General Medicine

» Elaine Moore - In need of understanding

In response to In need of understanding posted by free2ridejones:
Hi,
Your FT4 and FT3 are both within the normal or reference range, but they could be too low for you. If you're having symptoms of hypothyroidism then your levels may be too low. But if you're continuing to have a heart rate higher than 90 bpm after 10 min. of rest, you might ask about being on a beta blocker to reduce cardiac symptoms.

Most people with Graves' disease continue to have a low TSH, usually less than 0.1 mu/L. until they move into remission or are on too high of a dose of meds.
In your case I wouldn't worry about TSH falling since it's still higher than what is usually seen in people being treated for GD. Until your symptoms are in control and your heart rate is remaining normal, I probably wouldn't change your current meds. Best, Elaine

» Elaine Moore - TTC A/RAI; any input on poss probs

In response to TTC A/RAI; any input on poss probs posted by u25000:
Hi,
It's good that your doctors ran the APS work-up, and ideally you'd have the tests repeated to confirm that you're negative for lupus anticoagulant. I'd just ask to have the tests repeated after your clomid challenge test.
Usually, reference range for APS antibodies are reported as which means less than whatever the cutoff for sensitivity for the test is. If the normal range is less than 15, a result of 15 would be borderline so you might want to ask your doctor about that.
Your thyroid hormone levels FT4 and FT3 determine your thyroid status, but TPO antibodies also play a role, with high levels of TPO antibodies associated with a higher rate of miscarriage. You might want to check these results too and ask your RE if they could be contributing to the problem. Best, Elaine

» Elaine Moore - Advice please -Stressing!

In response to Advice please -Stressing! posted by JandC13:
Hi Jane,
The labs Dec 1 show hypothyroidism because of the elevated TSH and low FT3. Labs on Dec 15th look fine although some people need an FT4 and FT3 that are slightly higher (closer to the high end of the range). TSH is misleading which is why it's not supposed to be used to monitor ATDs. You're considered euthyroid or normal on ATDs when FT4 and FT3 are within the normal range regardless of TSH.
Typically, TSH will stay low or suppressed until the patient becomes close to remission although it'll rise if the ATD dose is too high. In persons with Graves' disease TSH is affected by both stimulating and blocking TSH receptor antibodies. So TSH levels can fall even when thyroid hormone levels fall. This happens when patients begin producing more blocking than stimulating antibodies and spontaneously move into hypothyroidism. Best, Elaine

» Elaine Moore - Graves and pregnancy

In response to Graves and pregnancy posted by mmeade07:
Hi,
Thanks for sharing.
RAI doesn't work well if the thyroid gland is unusually large or dense. In this case, the rays aren't long enough to penetrate all of the thyroid tissue.
Even when RAI doesn't work well, hypothyroidism can still develop over time. Even with one ablative treatment, over 90 percent of people become hypothyroid within 10 years. While most people become hypothyroid within a few weeks to a few months, for some people hypothyroidism develops up to 10 years later. Best, Elaine

» kaicee118 - Muscle Aches

Hi Elaine - I've written before-I have mild Graves Disease and just started Tapazole on 11/10/06. I just had my blood tested again on 12/18 and, although I don't have specific numbers, the woman on the phone preliminarily said the tests show I am still hyper.
For the past two weeks, however, I've been suffering from severe muscle and body aches. I've had a tentative diagnosis of fibromyalgia for over a year, although I've been thinking now that it's related to the thyroid problem.
Could the achiness be a result of a drop in thyroid hormone in my body, or could it be a kind of side effect of the Tapazole? It's been so bad that I've been taking one Lortab (from a previous prescription) every day this week.
Thanks in advance.

-- posted by kaicee118

» Elaine Moore - Muscle Aches

In response to Muscle Aches posted by kaicee118:
Hi Kaicee,
I suspect that you're hypothyroid and the woman you talked to probably didn't realize that a low TSH is expected for a long time after starting meds. You're considered euthyroid (normal thyroid function) while on meds as soon as FT4 falls into the normal or reference range. A persistently low TSH doesn't mean you're still hyperthyroid, but many doctors and other health professionals still get confused by this.

