General Medicine

» Elaine Moore - Graves' Disease and Side Effects

In response to Graves' Disease and Side Effects posted by princesssoft:

Hi,
It sounds like your dose of carbimazole is too high and is causing hypothyroidism. Common symptoms of hypothyroidism include joint pain, depression, mental fog, hearing loss or rather a slowness in recognizing verbal commands, constipation, weight gain, etc. As in hyperthyroidism, most people have a few predominant symptoms rather than all the symptoms.

Sounds like your range for T4 is around 12-24 although this could be an FT4 or a T3/FT3 level. The ranges are different in the U.S. except for TSH, which is the same worldwide. The usual starting dose is 10-30 mg daily.
The problem is that some doctors look at the TSH level and don't realize that it can take a very long time to rise. If your doctor is looking at your TSH level or measuring T4 instead of FT4 your results can be misleading. Both T4 and T3 levels are falsely increased in women because of estrogens. If you happen to be on oral contraceptives, T4 and T3 are easily 1.5 times higher than usual as these tests measure thyroid hormone that's linked to protein molecules. Estrogens cause a rise in the levels of binding proteins, which falsely increases the result. Linked to protein, thyroid hormone is inactive. Ideally, you would be having FT4 and FT3 levels.
I'm mentioning this because it's the usual cause of people being overmedicated with carbimazole or other anti-thyroid drugs. And this is why symptoms are more important than thyroid hormone levels. Your dose of Inderal is also fairly high for a young person and could also be contributing to symptoms. Inderal is used to reduce cardiac symptoms like heart rate and blood pressure. Too high of a dose can cause your vital signs to fall too low. Also, propranolol mildly reduces thyroid hormone levels by reducing conversion of T4 into T3. On a high dose like you're on T4 could rise while T3/FT3 falls dramatically.
I'd see if your GP can help you. You don't have to be seen by an endocrinologist to manage Graves' disease.
And you don't want to be on high doses of meds that are causing new (iatrogenic--caused by medicines or treatment) symptoms. Your thyroid hormone levels were only moderately elevated to start and your goal is to be on the lowest dose of meds needed to reduce them. The full effects take 6 weeks and it seems you may have had levels tested before you had a chance to see the effects of one dose.
Read some of my articles on dietary and lifestyle changes that can help you too as these will help you reduce the amount of meds you need to keep your levels within range. Best, Elaine

» Elaine Moore - Avoiding Iodine

In response to Avoiding Iodine posted by nurseheatherone:

Hi Heather,
Your levels are pretty normal although you wouldn't want them to fall much lower. They'll probably rise a bit and stay up during the first half of pregnancy. By mid-pregnancy they can start to fall so it's good to have your labs tested every 4-6 weeks. Hope you're feeling great and enjoying your pregnancy. Best, Elaine

» Elaine Moore - re: low TSH

In response to re: low TSH posted by fivebreaths:

Hi,
TSH can be totally misleading. This is because both stimulating and blocking TSH receptor antibodies can lower TSH. Stimulating antibodies (TSI) cause hyperthryoidism and blocking ones cause hypothyroidism. Many people with GD have both stimulating and blocking antibodies. When stimulating ones predominate, we're hyperthyroid. When blocking antibodies predominate we move into hypothyroidism. It's this autoimmune effect rather than burning out that causes about 20 percent of people with Graves' disease to spontaneously move into hypothyroidism.

Anyway, people with about equal amounts of stimulating and blocking antibodies will have normal thyroid hormone levels since the blocking antibodies prevent the stimulating antibodies from reacting with the thyroid cell receptor. But the antibodies are recognized by the pituitary gland as if they're TSH. (discovered in 2003 when Brokken learned that there are TSH receptors in the pituitary--I think you found this article last time we were discussing this on the board). Recognizing these antibodies as if they were TSH, the pituitary thinks our blood levels of TSH are fine. So the pituitary slows down on TSH production.

