General Medicine

» Elaine Moore - T3/Reverse T3

In response to T3/Reverse T3 posted by aviano:

Hi Avi,
that's a great article and one I hadn't seen. I know that in some European countries T3 levels are relied on more than T4 levels and that FT4 isn't often measured. My question would be where does FT4 fit in the scheme of things?
Measuring reverse T3 is definitely an interesting concept when you consider the tissue level they're talking about. I'll have to see if anyone else has published anything on this. Thanks for sharing it, Elaine

» dana65 - Maintenance Dosage of Tapazole

Hi Elaine . . . Is a maintenance dose of Tapazole usually 2.5 mg or 1.25 mg? And if a doctor wants to take you off the medication once your labs are normal, should one ask to continue a maintenance dose for a longer period of time? (I seem to recall you mentioning once that those on medication for at least a year have a higher rate of permanent remission. Can you reference an article showing that result)?
Actually, when the doctor is ready to take me off, I'd like to stay on and return to a more normal diet to see if that has any impact. (I especially want to do that because the doctor seems to not put much credence into following a low-iodine diet.) Any thoughts on that?
To catch you up: I've been on Tapazol for four months now (10 mg for 6 wks, 5 mg for 6 wks, and 2.5 mg after that.) My labs were completely normal when the dosage was reduced to 2.5. I was due for another appointment 6 weeks after that but couldn't make it so must now wait another 4 weeks to be seen. When I asked if I could reduce the dosage to 1.25, the doctor said, "Yes," but now I'm wondering if I should do that or not. My only symptom at this point is hair loss (which could also happen if I'm hypothyroid, right?).
Thanks for your time, as always.
Dana

-- posted by dana65

» Elaine Moore - Maintenance Dosage of Tapazole

In response to Maintenance Dosage of Tapazole posted by dana65:

Hi Dana,
The literature lists a maintenance dose of 2.5-10.0 mg daily for methimazole, but many people do fine on only 1.25 mg daily. Studies show the highest rate of permanent remission with long-term (average 4 year) low-dose ATD use. There are several studies showing this with the most well known the Yamamato study from the 1970's.
After only a few months, remission is possible, but you'd want to be sure by first lowering your dose and staying on 1.25 mg for at least 6 weeks to make sure you're secreting TSH normally. This would indicate that you're no longer producing significant amounts of TSI.
Dietary iodine has been listed as an environmental trigger of autoimmune thyroid disease for quite a few years now. Avoiding excess dietary iodine in fast/processed foods eliminates reduces this trigger. Also, thyroid hormone is made from tyrosine and iodine. Reducing the amount of iodine you ingest reduces the amount of thyroid hormone you can produce.
ATDs work primarily by blocking iodine absorption.
I have references cited with most of my thyroid articles that you can use if you need resources. Also, check PubMed for article abstracts. Best, Elaine

» dana65 - Avoiding Iodine

Hi again, Elaine . . . I do not have any trouble avoiding fast or processed foods, but I've also totally avoided dairy and seafood for the past several months. (I never eat cheese, I don't even butter my toast, and I never eat egg yolks -- so I don't even use mayonnaise any more.) I would guess that's why I became very deficient in Vitamin D and was prescribed a two-month weekly mega-dose prescription of Vitamin D. So now I'm wondering if I can soften that rigid diet just a bit without triggering the antibody action again . . .or must I wait until I've been in remission for a couple of years before trying to use milk in my cereal or buttering my toast or having a little cheese on occasion? Thoughts on that?

And once again, what defines "remission?"

Many thanks.
Dana

-- posted by dana65

» Elaine Moore - Avoiding Iodine

In response to Avoiding Iodine posted by dana65:

Hi,
remission occurs when your immune system stops producing TSI antibodies at levels that cause hyperthyroidism. Because these antibodies falsely decrease TSH, you can confirm remission with either a TSI level or a TSH level. A normal TSH in someone on a very low ATD dose would confirm remission.

a recent study published in Science showed that although many people are deficient in vitamin D, vitamin D supplements do not necessarily benefit the immune system. It's recommended that vitamin D be absorbed through sunlight. I recently wrote an article on this that you can find with the autoimmune disease articles.

