General Medicine

» 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

» nurseheatherone - euthyroid?

Hi Elaine, would I be considered Euthyroid with a TSH of .46 and a FT4 of 1.4, I know a while back you had said that it would be good to get my FT4 a bit higher than when it was 1.1. I agree that my bad symptoms were probably related to the rapid thyroid changes from being taken off ATD's. Now that I am back on them ( 2.5 tapazole)I feel fine again. I am goign to ask my Dr. to switch me to PTU. What would be a reasonable dose to start with that is comparable to 2.5 mf of tap, I just do not want to go hypo again. I am also still trying to figure out why she is tryin gto get me to do RAI with normal thyroid levels? I
Thanks again, Heather

-- posted by nurseheatherone

» vickwithpc - better thyroid #s without treatment

History Review:
T4 Free: 1.43 (Nov 07)
T4 Free: 1.27 (taken Feb 07)
T4 Free: 1.59 (taken Nov 06)

TSH: 2.54 (Nov 07)
TSH: 0.10 (Nov 06)

Thyroglobulin Antibody: 81 (Nov 07)
Thyroglobulin Antibody: 373 (Nov 06)

Thyroid Peroxidase: 43 (Nov 07)
Thyroid Peroxidase: 54 (Nov 06)

I am not being medically treated. These are the only tests my Dr. runs and I'm to go back in 3-4 months for monitoring.

My and my brain (!) have been feeling MUCH better, which surprises me because my stresses and busyness has gone up and I've fit more into my schedule than I've thought possible. I also lost my job in May and spent 3 months finding a new job with worse pay but I LOVE what I am doing and my coworkers. I would have thought additional stress would have been terrible on my numbers.

Is it typical for numbers to stay normal on their own once they are within acceptable ranges? How can I keep them this way? Prior to these recent results my Dr. wrote that I was "pre-graves disease" but that doesn't seem possible. I was under the impression that with those high antibodies it was just a matter of time before my thyroid would burn out. But maybe that is not true? Just wondering what your thoughts are with your knowledge.
Thanks Elaine!
Vickie

-- posted by vickwithpc

» Elaine Moore - euthyroid?

In response to euthyroid? posted by nurseheatherone:

Hi Heather,
While you're on meds you're considered euthyroid as soon as FT4 falls within range regardless of your TSH level. Your levels would be considered euthyroid now even if you weren't on meds.
A comparable dose of PTU would be about 25 mg daily.
I'm not sure why your doctor is pushing RAI. She may not have much experience with ATDs. Hopefully, she will learn something from your case. Best, Elaine

» Elaine Moore - better thyroid #s without treatment

In response to better thyroid #s without treatment posted by vickwithpc:

Hi Vickie,
Your thyroid antibody levels were initially elevated but not really very high. Thyroglobulin antibody titers greater than 1,000 would be considered high, and high levels are usually seen in Hashimoto's thyroiditis. Your levels are more consistent with subclinical Graves' disease, which is what your initial levels in 06 show.
People with subclinical hyperthyroidism and subclinical Graves' disease have a 50 percent chance of having their symptoms resolve spontaneously (without treatment). Whatever you've been doing is working and will likely continue to work. You'll want to continue to have lab tests though because there's also a possibility of spontaneously moving into hypothyroidism. Some labs are now using a high upper limit of 2.5 mu/L for TSH. Your FT4 looks fine now but you'll want to watch it also to make sure it doesn't start to fall. If it does you'll be ahead of the game by starting treatment early. Best, Elaine

» u25000 - Elaine: my latest health concerns

I tried a new GP(fem,DO like prev 2), hoping that she would be by "luck of the draw" more patient friendly (espec. a/insisting I share my recent infertility history so she could "better serve me"). Well in my 2nd appt today, after 2 mths of ongoing respiratory mucus,cough-minimal to worse at call for appt (since mc 8/30), I asked for an SED, ferritin, bone density, referral for AI issues to Rheum or Immun, also expecting she would offer flu shot. Knowing people as I've come to, I would say she scoffed at each question. Unbeknownst to her I am seeing an Reprod Immunologist now, and thanks to her tests, I not only have Graves, but now am Pos for ANA (neg 9/05), SSa(sjogrens), MTHFR hetero c677t, more to come. I just wanted to get on the ball w/my health since I'm convinced something more is going on w/this infertility. At the end of the conversation she offered the b/w, and referral, but failed to mention what I think should've been #1 (w/my so far undiagnosed, recurring for 15 years persistent cough and respiratory infections (sometimes referred to as bronchitis)) flu shot, as I AM trying to conceive. I never get offered a flu shot. I feel like the only way to get it is from a community flu clinic. Should I just give up on DOs and go to Integrationist. I'm a private person. I don't enjoy sharing my history w/apathetic strangers. It is so disheartening that I'm expected to share my private details and they don't help, even when I go for specific help. How can one develop relationship to call them "family doctors".

