General Medicine

» Elaine Moore - Ideal levels/ranges of TSH, T4, and T3

In response to Ideal levels/ranges of TSH, T4, and T3 posted by javatlkrs:

Hi Anne,
We all have our individual optimal levels for thyroid hormone, but most people feel best with thyroid hormone levels, FT4 and FT3, at least at mid-range. Many people also do best with levels nearer the high end of the range. Occasionally, people feel better with low levels, and this is why symptoms are much more important than lab results.

keeping a journal is the best way to keep track of what your optimal levels are. Or you can simply write down on your lab results what dose of meds you were on when your blood was drawn and how you felt overall.
TSH lags behind thyroid hormone levels, and most people with GD don't secrete much, if any, TSH unless their dose of meds is too high or they've moved into remission. Even with remission, most people will have a TSH between 0.3 and 1.0 unless they're moving into hypothyroidism.

After the first 6-8 weeks on meds, most people need a maintenance dose somewhere between 2.5 - 10 mg methimazole daily, It's rare for someone to need more. Best, Elaine

» Elaine Moore - Ideal levels/ranges of TSH, T4, and T3

In response to Ideal levels/ranges of TSH, T4, and T3 posted by javatlkrs:

Hi Anne,
The new TSH ranges suggest hypothyroidism when TSH rises over 2.5 mu/L. And with FT4's range being 0.8-1.8 your level of 0.8 confirms that you have inadequate hormone for your body's needs. Symptoms of hypothyroidism vary but common early symptoms include depression, mental fog, sleep disturbances, weight gain, constipation, and just feeling blah. Some people also feel anxious and are prone to panic attacks. Best, Elaine

» javatlkrs - Thank you

Elaine,
Thank you for your response and information. The symptoms that you described are how I feel. I saw my Dr. today and he suggested lowering my meds to 20mg of methimazole a day. I had one other symptom that is disturbing. I feel tightness in my lower throat. Like when you swallow pills and they get stuck in your throat. My Dr. wants me to have a sonagram. I'm wondering if this my be another symptom of becoming hypo?
I will follow your advise and keep a journal of test results, dates, symptoms, and overall feelings of wellbeing.
Thanks again for your website and all your help and advise.
-Anne

-- posted by javatlkrs

» juicymango - TSH vs TSI

In response to TSH vs TSI posted by daisyelaine:

Dear Elaine & u25000
Thanks very much for your answers. I have been away so I went to my hospital appointment today unprepared and when I told my consultant that I had read that TSH stays low because of TSI he told me categorically that I was absolutely wrong! I might still try to find the elusive article and send it to him (if I dare!) but I'm less concerned than if he hadn't agreed with me that I should lower my dose of carbimazole from 5mg to 2.5, and hope to stop meds completely soon if my FT4 continues going down/ staying low. He also dismissed my experience of how much juicing goitrogens/ avoiding iodised salt/ dairy etc affects my symptoms. Gah! I'm sure he's a very good Dr in some ways but his reliance on lab tests over symptoms and personal experience makes me angry.
Sorry about the rant, mostly I just wanted to say thank you.
And I am taking St John's Wort. Although I was wary because I was taking it when I developed GD, I haven't found any evidence that it can trigger autoimmune conditions so I'll see how I feel on it.
Thanks again
Best wishes
Helena

-- posted by juicymango

» u25000 - TSH vs TSI

In response to TSH vs TSI posted by juicymango:

I found the right article after my last post to you, thanks to Elaine. Go to Pubmed enter Brokken, its in the lower end re: tsh suppression in the title. They are short articles so you can see it will make sense quickly. So far everyone is right about symptoms and mid-hi range ft's. I wish I had the scrip in 2004/2005 I believe I may have been able to dose myself then to get my levels up, but I was never given a scrip becuz my low ft's were "inrange" (only the PTU (2wks-istopped it) was rx'd due to the "infamous" suppressed TSH; which inadvertently went up next mth (as I believe under the B&R theory, it was forced up when my already low ft's were forced lower w/it) unfort.I'm convinced my eye problems started becuz it got so low (just below range)). I felt GREAT w/hi ft's where my ft4 was slighly elevated (of course tsh was lowest). I feel OK w/mid range ft's, but personally don't want to be there as I'm TTC and tho the ft4 is mid and higher than 2004/05 labs, the ft3 is mid and similar to those years that I couldn't get preg while not on lt4, so I don't like being there.

I wish I knew how to send a link w/IE.

-- posted by u25000

» u25000 - Latest request for clarification/direction

I went to see Mayo endo (thought to be the best), hoping this would be the clarity of all things thyroid. But it turned into greater confusion and I decided not to lower my dose from 88 to 75mcg as he suggested per looow tsh & cancld my F/U appt.