You want to avoid excess dietary iodine. An occasional dairy product is fine. Best, Elaine

» dana65 - Avoiding Iodine

In response to Avoiding Iodine posted by daisyelaine:

Thanks, Elaine. After I posted that, I found your articles on remission and drug therapy, so I wouldn't have needed to bother you. I'll check out the articles first the next time . . .

Dana

-- posted by dana65

» Elaine Moore - Avoiding Iodine

In response to Avoiding Iodine posted by dana65:

Hi Dana,
No problem. It's always good to hear from Graves' patients who are proactive and doing well. Best, Elaine

» nurseheatherone - Avoiding Iodine

In response to Avoiding Iodine posted by daisyelaine:

Hi Elaine! it is has been a while since I have posted last but of course I have more questions. I just found out that I am about 5 weeks pregnant and I have a question about dairy. I have been pretty much been avoiding dairy because of the iodine content but I am now thinking I should add some back into my diet for extra calcium. I am aware that I can get calcium from other food sources, I am jsut afraid to cut out an entire food group while pregnant. I am supposively still in remission, and am to get my labs rechecked in May which will be 6 months without meds. I am thinking I will have to get them checked sooner than that to see if my body is goign to go hay wire again now that I am pregnant. Also, any recomendations on a good natural Pre natal vitamin with DHA, I seem to having issue with the prescriptions ones and getting a rash on my neck, maybe from the dye?
Thanks Elaine, Heather

-- posted by nurseheatherone

» Elaine Moore - Avoiding Iodine

In response to Avoiding Iodine posted by nurseheatherone:

Hi Heather,
Congratulations on your pregnancy!! I'd definitely add dairy. Just don't over do it. And take whatever prenatal vitamins your doctor recommends as long as they don't have more than 150 mcg iodine. You want a vitamin that has adequate folic acid. I take DHA in an essential oil capseule with GLA, DHA that I get from Life Extension (www.lef.org) Ask your doctor if something like that would be ok. I agree with you that DHA is very important. Even my puppy gets it in her food. See if your doctor has any samples you can try. I used to get rashes from supplements that contained iodine.

During early pregnancy, thyroid levels normally rise. The ranges are 1.5 times higher than usual for T4 and T3 and you can expect TSH to fall as low as .01 mu/L but not less than that. During the second half of pregnancy levels fall because of the increased estrogens using up all the binding proteins. So people on replacement hormone generally need more and people on ATDs need less. You'll probably not need anything but these are normal changes you should be aware of so you don't worry about them. Take care, and again, congratulations!! Elaine

» loriv134 - This is all over-my-head!!

I was diagnosed with Graves Disease back in 2004. My PCP did a routine lab test because of my complaints of fatigue. She called with my thyroid levels being quite low. She sent me for an uptake scan with subsequent results revealing Graves Disease. I found out a week later I was 7 weeks pregnant. Obviously I didn't know this when I had the scan done and doctors were nervous about the effects to the baby. My son was born 9 months later perfectly healthy and continues to be. I was seeing my endo every month during my pregnancy and the GD seem to go into remission. I was a mother with now 3 children after my son was born and didn't take care of myself and follow-up with my endo after the birth of my son. Back in January of 2008 I needed to see my PCP again for my asthma. She was not happy that I haven't followed up with my GD. So I finally decided it was time to take care of this all. After a first visit with an endocrinologist, I knew she was not willing to take the approach I wanted to and decided to look elsewhere. I did read Graves Disease: A practical guide and started to understand my role in the treatment of GD. The endo I'm seeing now is WONDERFUL. She understands my concerns and is willing to work with me. I was put on Methimozole and had a reaction including an extremely itchy rash and cold like symptoms. The doctor did a CBC to check for WBC count and mine was very low and was taken of the medicine. We spoke again to go over options and am now trying PTUs. My levels right before starting the PTU was an undetectable TSH. FT4 was 3.8 and FT3 was 13. These numbers mean nothing to me. I feel like some of these posts are over-my-head. I need to know if I'm doing the right thing with the PTUs. Or, with my last reaction should I just opt for the RI? I'm overwhelmed by this all. Any advise would be appreciated.

-- posted by loriv134