated RAI uptake.
If you had postpartum thyroiditis the uptake would be low. But since you have a high level of thyroid antibodies, you wouldn't be likely to have postpartum thyroiditis.

Regardless of the diagnosis, your goal now would be to lower your thyroid hormone levels. The uptake can cause your levels to temporarily increase. And exposing your baby to radioiodine for even 2 days isn't worth the risk. It's not only possible but very likely that your thyroid hormone levels will fall and your symptoms subside once your estrogen levels fall. Best, Elaine

» u25000 - TTC A/RAI; any input on poss probs

Please shed some light, not finding it anywhere else.
1/02 loss of normal PG at 20wks to infection, developed Graves (2002 had symptoms, TTC, no diag) 2/03 thyroid prob discovered by Ob; GP thyroid inept- still no meds 3/03 PG,mc; 4/03 diag by endo w/Graves sugg RAI, don't want to wait 6mths for preg, hold for 2nd opin, Stanford Dr refers to local endo 8/03 sugg Rai"best to resolve hyper and conceive w/out ATDs" 9/03 RAI; 3/04 told okay to conceive-no preg all 2004; 3/05 tsh rises out of neg-no meds 7/05 conceive and m/c 9/05; 1/06 tsh 15, now 50mcg levo; all of 2006 no preg; age34-38 during this time. Chromo Analysis fine; recurr preg labs fine; HSG fine; Here are significant labs:

10/01 Preg, tsh -.03

3/03 u/s mild enlarg heterog poss goiter; rt lobe 6mm nodule (preg; no scan done)

4/03 on PTU
tsh .07 (.35-5.5
ft4 3.0 (.8-1.8
ama 11 (0-35
ata -20 (0-40
tsi 4.7 (1.9pos

9/03 rai 17mci

2004 tsh -.01L ft4 1.37,1.34; no ft3

3/05 tsh 1.46, ft4 .72 (mild Ted-evident:physically,more lite sensit,pain
7/05 tsh 2.58 (conceived,but spot 8/05 menses
9/05 tsh 5.48H, ft3 2.4, ft4 .91 (m/c)
10/05 tsh 3.87H p/new ranges; ft3 2.5, ft4 .85
1/06 tsh 15.09H, ft4 1.01
3/06 tsh 1.96 (6wks on levo 50mcg
5/06 family loss off meds
10/30/06 tsh 5.55H, ft3 2.9, ft4 1.03
started levo 10/21
11/29/06 tsh 1.96, ft3 2.8, ft4 1.07
12/3: started 75mcg per research

specifically is there any info on what should have been done while tsh was suppressed a/RAI for 18mths, and its effect on fertility, even tho I read that ft3,ft4 are the real factors related to fertility, mine were normal, tho ft3 wasnt checked,except TT3 120 (60-181) on 2/05 and 5/05 was 90. Or is that the unspoken effect on the "axis" after RAI; 6mths i was told, not 18m. It doesn't help that I have not heard of any ONE person conceiving after RAI; only of those on ATDs. Also, just saw new "autoimmune" RE who did not feel I needed Antibody tests done again.

Any info is so graciously appreciated.

-- posted by u25000

» Elaine Moore - TTC A/RAI; any input on poss probs

In response to TTC A/RAI; any input on poss probs posted by u25000:
Hi,
I'm sincerely sorry for the poor medical care you've been given. First off, I know many people who have conceived after RAI, although while they were hypothyroid they have difficult trying to conceive, which is expected.

TSH stays low or suppressed for a very long time after RAI because of the dramatic increase in thyroid antibodies. TSH receptor antibodies are recognized by the pituitary as if they were TSH. Thinking you have adequate TSH in your blood circulation, your pituitary stops secreting TSH. This was shown by Brokken et al. around 5 years ago. It used to be thought that the axis was off after having thyroid hormone levels dependent on antibodies for so long. Although the axis is likely affected, the primary cause of a persistently low TSH in Graves disease is the TSH receptor antibodies themselves. Since we tend to eventually produce more blocking than stimulating TSH receptor antibodies after RAI, it's not unusual to have a low TSH even though you're hypothyroid.

For this reason, many endos only look at FT4 and FT3 levels after RAI (since the TSH result can be misleading). In your case you were hypothyroid in 3/05 with the low FT4 (usual range 0.8--1.8) and most of us after RAI feel hypothyroid with an FT4 below 1.6.

Because you have had multiple miscarriages, you should have been tested for antiphospholipid syndrome (APS). This is caused by the presence of lupus anticoagulant (various antibodies that occur in lupus and many other autoimmune conditions as well as alone). These antibodies cause blood to clot too fast. This is known as hypercoaguability and it's easy to treat if it's diagnosed. APS is the leading cause of miscarriages and strokes in young women, and many doctors check their patients with autoimmune thyroid disease for APS.

You might want to check the graves_support board at yahoogroups. There are several women who have had children after RAI on the board. The boards are quiteter during the holidays but you should find someone around.

Your primary goal is to find an endo who knows how to treat hypothyroidism after RAI and that can be a real chore. Asking at the boards for recommendations in your area can help. With the proper treatment for hypothyroidism and the needed tests for APS (see my article on lupus anticoagulant on 101), your chances of a successful pregnancy should increase. Best, Elaine

» free2ridejones - In need of understanding

In response to In need of understanding posted by daisyelaine:

Hi Elaine

I have some more lab results.