So, here I am again at the drawing board w/latest concerns:
1. On 88mcg w/mid ft's (feel ok-better on 100mcg hi fts), is it ok or not ok to increase to 100 now while mid-ovulation TTC cycle? I recently first time heard that m/c can happen w/dose changes( i thought that was only w/hypO,HypeR levels).
2. I've asked several docs for Ferritin but they all refer to my Hemoglobin (12+) as not indicative of need. Am I misguided when I thought that Graves can cause low Ferritin despite CBC normal? I wanted to check my Ferritin to make sure it is well enough for pregnancy (BTW I have been taking PNatals for past year). It was 17 2/05 when I was not on PN nor Lt4.
3. I've asked docs about adrenal insuff (again as I understand Graves pat can suffer-covering all bases), and docs don't think there is indication. Is there a way to know by symptoms or a test that I can ask for? (they also didn't know I had Sjogrens-which may be impeding my TTC)
4. Cortisol-the stress hormone-butterflies. Even tho I often can depress easily. I actually can recoup well. Is this why there is no indication for testing?
5. I read your article on AutoImmune Infert(adrenal); IVig-do you have any 2nd hand experiences of why not to try IVig re: autoimmune antibodies such as Sjogrens,ANA that may be hindering my Pregnancies?
6. What is your op on steroids (i didn't get them during RAI) during TTC cycle as immunosuppressant of overactive AB system, and is there a Neg effect re: TED (minimal-cosmetic chgs).
7. Have you heard of Heparin as an immune suppressor?
8. I understand Selenium works w/ATAs, what about TSI-is it an AB suppressor all around?
9. I am happy with 1T fish oil daily 3200mg, I may double dose for TTC. What do you think of Coconut Oil as well?
10. I soooo need to understand what type of DR to find, do you have any more hints. Thyroidologist vs Endo vs Maternal Fetal?
11. FINALLY, I feel like after I ordered TRab from Healthcheck they cancld the test. Is there another place to get TBII? And when I did have it done it was a total, I've seen that others get a split count of binding/blocking, which can help them convince docs of low tsh theory??

-- posted by u25000

» nurseheatherone - New labs

In response to New labs posted by nurseheatherone:
Hi Eliane, I went to see a internist( well his NP)who specializes in endocrinology, they listened to my symptoms, ran a ton of BW, and are going to F/U with me next week. The NP said that my symptoms sound like I am hypo and is thinking coming off the tap may be a good idea. SHe was going to run it by the Dr. and call me by the end of the week to let me know what to do. The night before I was feeling really anxious, so I took half of a .25 xanax ( only my 3rd time taking it) and I went into a full blown panic attack, it took me over an hour to calm myself down and fall asleep. I never thought I would get a reaction like that to xanax! also I have been fighting my anxiety all day today, no apetite, why am I so anxiouss now that I am bordering hypo?
I was negative for all other antibodies, except for right before I was treated my antithyroglobulin antibodies were 53, now they are all negative. Do you have to be positive for other antibodies besides TSI with Hashimotos? is Hashimotos and hashitoxicosis the same, hashitoxicosis being they hyper phase? my RAIU was 53%,if you were looking at that wouldnt that indicate GD?I always thought that my symptoms of weight gain, high BP and high chole were more hypo than hyper. Also in May 06 my TSH , the only one I have had on record before all of this was 2.5. What is the treatment for this, if this were the case? Would I need to be on ATD's? I have been reading your book and doing some research on this and it seems as though this fits me better. I am assuming you can have both GD and hashimoto's,
Thanks again!

-- posted by nurseheatherone

» Elaine Moore - Thank you

In response to Thank you posted by javatlkrs:

Hi Anne,
Both hyperthyroidism and hypothyroidism can cause an enlargement of the thyroid gland (goiter). In patients on anti-thyroid drugs, the symptoms you describe are usually associated with a goiter related to hypothyroidism related to excessively high ATD doses. Other symptoms of goiter include fullness in the throat area, difficulty swallowing, hoarse voice, etc. The recommended maintenance dose after the first 6-8 weeks is 2.5-10 mg methimazole daily so you might need another dose adjustment. Best, Elaine

» Elaine Moore - TSH vs TSI

In response to TSH vs TSI posted by juicymango:

Hi Helena,

Some doctors remain obsessed about TSH levels, and labs are partly to blame. When we first developed tests to measure TSH we thought TSH would always reflect thyroid function. In screening for thyroid disease, TSH is usually reliable. But in autoimmune thyroid diseases, this changes. If I have time over the holidays I'll try to find the article. You can also check the archives on the graves' disease board at mediboard.com. It was discussed in depth when the article came out in 2003. Best, Elaine

» Elaine Moore - TSH vs TSI

In response to TSH vs TSI posted by u25000:

Thanks so much for locating the article. Despite my good intentions, with a new puppy and long hours at work, I'm only accomplishing about 5 percent of what I plan. I appreciate your persistence in finding the article. Best, Elaine