General Medicine

» dogloverinmn - Gathering Information

In response to Gathering Information posted by daisyelaine:

Hi again Elaine,
I have more information now. I had a TSI run on 12/27/06. The results were 2.1 (= 1.3 is positive). My TSI back in May 2004, when I was originally diagnosed, was 1.7. Interestingly, they also ran a T3 Uptake which came back as 35 (28-41 = normal).
I'm tending to agree with your hypothesis that I'm maybe in a transition from hypoT to hyperT.
What I didn't tell you before is that unbeknownst to me, my body was transitioning (or flaring up) while I was still on the Levothryoxine (62.5 mcg daily). Needless to say, by the time I figured out what was going on, my hyperT symptoms were really scary. Naturally, this all happened over the Christmas Holiday. I was using 10mg Propranolol to get through the days. 9 days after my last Levothroxine dose, all my hyperT symptoms disappeared overnite, and my T3 dropped 40 points to 220. I got stronger for about 10 days, but since then I've been feeling semi-poorly again. Interestingly, the current symptoms don't feel like the hyperT I remember from a few weeks ago, it feels "different" somehow. Can I ask you a couple more questions, please?
1. I'm thinking I need to request labs again before I see my endo on the 31st. I will have been 3 1/2 weeks since my last labs and I feel it would be a waste of all our time to be discussing potentially out of date data. Do you agree?
2. Currently my legs (thighs) are killing me. This is more than weakness; it's pain. Yet I'm sleeping better and better, and putting on some of the weight I lost. But I'm not feeling what I could call 'stronger'. If I'm really transitioning from hypoT to hyperT, would the symptoms come on gradually?
I guess since my only hyperT experience quite literally came on overnite, then vanished 9 days later just as quickly, I'm not sure what to expect now that I'm off the Levothyroxine.
Thanks again Elaine. I really appreciate all your assistance. This stuff is hard to figure out!
Karin

-- posted by dogloverinmn

» Elaine Moore - Gathering Information

In response to Gathering Information posted by dogloverinmn:
Hi Karin,
Graves' disease or hyperthyroidism related to TSI is known to cause variable symptoms that change over time. That is, the predominant symptoms tend to change...so you can have a period of irritability and sweating, experience a period of remission, and then have a flare in which your only symptoms are increased appetite and weight loss.

In your case, you're also talking about symptoms related to exogenous (outside of the body) thyroid hormone from the levothyroxine replacement hormone that you were on.

Since you've had TSI all along, these antibodies have likely been contributing to symptoms along with the replacement hormone. TSI not only stimulates thyroid hormone production but it reacts with receptors in skeletal muscle, orbital tissue, skin cells, pituitary cells and perhaps other organs. The effects on skeletal muscle can be contributing to your muscle pain.

If you read my article on L-carnitine you'll see how this amino acid blocks the effects of thyroid hormone on these various tissues. This would be definitely worth trying in your case.

I agree that it would be helpful to have your labs right before your appointment. If you call the office nurse and explain that your symptoms have changed he or she should be able to call in an order for lab tests. Since you may still primarily have Hashimoto's your muscle pain could even be related to hypothyroidism if your TSI are part of Hashitoxicosis. If you've moved into full blown GD this should be apparent from your labs.

Your T3 uptake doesn't measure thyroid hormone at all. T3 is used as a reagent to help measure your levels of binding proteins, the proteins that carry hormones through the body. Long ago, this test was used to help determine how much of your total T3/T4 was represented by free hormone. Today this test is considered obsolete and we recommend running FT4 and FT3 levels. Your result suggests that any elevation in either total T4 or T3 was related to free hormone rather than binding proteins but this test isn't very reliable or we'd still be using it.

If you have Hashitoxicosis you're going to notice transient symptoms when there are surges of thyroid hormone. If you're moving into GD, symptoms can be similar because the course of GD isn't progressive.

The typical pattern in early GD is a waxing and waning of symptoms with periods of remission alternating with periods of stress. Some people will have symptoms that worsen over time and levels that keep rising but this doesn't happen much today since women tend to seek help before then or they figure out what might have triggered symptoms and eliminate these things. People are pretty wise this way. Best to you, Elaine

» u25000 - New labs done by self; interpret.desired

from my last posts I mentioned that no Endo or RE has redone my antibody levels so I did thru healthcheckusa; espec w/the concern lately that TPOab can exist or increase a/Graves diag (increase infert)

Jan 26, 2007:
TRAB serum: 4.3 (range 0.0-1.0 u/l)
borderline 1.0-1-5, posit 1.5+
TSI: 164 (range under 130%)
TPOab: 18 (range 0-34 iu/ml)
ATA: -20 (range 0-40)

April 2003 (10d on ptu)
TSI: 4.7 (+1.9pos)
ATA: -20 (0-40)
AMA: 11 (0-35)
FT4: 3.0 (.8-1.8)
TSH: .07 (.35-5.5)