16.10.06 15.12.06
Ft4 14.5 16.8 (10.0-23.0)
TSH 0.75 0.55 (0.30-5.00)
FT3 4.7 4.6 (2.8-6.8)

I am now 4 x 15mg of natural thyroid. Why would the TSH drop and is this a problem. I am worried I am doing something wrong. I am still taking 1-2 drop of Lugols and I also take a Selenium with A,C, & E and also and Iron tablet. I still have quite a fast heart rate but that was happening long before I was taking any of the above.

I would be interested in what you think I should do now and what meds to take and how much. I have to ask again I am still hypo???

Thanks again Margo

-- posted by free2ridejones

» u25000 - TTC A/RAI; any input on poss probs

In response to TTC A/RAI; any input on poss probs posted by daisyelaine:

thanks so much for your info, I will print your article. couple things:

RE: APS, 9/05 m/c I saw my 3rd OB whose lit claims they are hi risk, she did do the following and others for recurr m/c:
anticardiolipin antibody:
ACLA-IgG -15 expected -15
ACLA-IgM -20 expected -20

lupus anticoagulant neg expected neg
interpreted by pathologist
factorV leiden was cancld (per above results)

My new RE is planning a clomid challenge test, and did discuss "choking of capillaries" tests and treatment. But he is waiting for clomid tests first it seems which I won't be doing until next month since I'm late this month and long distance for cd2, cd10 labs I figured partner and I would take care of next month to incl sperm analysis. In meantime, he hasn't checked my labs and I presume won't pursue this APS thing until after clomid is done. I read that a 2nd test 6wks later is typically done to confirm no APS, which my Gyn didnt do. In case you had some tidbits on this.

Any advice on how to pursue this APS thing further, go back to gyn (local); ask RE to look at labs NOW, or FIND NEW of BOTH, based on what you sense here.

If above tests are true, no APS then do you see a problem w/my recent labs, could I have m/c if tsh was above 2-Tho I've heard you can get preg mildly hyper or hypo.

Do you think that antibody effect on the suppressed Tsh inhibited fertility all that time-as I also hear that it is the ft3,ft4 which impact fertility not the tsh, that has confused me since I was okayed w/fair ft4 3/04. I'm just trying to grasp my history while I know my age also plays role.

-- posted by u25000

» JandC13 - Advice please -Stressing!

Dear Elaine,

Thanks so much in advance for any advice!
My husband is 52 yrs old & a type 1 diabetic since age 11. He's on an insulin pump and has OK control, i.e. A1C's in the "normal range".

He was diagnosed with Graves Disease in Jan 2004 and started on methimazole. He has never had antibody testing or any other thyroid testing other than TSH, T4, T3, FT4, FT3. His FT4/FT3 levels have always seemed to be readily responsive to the ATD treatment.

He's had some issues with ATD treatment this year that we've pretty much sorted out: Earlier this year he was on 5mg methimazole every other day and developed "hyper symptoms" the endo was only ordering FT4/TSH and we finally realized that maybe FT3 was the issue (recalling that elevated FT3 was the main issue when he was diagnosed), we asked our PCP to order FT3's.

With the hyper issue this year, he ended up needing to be on 15 mg every day after first trying lower doses. Wanting to avoid feeling that bad again he ?apparently inadvertently went too long on the 15mg dose- he wasn't symptomatic, and was cruising on the lower "normal range" side until he abruptly dropped off- FT3 dropped below normal in 2 week period and he became very symptomatic for hypothyroid. He stopped ATD for 12 days (2 Dec) against endo's advice ("your levels are fine") and his levels came up. He restarted methimazole at 10 mg/day the day before the 15 Dec levels were drawn and plans to drop to 5 mg in a few days.
He has lost all faith in his endo and as this was not the 1st issue. He's changing endo's but wasn't able to be scheduled until Feb 07.

At this point he's still experiencing most of the symptoms he had while his levels were low: frequent headaches, brain fog, lack of energy, excessive sleepiness not helped by "sleeping in" and falling asleep during work time. He's very frustrated and stressed over this and is afraid he going to be fired for "sleeping" on the job" and difficulty doing his job due to "brain fog". Could his continued symptoms be due to recovery from running low lagging behind the lab values coupled with levels starting to run high. Why is TSH so low at this point, did the levels maybe creep up higher than what we see now?

Thanks again! J&C

FT4 TSH T3 FT3
15 Dec06-1.59 0.11 --- 3.46
01 Dec 06-0.89 4.68 ---- 2.02
17 Nov 06-0.97 not done------- 3.28
15 Sep 06-0.86 not done-------- 3.17
18 Jul 06-1.31 not done------ 3.86
26 May 06-1.84 not done------- 5.32
07 Apr 06-1.66 not done ------ 5.40
10 Mar 06-1.81 0.01 226 not done
18 Jan 06-1.58 0.03 ----- not done
19 Sep 05-1.02 0.52----- not done
22 Jun 05-0.94 1.01 ------not done
Lab ranges: FT4: 0.8-2ng/dl
T3: 60-181 ng/dl; FT3: 2.2-4.0 pg/ml;
TSH 0.35-5.5 mlU/L

-- posted by JandC13

» mmeade07 - Graves and pregnancy

I just wanted to let anybody know that I have had graves for 3 years. I found out when I got pregnant with my first. She is now 2 yrs old. I've had rai and it didn't work. I ended up pregnant again before another treatment of rai was done. My 2 yr old and healthy and I had a wonderful pregnancy so far with the new one on the way. It is possible to have graves and have normal pregnancies.

-- posted by mmeade07