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Elaine Moore

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Graves er en autoimmun tilstand som egentlig skal brenne ut av seg selv etter en stund.

Her  i landet behandles den gjerne med medisiner som setter ned stoffskiftet, som Neo-mercazole eller propylthiaruzil. Noen er overfølsomme for den ene og tåler bedre den andre. En viktig mulig bivirkning man må være obs på er agranulocytose. Da blir det plutselig for få leukozytter (hvite blodlegemer) og man må straks kontakte legen.

Andre steder bruker man radioaktivt jod som standard.

Jeg limer inn her utklipp fra et hyper-forum som gir noen interessante opplysninger om hva som trigger hyper-antistoffene.

Gluten er en kjent trigger for slike antistoffer, samt jod, røyk, stress, MSG, aspartame og mange andre ting .

fra forumet:

You might also want to consider any environmental triggers that might be preventing your TSI from 
falling as fast as you'd like it to. These include excess dietary iodines in fast/processed foods,
aspartame in Nutrasweet, stress, cigarette smoke, low selenium levels, etc.
A 300 mg PTU starting dose is fine although recent studies show that a lower dose, usually 200 mg 
is usually adequate for a starting dose. After about 6-8 weeks on your starting dose, your FT4 
should fall into the normal range. At this time you're considered euthyroid and your dose is 
lowered. And yes, PTU will lower your thyroid hormone levels regardless of the cause. Best, Elaine
Hi Liz,

Using 1.25 mg every other day and watching for a return to hyper symptoms sounds like a good idea.
One common reason for not responding as well to ATDs as one would like that I forgot to mention 
is environmental or food allergies. Hayfever or allergies to pollen, wheat, and soy are 
particularly problematic if they're not in control.

There are several studies showing the efficacy of long-term ATD use. One is Very-Long-Term 
Methimazole Therapy is Effective and Safe in Patients with Hyperthyroidism Caused by Graves' 
Disease by F Azizi, L Ataie, M Hedyati, Y Mehrabi, and E Sheikholeslami in European Journal 
of Endocrinology 2005;152:695-701. Best, Elaine


Hi Lacey,

Thyroid hormone is not an immune system stimulant. However, the immune system can react to the 
foreign proteins found in glandular extracts. That is why some people develop TED or notice 
problems when they start animal-based extracts. Using synthetic T3 doesn't cause this problem.

If you're deficient in either T4 or T3 then the cells in your thyroid gland, including immune 
system cells, work to try fixing the problem. The increased activity includes increased thyroid 
antibody production. This is why hypothyroidism should be avoided when using any treatment for 
hyperthyroidism.

T3 is more potent than T4. So you're more likely to notice some temporary hyper effects when you
first begin using it. This happens as your cells try to store adequate hormone, but the effects
generally diminish within a week or two unless your FT3 levels rise too high. It sounds like 
you're taking 0.625 mg Cytomel twice daily for a total of 1.25 mg. This is a very low dose. If
FT3 is too low you can have symptoms of arthritis and fibromyalgia, like rib pressure points 
under your arms. You want to look at your FT3 blood level to see if you're on an adequate dose 
of replacement hormone. Best, Elaine

One more thing Elaine......the reason I thought Cytomel was a stimulant to the immune system is
that Diana Schwarzbein who wrote "The schwarzbein Principle" says if your Insulin Resistant you
should stay away from Cytomel and well as allergy meds, coffee, smoking, anything that "acts" 
as a stimulant. She stresses in both of her boths againist the use of Cytomel. 

I was wondering if you have ever read her books and what you think of this?

Thank you,

Lacey

Lacey


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5 of 6 Posted Mar-12 7:49 PM Msg 4377.5 reply to 4377.4 
From elaineamoore
To: Laceygal 

Hi Lacey,

I'm not familiar with that author. I suppose her logic would be that foreign proteins could 
stimulate the immune system but this wouldn't hold true for everyone since we have specific 
genes that determine what substances our immune system reacts to and how strong the reaction 
will be. In fact, glandular substances are used in oral tolerance therapy, which is undergoing 
clinical trials for diabetes. 

