General Medicine

» 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

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

In response to TSH/TSI reference & St John's Wort (Grave's) posted by juicymango:

Hi,
The URL for the ATA reference is no longer active. The site is regularly updated. You might check the European Journal of Endocrinology for the original article by Brokken. The article was published in several journals, including this European journal.
Here's a link to an article by Mary Shomon describing how St. John's Wort can help people with thyroid disorders http://thyroid.about.com/cs/dietweightlo...
Ideally, your FT4 would be at least at mid-range and preferably near the high end of the range. Depression is one of the earliest symptoms of hypothyroidism, and lowering your ATD dose would likely help you. Mention all your symptoms of hypothyroidism when asking about reducing your dose. Best, Elaine

» Elaine Moore - Androgen Levels

In response to Androgen Levels posted by aviano:

Hi Avi,
I'm sorry to hear your endo experience didn't go well. Unfortunately, many endos today are more interested in diabetes, which can be more lucrative for them. It would be good if you could find an endo or internist with an interest or specialty in glandular disorders. Even a Family Practice Doctor or Osteopath with good diagnostic skills and the time to spend on the research would be a good option. Some Physician Assistant's are also more willing to go the extra mile. Best, Elaine

» Elaine Moore - Androgen Levels

In response to Androgen Levels posted by aviano:

Hi Avi,
The clinical textbook, The Thyroid, A Fundamental and Clinical Text, says exactly that and describes the effect of fluctuating thyroid hormones on bipolar disorder. This textbook is available at many hospital libraries. Take care, Elaine

» u25000 - TSH/TSI reference & St John's Wort (Grave's)

In response to TSH/TSI reference & St John's Wort (Grave's) posted by juicymango:

fyi, i asked same thing and just found it. Go to cap.org, click on CapToday button, click on 2007 articles, click Feb, "Untangling thyroid problems..." its the cover story-easy to find.

-- posted by u25000

» nurseheatherone - Weird symptoms again!

In response to euthyroid? posted by daisyelaine:
Hi Elaine, I am coming to you to see if you have any insight into what could possibly be causing these weird symptoms I am having. About a month ago after being off of my tapazole I developed some really yucky symptoms of aching back pain really only on my left side that sometimes would ache in my throat as well, almost like pulsating, headache, trouble sleeping and nausea. after about a week of these symptoms and two visits to my PCP, and almost driving myself to the urgent care, they checked my thyroid levels and they had gone from a TSH of 2.61-.46 and my FT4 went from 1.10-1.4 in the 2 weeks that I was off the meds. Also my ESR,Westergren was 22, a little high. Since I had dealt with these symptoms for a week and did hear back from my endo I decided to start taking my Tapzole again 2.5 mg and 1/2 of a beta blocker and my symptoms started to get better. My PCP had given me a muscle relaxer thinking I had a tension headache and back pain but neither that nor advil or tylenol took away the discomfort. When I finally saw my endo she said that she was fine with me staying on 2.5mg of tap and that I could probably stop taking the beta blocker at the end of the week. She also blew off my symptoms and said that she had never heard of these symptoms before and said that even if I had gone to urgent care they would have just given me a beta blocker and sent me home! I was just happy that I had finally found some relief so I did not really get into it any further with her. Now I am expecting my period and have had pre-menstrual symptoms and also started having palpitations that I started to take the beta blocker for again. Yesterday, I started to feel the weird symptoms starting back again, not as intense but miserable all of the same. This morning I thought that maybe I am hyper again so why not try taking 5 mg of tapazole, the symptoms are still there( I know it does not work over night). I get labs drawn on Monday, but I probably will not get the results back for another week after that and do not see my endo until after the holidays. I am just really interested in what these symptoms could be from. last time I wrote you about them you said that you thought they could be my FT4 changing/going up. I am just wondering how to fix them, it makes me nervous that my endo cannot explain them and they are very specific, same back pain in the same spot, same feeling it has to be my body changing or trying to tell me something is off. I have 2 endo appointments for other opinions coming up in a month or so, but this feeling of almost being hungover with aching pain can be pretty debilitating and scary, I am just praying that it does not get as bad as it was before. Would you continue 5mg of tap to see if it helps? I hesitate to think that I am hypo since when I had these symptoms last time I had become euthyroid, but with a quick drop towards hyper, I also was on my period oddly enough. Rambling again, but I have done some research on these symptoms and cannot figure them out. Even with medical training I do not even know where to start. Any insight would be appreciated. Thanks again Elaine.
Heather

-- posted by nurseheatherone

» u25000 - TSH vs TSI

I found the CAP article 2/07 which you referred to in a recent reply (was helpful as far as new expectations), but it didn't refer to the Brokken theory re: TSI falsely suppressing TSH. I looked over the ATA website for 2004 article, its difficult to find there, but still trying. In meantime, can you direct me to a specific site or link re: TSI causing a false suppression of TSH therefore the TSH is not as reliable w/Graves. Does it matter after RAI either or worsened?

Also do you have any info on why ft3 or ft4 should be at high end of range. I'm confidant I felt better on 100 when my ft3,ft4 were 3.8, 1.73 respectively, first time since before disease I'm guessing. Now my levels are tsh .10 ft4 1.3(lo-mid) tt3 88 (lo)and I feel less energy then when I was actually very active on 100 last summer. I'm on 88 due to low tsh. Mayo Endo wants me on 75 due to low tsh. I understand the Endo concern of heart disease and osteoporosis. But they never seem to care about symptoms and it seems that I often hear the need to be aware of symptoms. I hear ft4 is more accurate than ft3, which explains why he did tt3, yet I thought totals were obsolete. So I am really confused with what I should be concerned with: symptoms? ft3? tt3? or ft4? TSH? as a Graves: hypo after rai patient.

I will keep looking for a very Graves oriented Endo.

-- posted by u25000

» Elaine Moore - Weird symptoms again!

In response to Weird symptoms again! posted by nurseheatherone:

Hi Heather,
I'd stick with the 2.5 mg dose but probably wouldn't go any higher. It sounds like your symptoms of back pain may be related to your menstrual cycle or ovulation rather than your thyroid condition. Your sed rate is only slightly elevated but it could indicate an inflammatory condition. The headache and nausea could be from your levels rising and your 2.5 mg ATD dose should help reduce these symptoms if that's the case. Sorry I'm not much help here. Best, Elaine

» Elaine Moore - TSH vs TSI

In response to TSH vs TSI posted by u25000:

Hi,
Go to the library of medicine search engine pubmed for journal articles to find Brokken's articles. It's TSH receptor antibodies that cause the false decrease and these antibodies are usually elevated to a higher degree after RAI. But they're also present in most people with Graves' disease. Most people with Graves' disease feel best with levels on the high side of the range. We produce much more T4 than T3, and the free hormone levels are better indicators because they're not as likely to be affected by other factors.
There's an article in Medical Laboratory Observer from this past year on thyroid function tests too that mentions lower TSH levels being seen in patients with Graves' disease too if you have time to do a search. Best, Elaine