General Medicine

» Elaine Moore - Graves

In response to Graves posted by nurseheatherone:

Hi,
Graves' disease can rarely cause a positive ANA titer, and people can also have a low positive ANA titer for no reason at all. Take care, Elaine

» nurseheatherone - Graves

In response to Graves posted by daisyelaine:

HI Elaine, I just got back my most recent labs and in 2.5 weeks I went from a TSH of 2.61 to .46. My FT4 went from 1.1 to 1.4 and for some reason they did not check my FT3. I am assuming this rapid change was what was causing my symptoms. A TSH od o.46 should be within normal range but I guess not normal for me at his point. I started taking Tapazole 2.5mg and 1/2 of a beta blocker just to minimize my hyper symptoms and it has been working. Since I know now that I was over medicated in the first place and am not in remission( which I really did not beleive could happen so quickly) I am wonderin gif their would be any down falls of switching to PTU. I really do not want RAI and am planning within the next year to get pregnant, once my levels normalize,so I would guess that PTU would be my best option at this point. I know that PTU is not supposed to be as strong and that you usually have to take it multiple times a day, but is there any other issues with this drug. I would think that if it is not as strong that it wold be better since I am super sensitive to Tapazole. My endo wants to see me tomorrow so we will see what she says.
Thanks, Heather

-- posted by nurseheatherone

» Elaine Moore - Graves

In response to Graves posted by nurseheatherone:

Hi Heather,
PUT has a shorter half-life but it's effective as methimazole. Both of these compounds are best taken in divided doses 2-3 daily to provide stable blood levels.
Any change in thyroid hormone levels can cause transient symptoms of thyroid dysfunction as your body adapts to the change. The rise in FT4 is likely responsible for your temporary symptoms. It would be fine to change to PTU if your doctor approves this, using a dose of either 25 or 50 mg daily taken in divided doses. Being maintained on a low dose sounds like a good idea. Best, Elaine

» nurseheatherone - Graves

In response to Graves posted by daisyelaine:

HI Elaine, I went to the endo today and she basically told me that it was unlikely that I was goign to go into remission because I relapsed after stopping the tapazole and suggested taht in a month from now redraw my labs and then decide what I would like to do. SHe said that becasue I would like to start trying to conceive in the next couple of months that I think about getting RAI. I talked with her about PTU and she said that I can do that as well, but it may be best to do RAI. Now I am super confused, I am really tired of feeling this way and it would be nice to get some releif, if that is a possibility with RAI. After reading your book and talking with others it seems that it could take atleast a year to try to acheive remission on ATD's. I told my Dr. my concernes about TSI antibodies and pregnancy and she said that in all of her career she has only had one baby hyper from TSI's. This is a really hard decision. I also made an appointment with my OB to see what his opinion on the matter is but I could not get in with him until 12/17 after my endo apt. I thought it woul dbe a bit easier to become Euthyriod, do you think it would be a good idea to seek another endo's opinion or am I just going to get the same answer? I really appreciate all of your info Elaine, it is really helping me through some difficult decisions
Thanks again, Heather

-- posted by nurseheatherone

» fivebreaths - Low TSH only

hello Elaine,
...it's been a while since I've posted....
I was Dx'd w/ Graves last year... and I've been taking methimazole now since April of 07, and my thyroid levels came down, went up, and came down again, and dosage of methimazole has varied accordingly. Last week, my most recent lab results show that my TSH is now low again, but that the FT3 and FT4 are still in the normal ranges.
What does this mean?
Does this still technically indicate hyperthyroid?
I'm wondering because my Endo would like me to double my dose from 10mgs/day to 20 mgs/day. And no matter how much I object ( I do not wish to induce hyPOthyroid), she assures me that this is how it's done.
Can you illuminate any of this for me?
Thank you much, in advance....

-- posted by fivebreaths

» Kimberlykd - Please help interpret my test results...

Hi there, I'm confused as to what all these thyroid numbers mean, please help me interpret my test results. T3, Free 2.69 {1.88-3.52}, T4, Total 5.9 {5.0-11.3}, TSH 5.930 {0.520-5.080}! I ditched my Endo and switched to a GP but not sure how much he really knows about Grave's Disease. I'm currently taking 15mg Methimezole daily and he told me to stay on that dose. If the TSH is high and my T3 & T4 are in the normal range does that mean that I'm euthyroid or hypothyroid? Thanks for any help! Kim

-- posted by Kimberlykd

» Elaine Moore - Low TSH only

In response to Low TSH only posted by fivebreaths:

Hi,
The recommended dosing is based on your FT4 level. TSH will fall if your level of TSH receptor antibodies rises. People who begin producing more of either blocking or stimulating TSH receptor antibodies will see a fall in TSH even if they're moving into hypothyroidism (from blocking antibodies). Your FT4 is the best indicator of your thyroid status. Best, Elaine

» dana65 - Soy . . and ATDs

Hi again, Elaine . . I have 4 questions:

1. I read your message on page 59 (#586) that soy can contribute to hypothyroidism. If soy helps hormone levels fall, why would a hyperthyroid patient want to avoid them? (The Thy-Ca low-iodine diet, which I've been following to help my GD, says to avoid soy products.)

2. Do you know the percentage of GD patients who can get their condition under control without doing RAI? And how long can it take to do that?

3. Do some patients respond more positively to PTU than to Tapazole? i.e. If one doesn't work, might the other?

4. Would it be helpful to have any measure other than the FT4 taken? (I'm the one whose TPO antibody test last March showed a result over 8800 and am wondering if it would be helpful to see if that has come down . . . or is the FT4 itself enough.)

I'm arming myself because I think my endo prefers RAI and I fear she will say, "Well, the medication obviously isn't working, so we've got to choose between RAI and surgery." I know I'll resist that because I have NO bothersome symptoms . . although I'm taking L-Carnitine, which probably helps.

Again, thanks for all you do here. You clearly help so many people deal with this disorder.

Ciao,
Dana

-- posted by dana65

» Elaine Moore - Soy . . and ATDs

In response to Soy . . and ATDs posted by dana65:

Hi Dana,
Soy interferes with thyroid hormone metabolism and blocks iodine production. When soy formula was first developed many babies developed hypothyroidism until they began adding iodine to the formula. Even so, hypothyroidism can still develop, and this is thought to be from the inhibition of the deiodinase enzymes needed for metabolism. Many people with gluten sensitivity, which is common in thyroid disorders, also have allergies to soy. Because soy is added to so many foods, soy is one of the most common allergens in the United States.

About 1/3 of patients with Graves' disease are reported to move into spontaneous remission with no treatment at all. This was stated in the Clinical Series of North America Thyroid textbook. Worldwide, most people are treated successfully with anti-thyroid drugs, and studies report remissions ranging from 50-90 percent. Remission rates vary with most studies showing remission occurs within 12-18 months. More recent studies show the highest remission rates with longer use of a low-dose ATD, average 4 years.
I haven't seen any study showing that more people respond to one ATD over the other. I've always heard that the ATDs are equal although people who develop a rash from one ATD usually do fine with the other. PTU was developed first so some doctors are more used to it. They both offer benefits.
In your case, you'd want to have a TPO antibody test around 6 months after starting meds to see if your titer is falling. It should be. FT4 is the best indicator for monitoring your dosage whereas TPO antibodies are indicators of thyroid inflammation. Best, elaine

» dana65 - Soy . . and ATDs

In response to Soy . . and ATDs posted by daisyelaine:

Thanks, Elaine . . . although I'm still confused about WHY a low-iodine diet requires one to avoid soy, if soy blocks iodine production. Am I missing something here? - Dana

-- posted by dana65