General Medicine

» Elaine Moore - euthyroid?

In response to euthyroid? posted by nurseheatherone:

Hi Heather,
Glad to hear your symptoms are better. Changes in estrogen and progesterone levels around the time of your menstrual period cause a slight rise in thyroid hormone levels. Many women describe having symptoms flare right around the time of their periods. Take care, Elaine

» nurseheatherone - euthyroid?

In response to euthyroid? posted by daisyelaine:

Hi Elaine, Question for you? can you take a low dose beta blocker and L-carnitine together, is there and known interaction? last night I started to take 12.5 mg of a beta blocker for my bounding pulse. It is very strange my pulse never gets above 70 but when I lay down or am restin in the evenings and when I go to bed I notice it. This is the same thing that happened to me when I was first diagnosed, I was under the impression that once you became Euthyroid those symptoms were supposed to get better? I am wondering if I may need a medication increase,I guess I wil find out with my next labs!
Thanks, Heather

-- posted by nurseheatherone

» aviano - Androgen Levels

In response to Androgen Levels posted by daisyelaine:

Elaine:
Thanks so much for this info..I'm tracking my levels and "trends" and went back and looked at this after your suggestion..There is definitely a correlation between increased TSI Antibodies and increased DHEAs and testosterone (total and esPECIALLY free); however actual levels and TSH (probably due to some blocking TRAb activity?) DON'T correspond with increased overall androgens. And again, whenever I take estrogen (and possibly progesterone), this is the response that I'm getting. I have an app't with Duke endo (as new patient)tomorrow..the overall excess androgen thing IS familial..on both sides..Graves Disease on my Mom's side..possibly Hashi's on Dad's..so it's hard to tease out..
Thanks again for the info on HBIG..despite in-depth research and reading on Thyroid Disease, that is one I didn't know..
Avi

-- posted by aviano

» u25000 - Recent Endo visit

Finally made the effort to go to the "best" Endos to figure out my issues (Graves-rai induced Hypo; TTC). I went to Mayo. Well I only came out more confused. Currently I am on 88mcg since after last m/c (8/30) as RE felt tsh was too low. Here are the latest #s
10/29/07:
tsh .15
ft3 2.9
ft4 1.43

My Mayo endo said that tsh is the best barometer of whats going on and that I only need that test. He also said I should be on 75mcg based on these tests. I felt great (w/no wt loss 160#) at 100mcg before preg for several mths, and feel okay at 88 w/a little more lethargy. I exercised more at 100, less now on 88. I am concerned about going down to 75, espec. since TTC. He does not seem to believe in the TSI effect on TSH (suppression). He does not seem to have any studies or ideas on dosing/testing after RAI. Just that ft4 is not as useful as tsh. Pls help!!!!

-- posted by u25000

» Elaine Moore - Androgen Levels

In response to Androgen Levels posted by aviano:

Hi Avi,
That's an interesting observation about TSI and your hormone levels. The interactions of the various hormones and hormone receptors are pretty amazing so you could easily be right about this. Let us know what your doctors at Duke have to say. Best, Elaine

» Elaine Moore - euthyroid?

In response to euthyroid? posted by nurseheatherone:

Hi Heather,
It's common for palpitations to be more noticeable at night when you're laying down and your body is at rest. Palpitations can occur in both hyperT and hypoT although they're more common in hyperT. It's fine to take carnitine with your beta blocker. Take care, Elaine

» Elaine Moore - Recent Endo visit

In response to Recent Endo visit posted by u25000:

Hi,
It's unfortunate that the endo you consulted isn't keeping up with changes that have occurred in the last decade. Here's a quote from the CAP Today Feb 2007 issue, in an article by William Check, Untangling Thyroid Problems, Test by Test: The clinician must look at the TSH number in the context of whether the patient has thyroid autoiantibodies or other contributing risk factors, such as diabetes, obesity, or advanced age. The treatment threshold should be patient-specific." CAP is the College of American Pathologists. They're the experts in lab testing.

For years it's been known that TSH is falsely lowered in Graves disease. This was thought to be due to problems with the thyroid-pituitary-hypothalamic axis, but in 2003 Brokken et al figured out the cause, which is that the pituitary has receptors for TSH and TSH receptor antibodies and can't differentiate between the two. The ATA had an article in their newsletter about this in 2004 and there have been several CE courses for doctors listing this information.

It's unfortunate, too, that lowering your dose was recommended when your FT3 is already skirting the lower end of the range. Sadly, I'm not surprised because I've heard from others with poor endo experiences at Mayo. Best, Elaine

» aviano - Androgen Levels

In response to Androgen Levels posted by daisyelaine:

Elaine:
I will definitely let you know. One of my "pet theories" is that sometimes what looks like "bipolar" is actually vacillating thyroid disease..and those excess androgen levels definitely feel like toooooo muuuuch adrenaline. Another hormone
"diva" feels that I may have some adrenal hyperplasic activity going on (late onset, of course). Another reason for my visit to Duke.
Thanks again,
Avi

-- posted by aviano

» juicymango - TSH/TSI reference & St John's Wort (Grave's)

Hi Elaine
A few weeks ago (and subsequently), you mentioned an article by the ATA clarifying that TSH levels are artificially lowered in Grave's by the presence of TSI antibodies. I want to persuade my consultant that keeping my T4 low isn't helping me and I wondered if you had the webpage address because I haven't found it myself. At the moment I'm taking 5mg Carbimazole, technically the lowest dose, but as I also juice cruciferous veg daily, avoid iodized salt and dairy, and try to eat lightly, my T4 levels are low. I don't really have the impression that my immune system is healed yet but I'm hoping to persuade the doc to support me in dropping to half a tablet (2.5mg) per day, and then possibly controlling it through juice (although he doesn't believe that anything other than meds has an effect). I'm feeling pretty depressed at the moment and wondering if its seasonal as well as related to my thyroid. I know that St John's Wort is supposed to stimulate the immune system; do you know if its in a way that's good for autommune illnesses or not?
Sorry for so many questions at once!
Thanks for your support
Helena

-- posted by juicymango

» aviano - Androgen Levels

In response to Androgen Levels posted by daisyelaine:

Hey Elaine:
Back from Duke..very disappointing experience. Endo there looked right at me and told me that they (1) don't track antibody levels, (2) agreed that I had higher than normal androgen levels for a woman my age, postmenopausal..but didn't know what to do about it and couldn't help me". Very kind and supportive..but still a dead end.
Any other thoughts?
Avi

-- posted by aviano