Insulin resistance is not usually autoimmune. It's considered part of the metabolic syndrome 
and a lot of new information on this subject has come out within the last year. 

But since some people can react to glandular extracts Cytomel is a good alternative for you. 
Your FT3 level would be the best guide as to whether your dose is adequate or needs to be 
slowly increased. Best, Elaine



Hi Elaine~

What do you know about Astragalus and Graves' DIseae? Can I take it? I had RAI in 1999- 
and Radiation and steroids for the eye orbits a couple years later. Been "disease free" 
(sort of- are we really ever free?) for about 5 years now.

I have had a cold/sore throat/stuff nose and chest, etc., for 2 weeks now----don't feel as 
if I need antibiotics, but I am weary- have not taken ANY over the counter antihistamines, 
etc. My eyes are so dry that I would not be able to handle that. 

Any suggestions? And- what about Astragalus as an immune system protector?

Thank you- Susan


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2 of 4 Posted Mar-15 1:28 AM Msg 4380.2 reply to 4380.1 
From elaineamoore
To: Susanmaria 

Hi,

Astragalus would be good since it's an immune enhancer rather than an immune stimulant. 
In GD, especially after RAI, you want to strengthen but not stimulate your immune system. 
Immunomodulators like astragalus and plant sterols/sterolins are helpful as is a 
nutrient-rich diet, particularly avoiding saturated fats and sugars. Vitamin C, stinging 
nettle and quercetin help with cold-like symptoms and allergies. Flaxseed oil supplements 
and antioxidant vitamins also help with TED and immune system healing. Some of the newer 
antihistamines like claritin don't cross the blood-brain barrier so they don't cause the 
nervousness and dryness of the older compounds. Best, Elaine

Visit my new suite 101 topic on autoimmune diseases at http://autoimmunedisease.suie101.com 
Author of Graves' Disease, A Practical Guide; Autoimmune Diseases and Their Environmental
Triggers; Thyroid Eye Disease, Understanding Graves' Ophthalmopathy


Thanks Elaine~



Could you let me know WHAT type/kind of Astragalus is the best for GD ---extract, root, 
how many milligrams? etc! Thank you!

You also mentioned Plant Sterols- what type? Is there a brand name that you prefer or 
would suggest?

I appreciate your fast response. You are always so helpful!

Susan


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4 of 4 Posted Mar-16 6:08 PM Msg 4380.4 reply to 4380.3 
From elaineamoore
To: Susanmaria unread 

Hi Susan,

You can take astragalus as a tea, capsule, or tincture. For use as an immodulaor, using 
3 "00" capsules three times daily seems to work best. As a 1:5 tincture in 60 percent 
alcohol you can use 30 drops up to 4 times daily. 

The immunomodulators were first described in the last two decades. The brand name 
Sterinol has probably been around the longest as far as patent medicines go. It can 
be taken up to three times daily. Other plant sterols are found in Noni, Nonu, Nono, 
and other immunomodulators include reishi mushroom extract, German chamomile, and flower
pollen extract (as long as you don't have pollen allergies). Many companies have also 
introduced combination immunomodulators and I try to comparison shop, usually finding 
products for sale at Puritan's Pride or the Vitamin Shoppe. Best, Elaine



Elaine, Is the treatment for GD the same as for Hyper? I read somewhere that only 
20-30% of people with gd respond to the anti-thyroid drugs. What is the difference. 
I am hyper,now the doctor says I'm GD. I'm confused. 

