General Medicine

» Elaine Moore - Latest request for clarification/direction

In response to Latest request for clarification/direction posted by u25000:

Hi,
I'd use evening primrose oil over coconut oil because of its helpfulness in PMS and gynecological problems.
The change in dose from 88 mcg to 100 mcg shouldn't cause the abrupt changes in levels that cause problems. But it also wouldn't hurt to wait a few days if you're not hypothyroid. You do want to avoid levels that are too low for your body's needs.
Ferritin can be low without causing anemia. Check out this link
http://www.nlm.nih.gov/medlineplus/ency/...
With a ferritin of 17 in the past, you'd want to have it checked again and also have your iron level checked. Ferritin stores iron and ultimately your concern is whether your stores of iron are adequate.
Adrenal insufficiency is suspect when cortisol levels are low. If they are you need to confirm this with further tests. If your cortisol level is normal, you wouldn't need other tests. Symptoms are often generic so you'd need blood tests.
A lot of people have had good results with IVIG. It's an expensive therapy, and you'd want to consult with a reproductive specialist on this. I'd also look into low dose naltrexone. Creighton University has some info, and I have an article on using LDN for infertility. This treatment is inexpensive and free of side effects. It's also used in Sjogren's and offers benefits in all of the autoimmune diseases in which it's been studied.
I'd focus on these two therapies rather than corticosteroids if your major concern is trying to conceive.
I haven't heard of heparin as an immune suppressor. It stimulates the production of platelet antibodies so I wouldn't think so. It's helpful in women with antiphospholipid syndrome.
I think since your thyroid levels are in control using either an 88 mcg or a 100 mcg dose, I'd focus more on the reproductive specialist. Total TSH receptor antibodies are a good test because both blocking and stimulating TRAb suppress TSH. And most of us who had RAI have both of these antibodies. After a few years we start producing more blocking than stimulating antibodies, which is why hypothyroidism worsens over time after RAI. Good luck with everything. Best, Elaine

» u25000 - Latest request for clarification/direction

In response to Latest request for clarification/direction posted by daisyelaine:
Thanks so much Elaine; I'm working hard to be very proactive and helpful to others as I learn from others, like you.
So, basically I should be fine w/an up increase from 88 to 100 while TTC. Thats what I thought prev as I had read that preg women should up their dose 50% but a board member said that changes can cause anovulation/miscarriage so I had to revisit. I've waited the usual atleast 6-8wks for dose changes, except when I was preg and m/c in 1.5 mths I went down from 100-to 88 per RE week of conception, then upped to 100 a/preg confirmation, then went down to 88 after loss.
I was curious instead of going straight to 100, what if I did 100 on the weekends just to give a slight boost?
I have seen an RE and now also an RI, thats where I've got the IVig info but I'm nervous about that; but would do anything I can to eliminate AI ab's. I am currently on Pred for that up to 12wks then to be weaned. Are you saying you would rather IVig vs Pred, assuming you know a little more than I, I've just started w/RI protocal.
I will look up Creighton/LDN; I wish I could get into that LDN right away, but now I'm not sure if I can get the scrip that quick from someone, not mentioned by RI, RE is conventional but open.
I errored in terms. I said Heparin, but I meant Lovenox, as it will improve blood flow to uterus, which my tests were not great there. It can inhibit clotting caused by antibody inflammation at implantation. Any thoughts/opinions, always appreciated.

-- posted by u25000

» Elaine Moore - Latest request for clarification/direction

In response to Latest request for clarification/direction posted by u25000:

Hi,
Prednisone will help reduce inflammation and antibody production while you're on it. This can be very helpful for autoimmune diseases, but it seems IVIg is more specific for problems with infertility. Your reproductive specialists are the experts here so I'd go with whatever they say.

Lovenox is a type of low molecular weight heparin and an excellent treatment when autoimmune clotting disorders like antiphospholipid syndrome.