At about 6 weeks after starting meds, your FT4 should be normal or even low if you started out on 30 mg Tapazole or more. The new recommendations are for using a starting dose of only 10 mg daily. At 6 weeks, most people are on a maintenance dose between 2.5-10.0 mg Tapazole daily. It's also best taken in 2-3 divided doses to provide stable blood levels.

Fibromyalgia is linked to hypothyroidism. Low levels of thyroid hormone exacerbate symptoms. For this reason, some physicians use thyroid replacement hormone to treat patients with fibromyalgia if levels are on the low side but stll normal.

The early stage of Graves' disease is a period of hypothyroidism, and sometimes fibromyalgia emerges during this phase. Ask for a copy of your lab results to make sure that your levels aren't falling too low. After the first 6 weeks, when all the hormone is released from the gland, you can get by with a lower Tap dose. You want the lowest dose needed to keep your FT4 and FT3 within range. Best, Elaine

» HCwriter - NO SEX DRIVE freaking me out!

Hi. I have Graves' Disease, which went undiagnosed for several years and became very severe. When I was finally diagnosed, I saw a few bad docs who overmedicated me to the point of extreme hypothyroidism. I then found a good endo who is regulating me on Tapazole (although he and everyone else wants me to do RAI, he is supporting my decision to use meds). Needless to say, I've had every symptom (common and uncommon) there is under the thyroid sun - both hyper and hypo!

A few years ago, BEFORE I was diagnosed with Graves' (so was on NO meds at the time, but SEVERELY hyper) my sex drive/libido just DISAPPEARED one day. Literally like a switch. One day there; next day gone. Zippo. I can't get stimulated in any way, and having an orgasm is out of the question. Seems like there is absolutely no blood flow happening. This was NEVER a problem for me before!! I used to be able to just fantasize and become stimulated. (FYI - I'm in my mid-30s and had no decrease at all in my libido until the day it "turned off". In fact, my libido was quite strong.)

This is scaring me to death - and even more so that it was so sudden. It's like a fuse blew out and I'm afraid I won't be able to turn it back on. It's been years! HELP!!!

My body/brain has been so whacked, emotionally and physiologically, for many years with this thyroid craziness going on - plus the swinging back and forth between hyper and hypo (although I was mainly hyper most of the time). My only hope is that now that I'm regulated, I'm thinking maybe it might take a while for everything to fall into place and become homeostatic again - including my libido. Does anyone agree? Disagree?

Any advice, thoughts, stories you could share would be greatly appreciated.

-- posted by HCwriter

» Elaine Moore - NO SEX DRIVE freaking me out!

In response to NO SEX DRIVE freaking me out! posted by HCwriter:
Hi,
You didn't mention if you were a male or a female. Females often have an increased libido while hyper because of a fall in estrogen compared to testosterone, whereas males often have decreased libido if estrogen levels rise.
In hypothyroidism, both males and females often have low libido because of a decline in most sex hormone levels.

Things reported to help females include DHEA, avena sativa, arginine, ginkgo biloba and MACA.
Things reported to help males are pretty much the same except that males may also want to have their free testosterone levels checked if thyroid levels are normal and they're still having problems.

In most cases, for a person as young as you are, restoring thyroid hormone levels, and returning them to the high end of the reference range, like a 1.6 ng/ml FT4 when the reference range is 0.8-1.8 should fix the problem.
Best to you and Happy New Year, Elaine

» Calypso0317 - A question about the integrationist doctors you mentioned

This is on a side note and I apologize but I am currently looking for an integrationist doctor in NY City or Brooklyn and cannot even find a listing. Google search comes up with nothing. Does anyone have any idea how to find someone? I posted here since integrationists are mentioned and I figure someone must know how to find them. I would really appreciate any information anyone has. Thank you.

-- posted by Calypso0317

» Elaine Moore - A question about the integrationist doctors you mentioned

In response to A question about the integrationist doctors you mentioned posted by Calypso0317:
Hi,
Because integrationist physicians combine techniques of both conventional and alternative medicine, they're usually listed under holistic healing. One of the best know centers is the Olive Leaf Wholeness Center in NYC run by Dr. Rudoloph Ballentine, the author of Radical Healing. Several different physicians with different holistic focuses work here.

Dr. Eric Braverman, another integrationist physician, has a PATH healing center in NYC. But if you do a search for holistic healing centers, you should find many other resources. Hope this helps, Elaine