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6 of 8 Posted Feb-18 2:43 AM Msg 4341.6 reply to 4341.5 
From elaineamoore
To: Linda34810 

Hi Linda,

Hyperthyroidism is the condition of having elevated thyroid hormone levels, and Graves' 
disease is the most common cause of hyperthryoidism. All types of hyperthyroidism can 
be treated with anti-thyroid drugs. ATDs both lower thyroid hormone levels and help the
immune system heal. In GD, a defect in the immune system causes GD and this is a 
self-limiting condition, meaning that it eventually resolves. Newer studies show a 
much higher remission rate with ATDs, and Harvard researchers state that most everyone 
will respond to ATDs when they're used properly, that is, until remission occurs. A 
recent Japanese study showed a remission rate of 81%. Rates higher than 60% are commonly 
seen in Europe where ATDs are used in nearly all cases. Best, Elaine

Author of Graves' Disease, A Practical Guide; Autoimmune Diseases and Their Environmental
Triggers; Encyclopedia of Sexually Transmitted Diseases; Encyclopedia of Alzheimer's 
Disease; and an upcoming book on hepatitis. 

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7 of 8 Posted Feb-18 3:00 PM Msg 4341.7 reply to 4341.6 
From Linda34810
To: elaineamoore 

Thank you Elaine, so as long as I take my meds I should be o.k weather it's hyper or GD?

Also, I just came out of the hospital and the doctor put me on 300mgs of PTU a day, isn't
this a very high dosage? Should I be concerned?


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8 of 8 Posted Mar-16 5:50 PM Msg 4341.8 reply to 4341.7 
From elaineamoore
To: Linda34810 unread 

Hi Linda,

Sorry I just found this message. A 300 mg PTU starting dose is fine although recent studies
show that a lower dose, usually 200 mg is usually adequate for a starting dose. After about
6-8 weeks on your starting dose, your FT4 should fall into the normal range. At this time 
you're considered euthyroid and your dose is lowered. And yes, PTU will lower your thyroid 
hormone levels regardless of the cause. Best, Elaine



I can't get this into my poor Gravish brain. When I get a blood test is the TSH number what
it was 6 weeks ago since the TSH lags behind 6 weeks. So if I am adjusting a dose, I am 
actually adjusting to a dose to help what my TSH was 6 weeks ago? This is confusing to me.

Here are my labs. I started on 5 mg of tap after the nov bloodwork. felt great for 6 weeks
and then slowly got very sluggish and cold. So they cut it in half after the Feb bloodwork
and I feel a little better. 

Is the FT4 a little low? And if so how can I fix that. the endo doesn't do block and replace.
Why do they even test the TSH if it doesn't mean much. In my case I felt awful when the
TSH started going up...even though it didn't go up that much.
Thanks for any input. It's greatly appreciated.

July 2005 ------ felt just ok TED worsening
ths.82 (0.34-5.6)
Ft3 3.5 (2.3-4.2)
Ft4 0.77 (0.58-1.64)
thyroidgobulin ab Less thn 1.0 (0-2.3)
thyroprox 29(0-40)

Oct 2005 ------ nervous wreck and tired
TSH .13 (.34-5.6)
FT4 .95 (.58 1.64)
TSI 3.1 (0 1.3)



Nov 2005 skinny, sweaty, tired, napping 
TSH 0.08 (.34-5.6) different lab
FT3 3.9 (2.1-4.2) ------- Started Tap 5 mg
FT4 1.3 (0.9-1.1)
------ Felt wonderful at this point
January 16,2006
FT4 0.9 (0.58-1.64)
TSH 1.81 (.34-5.6)
------ Started to feel like a slug,freezing!
Feb 26, 2006 ------ Was a slug
TSH 7.06 (.34-5.6)
FT4 0.9 (.58-1.64


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2 of 2 Posted Mar-16 1:39 AM Msg 4381.2 reply to 4381.1 
From elaineamoore
To: Robomomdonna unread 

Hi,

Don't worry about the 6-week lag. TSH is also affected by your TSH receptor antibodies. 
They falsely lower it. TSH has very little value in monitoring ATD therapy except that 
it will rise if you move into overt hypothyroidism, and it will show up in this case 
before thyroid hormone levels become abnormally low. As soon as FT4 becomes too low for
your body's needs the TSH level can rise. So while the result shouldn't be used to
monitor your thyroid status it helps in showing a move into overt hypoT.