It's fine to increase your dose to 100 mcg for a few days during the week. You might also want to try 2 days of the 88, a day of the 100, two days of the 88 to start, which will provide more stable blood levels. Thanks again for your help. Best, Elaine

» Elaine Moore - New labs

In response to New labs posted by nurseheatherone:

Hi Heather,
An internist specializing in endo is a good choice. Anxiety is a common symptom of hypothyroidism. I'm not sure of the mechanism behind it but anxiety occurs more often in hypothyroidism than hyperthyroidism, which is more likely to cause nervousness.

Side effects are reported to occur early on with Xanax and usually subside after 4 weeks of use. One of the reported side effects is nervousness.

Not all hypothyroidism is caused by Hashimoto's thyroiditis. In your case, the hypothyroidism seems to be related to taking the ATD when your thyroid hormone levels weren't high. In Hashimoto's thyroiditis, thyroglobulin and TPO antibodies are typically very high. Autoimmune hypothyroidism can also be caused by blocking TSH receptor antibodies.
Hashitoxicosis is a condition of Hashimoto's thryoiditis in which TSI are also present. TSI are the antibodies that cause hyperthyroidism in Graves' disease. Hashitoxicosis can cause transient symptoms of hyperthyroidism.
A 53% uptake at 25 hours, while elevated, isn't very high. This would fit with your starting out with a subclinical disorder.
The initial phase of Graves'disease is a period of hypothyroidism, which is usually mild and diagnosed. This may have contributed to your symptoms and would be associated with your TSH of 2.5. You probably then moved into subclinical hyperthyroidism, and the ATDs contributed to your hypothyroidism. Without ATDs, you may be euthyroid (normal thyroid function tests) or still have a low TSH, indicating subclinical hyperthyroidism. Subclinical disorders usually resolve on their own, but a beta blocker may be needed to reduce symptoms. Best, Elaine

» nurseheatherone - New labs

In response to New labs posted by daisyelaine:
Dear Elaine, i really appreciate you helping me understand all of this. Besides the anxiety, after a week and a half of switching to 1.25 of Tap I am actually feeling OK. I really think that I may have been better off if my doctors took a wait and see approach to this subclinical GD/GD. That is interesting to know about the xanax, honestly, I would prefer not to start relying on anti-anxiety meds if I can help it. My doctor prescribed me buspar to take for anxiety which I have not started to take yet, I am trying other methods to reduce the nervousness,although difficult I hope will benefit in the future. With all of my anxiety symptoms, weight loss ( total about 10 lbs),loose stools, palpitations, I was wondering if I was going hyper again, but when I was hyper I did not have all of these symptoms, so why would I develop them now. I guess my symptoms are just the opposite of what would be expected. Would I have TSI antibodies of 143% if I only was subclinical? Also the only other antibodies that were positive were the anti-TG at 53, now they are negative, I am assuming these are not high enough to indicate Hashimotos. I am not sure if I have been tested for the blocking TRAB. I am going to discuss all of this with my new Dr. and see if he will take me off of ATD's and see if I can be fixed:)
Thanks again, Heather

-- posted by nurseheatherone

» Elaine Moore - New labs

In response to New labs posted by nurseheatherone:

Hi Heather,
Buspar has side effects of nervousness and excitability in some patients. See http://www.rxlist.com/cgi/generic/buspir...

As for thyroid disorders, they're associated with a wide variety of symptoms, but most people only have a few predominant symptoms. Some symptoms, such as nervousness, are more common than others. But some people will only have a few atypical symptoms like headache and nausea. We're all different.

Symptoms of hyperthyroidism generally occur at TSI levels of around 125% activity. But this varies because people who also have blocking antibodies usually won't notice symptoms until TSI is higher because the blocking antibodies block both TSI and TSH from reacting with cell receptors. Also, there are many different subtypes of TSI, with some having more affinity for the TSH receptor subtypes more likely to cause hyperthyroidism. For this reason some people will have severe symptoms when their TSI levels are less than 100.