Also, re: supplements, thanks to research w/Graves issues, I am taking Fish Oil(eye pain;joints), Selenium (not sure why), Lysine(hair follicles w/lt4), Larginine (Mthfr;blood flow),baby aspirin (blood flow). I heard Andrew Wiell say his top3 were selenium, larginine and alphalipoic. I see Lcarnitine mentioned here alot. Is there something else I could incorporate of value or exclude?

Also please clarify, every RE (3) so far ONLY looks at TSH. I so agree w/your idea that TRab effects the tsh and only FT4 should be considered. Is this only after RAI, with meds, or always. I am considering going to one of the top hospitals in country, for an ENDO just to get a final opinion. After July cycle for preg, RE reduced from 100 to 88 due to tsh at .04, while ft4 was only weakly elevated. I feel as tho I should be on 100 but the tsh tells them otherwise. Here's latest #s:

**GRAVES DEVEL A/JAN02 LOSS;RAI 9/03;LT4.50 RXD 1/06 a/tsh 15.
7/7/07: 100mcg-2 mths; before preg
tsh .04 (.35-5.5)
ft3 3.2 (2.3-4.2)
ft4 1.73 (.8-1.8) this was done w/diff lab max 1.72))
*reduced to 88mcg per RE

8/7/07: 88mcg-3wks, pregnant
tsh 1.34
ft3 2.0 (this is the lowest ever b4 and after lt4)
ft4 0.9 (this=2005 #s when I was not on lt4,hypo,tho tsh levels on 75mcg

ama 18 (same as 1/07; 11 4/03)
tgab -20 (same as always)
tsi 3.1 (164 1/07; 4.7 4/03)

Its clear I don't have hashi. So I don't have those ANTI THYROID abs neg.effecting pregnancy; but I DO have TSI which stimulates my hormones one way or another; can cross placenta if not monitored properly and cause hyper baby. Until then what do these TSI levels mean to you? Should I definitely ignore tsh because of them? Why don't REs get it if so? Will my extra special Endo appt make a difference in educating/treating me?
thanks so much. your attention is as usual so appreciated. we are lost w/out you. I only wish I found you before 2007 (rai 9/03).

-- posted by u25000

» u25000 - Elaine: my latest health concerns #2

In response to Elaine: my latest health concerns posted by u25000:

Sorry I try to be as concise as possible; then something happened w/post and missed these:

8/24/07: 100mcg-2wks; confirmed loss this week
tsh .281
ft3 3.1 (better in comparison to post rai,hypo'05,a/prev100mcg
ft4 1.3 (same as above

10/29/07: 88mcg-2mths; after loss returned to lower dose
tsh .15
ft3 2.9 (this is same#as 10/06when I was hypo symptomatic;hi tsh
ft4 1.43 (seems better im comparison

the tsi ama tgab on prev post were from this date as well.

-- posted by u25000

» nurseheatherone - euthyroid?

In response to euthyroid? posted by daisyelaine:
I agree, I have made an apt with a integrative Dr. who specializes in women's health endocrine issues, natural healing and accupuncture. SHe is the one that Mary J shoman sees, Iwas so glad to see that she was in my area. Unfortunately the first apt. is in February because they only take 2 new pts. a day because it takes 2-3 hours for the first apt, what a difference. So as of now I am going to continue to take meds and not rush into anything. On 2.5 mg of tap I feel the best I have in a long time. The only thing that I still have is that throat pressure, I have kind of learned to live with it although it is nerve racking. I notice it gets worse when I eat,after I take my multivitamin or if I get nervous so I try ot relax myself and eventually it becomes tolerable. It arrives only after I take the Tapzole, usually early afternoon,but that could also be just the timing of the day. I slightly remember this happening before I started the med so I am not thinking there is any relation,although the fisr week I was off it it I noticed it less. Everyone I tell about this issue just shruggs their shoulders and palpates my thyroid and says it feels ok. SHould I get another Thyroid U/A just incase? the last one was done in June 07. Sorry to ramble, Have a very happy Thanksgiving!
Heather

-- posted by nurseheatherone

» Elaine Moore - Elaine: my latest health concerns

In response to Elaine: my latest health concerns posted by u25000:

Hi,
Your supplements look good. Selenium is helpful in reducing levels of thyroid antibodies.
TSI falsely lower TSH, and TSI levels rise after RAI. The levels eventually fall but they can persist for many years, especially if you have allergies or other causes of immune stimulation. It could be allergies that are causing your cough. TSH is also falsely suppressed in patients with active Graves' disease, which is why FT4 should be used for monitoring therapy. Hopefully your RE will understand how misleading TSH can be.
Have a Happy Thanksgiving, Elaine