In your case, reducing your dose to 2.5 mg or 1.25 mg daily would be the easiest 
solution to raising your FT4. It's important to avoid hypoT because your gland speeds 
up activity trying to correct the problem. This causes increased antibody production 
and can worsen TED. Best, Elaine



Elaine:

Here are my lab results from 3 weeks ago:

TSH: .08 (up from less than .01)

T4: 8.7 (4.50-12.5)

T3 Total: 160 (?-181)

I am on 50 mg of PTU down from 100 mg PTU about 4 weeks ago. Last week I started 
really having trouble with my eyes again. I was fine when I went off Prednisone 
and to PTU at 150mg/day. About 2 weeks after moving to 50mg/day I began having 
lots of swelling in the right lid, lots of pain with movement in the right eye 
and dryness.pain to the touch in the left eye. I am having my labs drawn again 
next week, but cannot for the life of me figure out why I'm having TED trouble. 
Usually when my levels improve, the TED improves. The only thing is that I got a 
cold about 4 weeks ago and my psoriasis flared. I stuck on my PTU at the same levels
and mad my labs drawn 2 weeks post cold and my levels improving. 

Why would my TED be getting bad again? Am I on too little PTU? I didn't want 
to take more than 50mg since my T4 seemed to be getting lower more quickly than my
T3 or TSH. I am not having any Hyper symptoms. My eyes are very sensitive to 
level changes. I can usually tell right away when my levels are off because my 
right eye gets puffy. Now its really swollen again, like before I was on 
Prednisone the last time. 

Could my T4 be too low and its causing the pain/dryness/swelling? Or, could 
I have to increase my meds to get this to even out? I am also making an appt 
to see my opthamalogist again, maybe he'll put me back on Prednisone. Ugh. 
I know my endo will suggest removing my thyroid - not an option for me.

Thanks for the help,

Kim




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2 of 2 Posted Mar-8 4:44 AM Msg 4375.2 reply to 4375.1 
From elaineamoore
To: samlab25 unread 

Hi Kim,

I'm sorry to hear that your eye symptoms are worse? If your thyroid hormone 
levels were too low before, this may have increased thyroid antibody production,
which would cause effects for up to 2-3 months. Your labs look fine although T4
and T3 are both usually falsely elevated in women. It would help to have the FT4
and FT3 levels to make sure that your levels aren't too low for your body's needs.

It could also be that your cold stimulated your immune system, which is the usual
reaction. This, or any immune reaction to allergens, could have stimulated your 
immune system and increased thyroid antibody production. Studies show a link 
between low selenium levels and thyroid autoantibody production. Selenium and 
other antioxidants are now being used along with methimazole in Graves' disease 
with good results. Vitamin E, vitamin C, Zinc, beta carotene and selenium are the 
ones most often used. And you probably already know about the benefits of 
flaxseed oil. Flaxseed oil has been shown in numerous studies to improve eye 
dryness and help the immune system heal. Best, Elaine



Hello

I was diagnosed with Graves about a year ago. I've been on Methimazole and 
I'm now at 2.5mg a day. After about 4 months on methimazole, I developed 
tingling numbness in my hands and feet. I also get cramping in my hands and 
forearms to the point where I can't type or hold a book. I have a pretty wild 
tremor in my right hand when I hold it out flat. I occasionally can feel tremors 
in my chest and head. All of this gets worse when stressed. In the last month, 
I've developed a burning sensation in my shoulders. I also get a needle prick 
sensation in my spine and legs. I also get so exhausted in the afternoon most 
days. I'm just miserable. I couldn't type and email this morning and started 
crying at my desk. On the bright side - I sleep great and I have no eye problems.

I felt better before I was diagnosed.

I've been sent to a neuro-muscular center about 4 hours away. I live in a 
pretty rural community and my general practice doc and the neurologist here 
don't think they can help me. I haven't been to an endo.

My gp told me I could go off of the methimazole - but, I'm going to taper it 
off slowly. He cut my dose in 1/2 once and I ended up in the ER thinking I was 
having a heart attack. So, I'm scared.

