General Medicine

» nurseheatherone - Another Graves questions

In response to Another Graves questions posted by nurseheatherone:

just wondering , I have not talked withmy endo yet, but is it safe to assume that my symptoms are not a side effect or reaction of the medication and just symptoms of hypo/quick thyroid hormone changes. I would think that I would not experiance side effects at this low of a dosage( 5mg. I am just wondering if a switch to PTU would be helpful since it is less potent that Tapazole?
Thanks, Heather

-- posted by nurseheatherone

» Elaine Moore - Another Graves questions

In response to Another Graves questions posted by nurseheatherone:

Hi Heather,
Soy can contribute to hypothyroidism so you may want to cut back on it. Not all vegetables are goitrogens. Vegetables offer so many benefits because of their high nutrient content that you'd want to keep them in your diet. Take care, Elaine

» Elaine Moore - Another Graves questions

In response to Another Graves questions posted by nurseheatherone:

Hi Heather,
It's not the dose that matters but what your thyroid hormone levels are at that particular dose. The recommended dose for methimazole is 2.5-10.0 mg daily. If 2.5 mg is too high of a dose, block and replace could be used. If I recall your thyroid hormone levels weren't very high at the onset and it seemed as though you could easily move into hypothyroidism on ATDs.
The ATDs cause certain symptoms as a result of thyroid hormone levels falling too low. You could ask about trying PTU if you think it might help.Best, Elaine

» acaryjohnson - pain in throat

Hi Elaine. In case you don't remember me, after seeing my labs a couple weeks ago, you recommended I take my dose of PTU down to 25mg/day in increments from 150mg. You also mentioned I might have some transient hyper symptoms that would normally go away in a week or so during the transition. That was true for the first week when I went down to 75mg - the main symptom I've had is pain in the area of my thyroid, but it went away after the first week. Now I'm down to 50mg/day and it's been a week and the pain is back and not going away. Sometimes the time of day I take my dose varies - I take vitamins in the morning, so I try to wait two hours to take my first dose of PTU to allow absorption of the vitamins. Does timing make a big difference? I've also been using goitrogens - soy yogurt in the mornings, almonds, spinach at other times and lemon balm tea; I've stayed away from pre-packaged foods and refined sugar mostly. Do you have any idea how I can best relieve the pain in my throat? Should I go back up to 75mg/day? I did have a cold a couple weeks ago too that I still have a bit of a cough from, but it's not the kind of sore throat you get with a cold, it definitely feels like my thyroid. My next labs aren't for another couple of weeks. Thanks for your help and suggestions.

-- posted by acaryjohnson

» nurseheatherone - Another Graves questions

In response to Another Graves questions posted by daisyelaine:
when I first was diagnosed my endo told me that we thyroid labs were not that bad, but since my TSI was 143 she started with the 10mg of tap. I kind of thought it was strange when she only wanted me to see her about every two months. The Dr. for some reason has not called me back yet so I went ahead and started to take the 2.5 mg of tap( decreasing from 5 mg) I feel as though I am managing my own levels since I am the one who has been going to my Promary care every 5-6 weeks to get new labs, I would have been really hypo if I waited until the end of November when I have my scheduled F/U with my endo.

When you say that TSH is falsley decreased with GD, does that mean that if my TSH went from 0.0001 to 2.61 in a little over 2 months does this mean that I may actually be more hypo than my most recent #'s are showing? about how long on the lower dosage should I expect my labs to normalize?

The other thing I did want to inquire about is pregnancy and GD, I have read your articles on this and am wondering is it better to wait for remission before trying to get pregnant? I was under the impression that GD may go into remission during the second trimester but Post partum could start acting back up again. I was hoping to start trying to conceive sometime this spring/summer, when would be the ideal and safest time to start thinking about this? I really did not want to wait a whole year after started the tapazole which would be in July. I would think that even if I went into remission what is the chances that a pregnancy wouldn't trigger the GD again, it just seems a bit tricky. I should really be paying you for your services, as many questions that I ask, you are much more helpful than my Doctors

Thanks again, Heather

-- posted by nurseheatherone

» nurseheatherone - Another Graves questions

In response to Another Graves questions posted by nurseheatherone:

Hi Elaine, just as an update my endo finally got around to seeing my labs this morning and called me and left a message for me to stop my Tapazole completely and at the end of Novemeber she would recheck them and go from there. Is this a completely unheard of thing to do, is this going to hinder my treatment at all?
Thanks, Heather

-- posted by nurseheatherone

» Elaine Moore - pain in throat

In response to pain in throat posted by acaryjohnson:

Hi,
You shouldn't have pain in your thyroid although you can feel fullness or pressure.
Pain in your throat sounds more like a sore throat. Since ATDs can suppress or lower the white blood cell count, it's important to watch for signs of infection. Infection can signify a low cell count related to too high of an ATD dose. A sore throat is one of the things you want to watch for while on ATDs. You should call your doctor and report it. If he or she thinks it's warranted, they'll order a CBC,

» Elaine Moore - Another Graves questions

In response to Another Graves questions posted by nurseheatherone:

Hi Heather,
Usually, TSH will stay lower than 0.01 for some time because of the false decreased related to TSI. Most people won't secrete TSH at all unless they've become hypothyroid from too high of an ATD dose or moved into remission. In your case too high of a dose seems more likely.
It's best to think of pregnancy when you're on a stable ATD dose, one that's keeping FT4 at least at mid-range regardless of TSH. This indicates your levels are in control.
Most people can lower their ATD dose or stop it during the second half of pregnancy. There's no guarantee that remission occurring at this time will be permanent but for many women it is. Having a noticeable decrease in TSI would be a good sign. Best, Elaine

» Elaine Moore - Another Graves questions

In response to Another Graves questions posted by nurseheatherone:

Hi Heather,
Stopping the Tapazole is fine especially since you didn't absolutely need it in the first place. Your labs were subclinical or close to it if I recall properly, and subclinical disorders are likely to resolve on their own. You can run into more problems and risk increasing thyroid antibody levels when thyroid hormone levels fall too low. I'd stop meds and continue with your lifestyle changes. Best, Elaine

» nurseheatherone - Another Graves questions

In response to Another Graves questions posted by daisyelaine:

yay! I hope that is the case, in the mean time I have to start feeling better from all of these sudden changes in my thyroid. Would I have had a subclinical form of GD and still have TSI of 143 and TSH of 0.001, I often wondered if that were the case. I would definetely want to wait until my levels were stable before tying to get pregnant but that is good to know that soem woman stay in remission even after their pregnancy.
Thanks again, Heather

-- posted by nurseheatherone