A low TSH on its own doesn't do anything but keep your thyroid gland from producing too much thyroid hormone (normally, TSH stimulates thyroid cells to grow and produce more hormone). But because in most people TSH reflects your thyroid status with a low TSH seen in hyperthyroidism, this result is misleading. Many, but not all doctors, realize that a low TSH in people with Graves' disease doesn't necessarily mean hyperthyroidism. The ATA had an article on this in 2004 after the Brokken article came out.

In your case, a very low ATD dose would help your immune system heal and reduce thyroid antibody production. But it could also cause your levels to fall too low for your body's needs, causing symptoms of hypothyroidism. To avoid this, some doctors will use block and replace therapy (adding thyroid replacement hormone to the ATD). In your case, this would work and with this protocol the ATD is eventually stopped and people stay on a low dose of thyroid replacement hormone to slow the gland down, which stops thyroid antibody production. Best, Elaine

» Elaine Moore - Discussions for Me

In response to re: low TSH posted by daisyelaine:

To ensure a faster response, please send discussions in which you would like a response from me to the spa topic. Spa services are an important feature in any autoimmune disease healing plan. Thank you.

» princesssoft - Graves' Disease and Side Effects

In response to Graves' Disease and Side Effects posted by daisyelaine:

Thank you, Elaine

I saw my GP and he agrees that the dose of Carbimazole was too high and causing hypothyroidism. He thinks the specialist was looking at a set of blood test results from before the dose was increased the first time and that's why she increased my dose. Either way, he has reduced my dose to 10mg and the symptoms subsided within 48 hours. Also, yes I was taking oral contraceptives, I've stopped taking them for now to see if that makes a difference to the next set of blood test results.

Thank you so much for the information, it really helped.

-- posted by princesssoft

» petersonc - advice on grave's

In response to advice on grave's posted by daisyelaine:

hi elaine,
i havent been on in awhile. i was wondering if side affects of the mouth were common either with gd or the methimazole. i have had angular cheilitis for several months and just recently have a swelling my dentist thinks is a mucocele (clogged salivary gland). I am still taking the methimazole and recently my doctor upped the dosage. i will probably have to seek a second opinion because my current endo will only keep me on meds for a short time. but i was wondering about these weird mouth symptoms. i did use a fungal cream and topical steriod prescribed by my medical doctor and the angular cheilitis seems better?! thank goodness!!
any response is appreciated.
thanks
carla

-- posted by petersonc

» Elaine Moore - Graves' Disease and Side Effects

In response to Graves' Disease and Side Effects posted by princesssoft:

Hi Princess,
You're welcome. It's a good thing you're pro-active and questioned what was going on here. Best to you, Elaine

» Elaine Moore - advice on grave's

In response to advice on grave's posted by petersonc:

Hi,
Could your methimazole dose be too high? You want a dose that keeps FT4 at least at mid-range, preferably near the high end of the range, regardless of TSH. According to Broda Barnes, a dose that's too high and causes hypothyroidism could increase your risk of infection. Angular cheilitis is reported to occur in thyroid disorders but the definitive cause is infection with Staphylococcus aureus and/or Candida albicans. Best, Elaine

» kitykatt - Great Labs

Elaine, It's been about eight weeks since my last post. As you may or may not remember, my doc wanted me to take 30mgs. of meth. You helped me understand my labs. (graves) I felt my dose was too high. After consulting with you I made the decision to lower my dose and I'm happy to report my labs look the best ever! I'm so pleased. I'm meeting with my naturopath this Thursday and I'm so excited!! I'm so glad I listened to you and my body, and I'm so confident that now my new doc will take me to the next level. THANK YOU, THANK YOU, YOU ROCK!!!! Jackie

-- posted by kitykatt

» kwild89 - questionable graves disease please read!!

i have a question if anyone can help me i was very ill for about three months and was having increased heart rate it has some what gotten better as in it rarely happens now and when it does its not as fast so i did blood work with my doc and it says my t4 levels are high but my tsh levls are normal soi went to an in endocrinologist and he diagnosed me with graves disease now im not to fimiliar with it but from what ive researched dont u have to have low tsh levels for that and couldnt this just be a bad case of thyroiditis that has lengered on?? well im going to do a follow up at ucla in a month but tell then could anyone help thanks
>kyle

-- posted by kwild89