Do these symptoms sound like a reaction to the medication? Should I wait and 
see if I feel better off the meds or, should I continue with the neuro-muscular 
center. 8 hours of driving and missing a day of work for a 1 hr consultation 
just seems ridiculous. 

Thanks

Sharla


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2 of 6 Posted Feb-23 7:56 PM Msg 4367.2 reply to 4367.1 
From elaineamoore
To: sharlac (sharlac2) unread 

Hi,

I'd skip the neuro-muscular disorder consultant since it's not certain that 
it's needed. Peripheral neuropathy and some of the tinging symptoms you mention
frequently occur in hypothyroidism. You don't need an endocrinologist 
necessarily, but you want to make sure that your doctor is running FT4 and FT3 
levels. You wouldn't need an FT3 with every set of labs but you should have one
now if you haven't in a while.

Doctors with little experience using ATDS often over-medicate patients, 
especially if they rely on the TSH test. TSH will stay low for a long time 
and in general TSH won't even rise until you're near remission or have become 
hypothyroid from too high of an ATD dose. You want to make sure that FT4, 
especially, is near the high end of the range or it may be too low for your 
body's needs. With FT3 you want to make sure it's at least at mid-range. 

If your ATD dose is too high, you can reduce it to 1.25 mg or you can ask 
to try block and replace. In this protocol you leave the ATD dose alone and 
add a little bit of thyroid replacement hormone. And you probably want to make 
sure your doctor has run some immunological tests like an ANA to rule out other 
autoimmune disorders. Tremor can occur in hyperthyroidism and rarely neuropathy 
can occur. So you want to look very closely at FT4 and FT3, watching for both 
hyperthyroidism and hypothyroidism. Some people will have an FT4 that's within 
range but have a very high FT3. Most tremor is essential and without a specific
cause, but when it occurs in someone with a known thyroid disorder, thyroid 
imbalance can be the cause. Once you get copies of your labs it'll be easier
to tell what's going on. Best, Elaine

Author of Graves' Disease, A Practical Guide; Autoimmune Diseases and Their 
Environmental Triggers; Encyclopedia of Sexually Transmitted Diseases; 
Encyclopedia of Alzheimer's Disease; and an upcoming book on hepatitis. 

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3 of 6 Posted Mar-1 8:12 AM Msg 4367.3 reply to 4367.1 
From ajhudgin
To: sharlac (sharlac2) 

Hi,
You might try taking calcium to combat the tingling numbing sensation. 
When your thyroid is being being repressed it can throw your parathyroid 
off which controls calcium levels in your body. I had a total thyroidectomy 
a year and a half ago after dealing wth Graves for over ten years. After 
surgery my doc told me to be aware of that tingling sensation because it 
can indicate a lack of calcium. I recomend calcium aspertate... it's a very 
concentrated form of calcium that disolves instantly in your mouth thus 
entering your blood stream more quickly. I'm sorry I don't remember the 
brand name but if you do a search I'm sure you can find it. 


Reply Options 

4 of 6 Posted Mar-3 4:54 AM Msg 4367.4 reply to 4367.3 
From sharlac (sharlac2)
To: ajhudgin 

Hi
Thanks for tip, I really appreciate it. My doc did check my parathyroid 
and calcium and they were normal. Because tests are just one moment in 
time, I will work on getting enough calcium like you suggested. About 
2 weeks ago, I cut my anti-thyoid in half and I've been feeling a lot 
better in the last few days. My TSH has been 2.7 - but, maybe that is 
hypo for my body. I'll keep working on it.
Thanks!
Sharla


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5 of 6 Posted Mar-3 6:12 AM Msg 4367.5 reply to 4367.4 
From ajhudgin
To: sharlac (sharlac2) unread 

Your welcome,
I know how frustrating dealing with thyroid disease is.
Good luck to you
Amy


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6 of 6 Posted Mar-6 7:42 PM Msg 4367.6 reply to 4367.1 
From sammawamma (sammawamm1)
To: sharlac (sharlac2) unread 

Thank you so much for posting this; I'm so happy I could hug you through 
the computer. I've been dealing with the exact same thing on and off for 
MONTHS now! Tingling and numbness, hands and feet - mine also comes with 
some swelling, too. And it definitely gets worse with stress!!! My 
shoulders and chest have bothered me practically since I started ATDs. 
I too felt WAY better before I was diagnosed...oh, how that statement 
rings true!!!!! 