Hope this helps. best, Elaine

» nurseheatherone - New labs

In response to New labs posted by daisyelaine:

Thanks Elaine, the anxiety is better, I am not taking any of the medications at this time, but do get anxiouss with the throat tightening and pressure I get, more often lately. I did get new labs back and I think you may be right! my TSH is 2.619, Ft4 1.16, Ft3 142 my cholesterol is horrible at 277 triglycerides 183! This is with being on 1.25 mg of Tapazole for about 2 weeks, so my T4 went up a bit along with TSH, but my T3 went down. I wonder is this could explain some of my symptoms? I have a F/U with the new Dr. on Thursday, so I am hoping this means I am off the Tap! and hopefully will be on the road to recovery. I am also working with a ND and he is putting me back on a leaky gut protocol and wants me to go gluten and dairy free. If I am more hypo than hyper, why am I losing weight and having loose stools, I guess I gained weight and had loose stools when I was hyper so I am hoping my body is just trying to correct itself.
Thanks again!
Heather

-- posted by nurseheatherone

» nurseheatherone - New labs

In response to New labs posted by nurseheatherone:
So I decided to stop my ATD's today, I go to get my new Dr's blessing on Thursday. One thing that I am finding kind of strange is I am noticing that at times it is hard for me to pronounce my words? it is a very weird feeling, I am an advice nurse so I am talking all day and it just seems like at times my words cannot keep up with my brain. Also after only 15 days of my LMP I am now starting to spot and getting some symptoms like I may be starting my period again? this has never happened to me before. My question is, how long does it usually take for thyroid hormone to start to build up again? and would any Dr. put me on thyroid hormone with GD? maybe just for a little bit to get me back to normal? I am sure they will want to wait and see. Also, if the beta blocker has contributed to my high triglycerides does L-Carnitine help with palpitations. I started getting them after restarting my Tapazole, I am assuming from being hypo because my pulse is slow.
Thanks, Heather

-- posted by nurseheatherone

» u25000 - TRab/TBII/TSI

I really need clarification as the time draws near. As you may recall I am TTC after Aug MC. I read that patients suggest I get a TRab (TBII) before and during preg. That a Peri must monitor this. So far I have yet to meet a Dr who cares about these, so I am desiring to be prepared in case I conceive soon. I have seen an RI and it was she who did the recent TSI (3.1 (1.3pos)). My Mayo endo didn't seem to care recent visit. I read alot about TPOab/TGab effects on Preg and aided by IVig, but nothing on TSI (I even read this in the AI & Preg section of ThyroidManager. There was nothing said about TSI. My TSI last Jan was 164 (130pos) which I presume was due to not having had recent pregnancy. I just don't see what anyone will do about TSI when I read nothing about it. Yet I'm supposed to get (pay) for these tests. BTW, in Jan I also did TRab which was 4.1 (1.9pos) w/lower TSI 164 (still elev), but the TSH was 1.66 (hardly suppressed-a/3m on lt4). I just want to know what I should expect from a Peri during a crucial time. I have gone to Yahoo and Medi, Yahoo seems less technical. Medi is more helpful but still somewhat generic seeming. I just can't get solid info. And it surprises me greatly that after Graves AND after RAI AND with the poorly educated Docs we have, that people get and stay Preg. I go to Graves boards, which should be indicative that every pat.has TSI, yet I rarely see this discussion among those TTC. I beg you for some direction, I realize Preg is not your thing.

-- posted by u25000

» Elaine Moore - New labs

In response to New labs posted by nurseheatherone:

Hi Heather,
If you have gluten or dairy sensitivities, you won't absorb food properly and you'll have loose stools. You can also lose weight. The ND's approach sounds like a good idea. Food sensitivities may be causing more problems than your thyroid levels. Best, Elaine