I cannot find a progessive Endo/PCP; I have found several intergrationists who are not covered by insurance, but I'm also concerned that they do not have the autoimmune background I need. Please give me some advice on what I need to do in meantime or urgently. Thanks.
(Symptoms 9/02,diag Graves 4/03,Rai 9/03,Hypo 12/06,TTC all this time)

-- posted by u25000

» Elaine Moore - New labs done by self; interpret.desired

In response to New labs done by self; interpret.desired posted by u25000:
Hi,
The labs from 2003 include ATA, which is antithyroglobulin antibodies, and they were negative. AMA are antimicrosomal antibodies, which are the same thing as TPO antibodies. These too were negative.

Your recent labs show that your TSI level is high enough to cause hyperthyroidism if you had a thyroid gland. Your TPO and anti-thyroglobulin antibodies are negative. Your TSH receptor antibody test is higher relative to your TSI result. This suggests that you have both stimulating (TSI) and blocking TSH receptor antibodies. These antibodies will cause your TSH result to be falsely decreased so you'll want to be carefuly to use both FT4 and FT3 levels to gauge your thryoid status.

Should you become pregnant, you'll want to have another TSI. TSI can cross the placental barrier and cross transient fetal hyperthyroidism. This is rare but it still warrants close monitoring.

A good idea would be to work on reducing TSH receptor antibodies by helping your immune system heal. A nutrient-rich diet, stress reduction techniques, avoidance of known thyroid triggers, avoiding food or enviromental allergens will all help you. There are some other antibodies, for instance antibodies to sperm, that can cause fertility problems.
You might consider seeing a reproductive specialist. Acupuncture is even being used today for problems with infertility. Best to you, elaine

» vickwithpc - duration of early graves before officially Graves

Hi! I can thank at a minimum my mom, aunt, great aunt, and 1st cousin on my mom's side for thyroid problems. I feel like I am losing my mind (my boss of 10 years can't understand what is wrong with my brain for the past months) because I am making mistakes or forgetting things (I'm keeping a list b/c I don't know what to do about it!), I am always stressed out (but who isn't too busy these days) and paranoid over things, I quickly change moods (my poor family!), I try to gain weight and eat more, but I still wake up, use the restroom, and my flat stomach is back, and the list goes on....

Here are my lab results:
T4 Free: 1.27 (taken 1 week ago)
T4 Free: 1.59 (taken 3 months ago)
TSH: 0.10
Thyroglobulin Antibody: 373
Thyroid Peroxidase: 54

My Dr. diagnosed me with early Graves, and is not prescribing any meds. I am to go back again in a few months to retest TSH and FT4.

I just want my brain back. How long before I can expect my FT4 number to go bad. Or won't it? I've been reading what I can, and I can't find any clear information on how long symptoms happen before full-blown GD is diagnosed. Or maybe there is something I can do on my end to get better without any more numbers going bad?

Thank you so very much.
Vickie, age 32

-- posted by vickwithpc

» Elaine Moore - duration of early graves before officially Graves

In response to duration of early graves before officially Graves posted by vickwithpc:
Hi Vickie,
Graves'disease doesn't follow a set pattern. Some people will have recurring symptoms that come and go and eventually resolve without thyroid function tests ever becoming abnormal. Thyroid hormone is indeed very potent. So small changes from your usual levels can cause some dramatic changes that aren't reflected in lab results.

In your case, your elevated levels of thyroid antibodies show that you have thyroid autoimmunity. That is, you have thyroid antibodies that are affecting your thyroid function. Whether these antibodies go on to cause true or overt thyroid disease or resolve on their own is difficult to predict. For this reason, thyroid disorders can sometimes take a while to diagnose.

Some doctors would see that your low TSH with a normal FT4 warrants also having an FT3 level. In some people with Graves' disease, FT3 is elevated while FT4 remains normal. Even without this level, you'd be diagnosed with subclinical Graves' disease. Subclinical GD isn't usually treated aggressively since levels can resolve on their own. But when symptoms are present, or when FT3 is elevated, other meds such as beta blockers (Inderal, Toprol, etc) are used to help relieve symptoms.

Lifestyle changes can also be used to abate symptoms in subclinical disorders and reduce disease progression. These include avoiding excess dietary iodine in fast/processed foods, avoiding aspartame in NutraSweet and cigarette smoke, known or suspected allergens, particularly wheat, and incorporating stress reduction techniques such as yoga or light exercise.