I have found that ibuprofen helps with the swelling/numbness - but never
for long enough. I have been to the endo and my GP multiple times about 
this, each doctor just points me back at the other one. They do test my 
levels when I ask them to, but only look at TSH. Grrr! I've since fired 
my endo and may have to do the same for the GP, LOL! I have tried 
adjusting ATD doses but I feel like my levels are contantly changing, 
so it's hard to keep up. No, it's impossible. I'm beginning to think 
there's some pattern to my cycle and my thyroid symptoms. But just when 
I had given up and figured I just had to ride it out, I see this post. 
I will look into calcium and get yet another test done. I'm just so 
happy to know this is "normal" - as normal as we're gonna get! LOL Thanks 
again!


Hi Elaine,

I had RAI done on Oct 4th. I was put on 100 MCG of synthroid the end of 
November when my TSH was 70. 6 weeks later my TSH reduced to 43 and my 
synthroid was increased to 150. Here is the labs that I just had done:

TSH .71 (.4-5.)

FT3 270 (230-420)

FT4 1.6 (.8-1.8)

All of my labs are in the normal ranges, however, is there a ratio 
between FT3 & FT4 that I should be concerned with? Does it matter where 
they fall with in the normal range?

Thanks for your help,

Sheila


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2 of 4 Posted Feb-25 6:19 PM Msg 4370.2 reply to 4370.1 
From elaineamoore
To: wickfam (wickfam2) 

Hi Sheila,

Glad to hear you're doing well. As for the ratio of FT3 and FT4, there 
haven't been any studies showing what an ideal ratio would be. And 
that's probably because good assays for FT3 have only been widely 
available for the last few years.

The reference or normal range is a good guideline, that is, you wouldn't 
want levels outside the range. But for deciding what type of replacement 
hormone is optimal for you, symptoms play a larger role. For instance, 
many people would have symptoms of hypothyroidism with an FT3 level like 
yours. For some people, adding 100-200 mcg selenium daily to help conversion
of T4 into T3, might be enough to help them feel better. Other people might 
need to be on T3 as well as T4 (Synthroid) replacement hormone. There are 
studies showing that people benefit from the addition of T3 and other studies
saying that there is no improvement. It seems, though, that people with 
severe hypothyroidism (people after RAI or thyroidectomy) often need T3 
replacement hormone, whereas people with mild hypothyroidism from other 
causes may not.

You might want to review the symptoms of hypothyroidism although I suspect y
ou're pretty familiar with most of them after having an elevated TSH. Subtle 
symptoms include depression, joint pain, digestive disturbances, and hearing 
loss. If you think you might benefit from the addition of T3, ask your doctor
about adding it. Best, Elaine



3 of 4 Posted Mar-1 9:35 PM Msg 4370.3 reply to 4370.2 
From wickfam (wickfam2)
To: elaineamoore 

Thanks Elaine for your reply! 

Can you tell me how long it would take after starting to take Selenium 
before I would feel if it is helping? 

Sheila


Reply Options 

4 of 4 Posted Mar-2 5:50 PM Msg 4370.4 reply to 4370.3 
From elaineamoore
To: wickfam (wickfam2) 

Hi Sheila,

It usually takes 3-4 weeks to notice the effects of selenium replacement 
if your levels have been quite low. If they're just mildly decreased you 
could notice improvement sooner. Those of us with thyroid disorders have a 
number of nutrient deficiencies. Some people notice an overall improvement 
within a week of starting a good multi-vitamin. Best, Elaine



Hi Elaine,

I first wrote you in November under the subject "Cyst and antibodies, 
what's going on?" (and your replies were very thorough and helpful!). 
I have a hot nodule and slightly low TSH, but my FT4/TT3 have been in the 
low/normal range lately. You theorized that I am primarily hypOthyroid 
and the hot nodule was sort of a last ditch effort from my thyroid to 
try to produce enough hormone (paraphrase for "compensatory hyperplasia"
I think was the term). Since then I have got a hold of my old medical
records, and the labs and uptake/scan done in 2000 seem to back up that
explanation. Although I was diagnosed with GD after the 3/00 uptake/scan,
the fact that I had a "heterogeneous" goiter would seem to point towards
a hot nodule (although without the films I can't be totally sure). 
That particular endo later changed the Dx to "thyroiditis."