You may also want to keep copies of all your lab results so you can watch for slight changes in your FT4 and FT3 levels. And make sure your doctor has ordered at least a CBC and a metabolic panel to make sure that there aren't other conditions causing your symptoms. Best,Elaine

» vickwithpc - duration of early graves before officially Graves

In response to duration of early graves before officially Graves posted by daisyelaine:

Thank you for your fast, knowledgeable reply! Are you saying McDonald's french fries and Taco John's Potato Ole's aren't the best foods to eat with this condition?!! ha-ha, but seriously, I love those foods and my diet soda.

Would my Dr. think it to be out of line for me to print your response at my next appointment and ask for the metabolic test?

As far as stress, I don't have any of the major stresser's in my life, but, I balance (try!) 3 jobs and mothering and parenting. Two of which are musically related to teaching/performing piano. Piano is the LOVE of my life, but also causes me a great deal of stress. (As any job!) Would cutting back on some of the performing perhaps stabilize some of those numbers?

One last question.....understanding that there isn't a "crystal ball" out there, but is it possible with your knowledge to ball-park a number regarding how long my numbers could have been like this?
You are the best! I'm glad I found this site!
Vickie

-- posted by vickwithpc

» Elaine Moore - duration of early graves before officially Graves

In response to duration of early graves before officially Graves posted by vickwithpc:
Hi Vickie,
Yes, changing your diet will make a big difference. For many people, just eliminating diet soda restores normal thyroid function. With the fast food, you can cut back slowly if it's going to cause more stress to start cooking. Try adding more fruits and vegetables and slowly changing your diet.

Many doctors become offended when patients bring in internet advice. And some are glad to see their patients involved in the healing process. It might be easier to ask the receptionist if you've had a CBC or metabolic profile lately and ask for a copy of the results. If you haven't it wouldn't hurt to ask your doctor if he could order these tests with your next labs. If he's an endo, he may tell you to ask your primary care physician. Often, specialists focus exclusively on their area of expertise.
It's impossible to tell how long your thyroid tests have been off. But it's not unusual for people to realize upon being diagnosed with a thyroid disorder that they've had symptoms for many years. With Graves' disease, most everyone has an initial period of hypothyroidism that's mild and not diagnosed although some people have overt hypothryoidism for years before moving into Graves' disease.

True, all work tends to be stressful. I wouldn't cut back on the performances. I'd just incorporate some stretching or breathing exercises. You should notice some reduction in stress just from changing your diet, especially eliminating the diet soda. Best to you, Elaine

» tdove52 - Hyperthyroidism and running

Hi,

I was initally told I have hashimoto's, then Grave's, now hashitoxicosis. My FT3 (324)and FT4 (8.4)are now within normal range (Just taking beta-blockers for symptoms)but my TSH remains low at 0.01 and has been for 6 months.My TSI is 203, TBII is 42 and TPO 114. Last RAUI was normal, but in Oct it was 4%. My main concern is that I would like to resume running (was training for marathon) but told to limit to walking or just light jogging until TSH is normal. What do you know about running and it's affect on stressing the immune system or running and ill effects on Cardiosystem with low TSH, but normal FT3 and FT4? Some days I feel good, other days very tired. Thank you!

-- posted by tdove52

» Elaine Moore - Hyperthyroidism and running

In response to Hyperthyroidism and running posted by tdove52:
Hi,
Your elevated TSI and TBII levels suggest that you have both stimulating and blocking TSH receptor antibodies.
These antibodies sort of cancel each other out in that the blocking antibodies prevent TSI from stimulating thyroid cells to produce excess thyroid hormone.

TSH receptor antibodies are recognized by the pituitary gland (via its own TSH receptors) as if they were TSH. Thinking you have adequate TSH levels in your blood the pituitary slows down on TSH production and secretion. Consequently, TSH levels are falsely decreased and the test result is misleading.

Unfortunately, even though this is well known in research circles and the ATA even had an article on their website and in Clinical Thyroidology several years ago, many endos don't realize this. Labs are to blame since we mistakenly announced that TSH was the best indicator of thyroid function in all cases back when we first developed tests to measure TSH. In normal people, this fits. But in autoimmune thyroid disease TSH is frequently misleading.

A low TSH on its own doesn't do anything.
TSH normally orders thyroid cells to grow and produce and secrete thyroid hormone. When you have TSH receptor antibodies they take the place of TSH and they regulate your thyroid hormone levels.

In people without autoimmune thyroid disease the TSH level does usually reflect thyroid status. In your case, FT4 and FT3 levels are better indicators of thyroid status. Your low uptake suggests hypothyroidism or thyroiditis rather than hyperthyroidism. Probably, you have enough available TSI to keep your levels within range, and the blocking antibodies keep you from becoming hyperthyroid.

Strenuous running can trigger GD. But if you're well conditioned and you don't overdo it (where your heart rate isn't returning to normal) you can run. Many people with GD continue to run once their FT4 and FT3 levels are in control.

You should probably discuss this with your doctor again. If you're used to exercising you can experience stress if you're forced to avoid it. Best, Elaine