I have another question for you about the nodule, and a question about 
all those labs. First, could my nodule be a hemorrhagic adenoma (would 
this be consistent with compensatory hyperplasia?) And if so, could it 
be a follicular adenoma based on the details from the ultrasound report?
It is an autonomously functioning, complex nodule with "thick, irregular
internal septations". And if the nodule was caused by compensatory 
hyperplasia, would the normal lobe of my thyroid show any kind of problems
on the ultrasound (it doesn't). My first endo said that since the 
nodule is getting bigger, I will go hypER and I need to have surgery, 
but when I got a second opinion that endo said the nodule is dying off, 
so I don't need to do anything and I wont' go hypER.

Second, do my labs show any sort of pattern? I know they are incomplete 
but I was wondering if anything jumped out at you. I am trying to figure
out whether my depression may be related to whatever is going on with my
thyroid, and I have an appointment with a psychiatrist to discuss going off
the Zoloft that I've been taking since 2004. (I read that 
Zoloft/sertraline can cause hypOthyroidism, and it also does not seem to
be working as well as it used to).

Thank you very much for any input you could give me. It's frustrating 
trying to sort all this out and you (and your book and articles) have 
been such a big help to me. 

Amy


3/8/00
TSH 17.3 (0.4-4.0) HIGH
TT4 5.4 (4.5-12.5)
TT3 1.4 (0.8-1.8)
FT4 Index 5.2 (4-11)
T3 Uptake 0.97 (0.77-1.17)
on birth conrol pills


3/21/00 Uptake and Scan
2 hr uptake 18% (2.5-7.5%) HIGH
24 hr uptake 47% (10-30%) HIGH
Diffuse heterogeneous goiter
Visible pyramidal lobe
Dx Grave's Disease 


4/5/00
TSH 6.2 (0.4-4.0) HIGH
TT4 6.7 (4.5-12.5)
FT4 Index 6.4 (4-11)
T3 Uptake 0.96 (0.77-1.17)
birth control pills 


6/7/00
TSH 1.8 (0.4-4.0)


12/4/01
TSH 1.57 (0.4-4.0)
TT4 5.9 (4.5-12.5)
TT3 1.2 (0.8-1.8)
FT4 Index 7.4 (4-11)
T3 Uptake 1.26 (0.77-1.17) HIGH
birth control pills
3/20/01 
TSH 0.96
TT4 8.0 (4.5-12.5)
...[Message truncated]
View Full Message

--------------------------------------------------------------------------------

Edited Feb-20 by capuchin0monkee (capuchin0mon) 

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2 of 4 Posted Feb-23 7:34 PM Msg 4365.2 reply to 4365.1 
From elaineamoore
To: capuchin0monkee (capuchin0mon) 

Hi,

Your first set of labs with the 17 TSH show that you were hypothyroid. 
your subsequent labs where TSH fell do not necessarily mean that you 
were hyperthyroid. Also, while your uptake was slightly increased, it's
not as high as the levels seen with overt Graves' disease.

Your high elevated thyroglobulin and TPO antibody titers are the type of 
levels seen in Hashimoto's thyroiditis (autoimmune hypothyroidism). You 
also have TSI, which are the antibodies that occur in Graves' disease. 
You probably also have blocking TSH receptor antibodies. Both blocking 
and stimulating (TSI) TSH receptor antibodies falsely suppress TSH and 
make this result unreliable.

It looks like you have Hashitoxicosis which is a condition of primarily 
hypothyroidism along with TSI antibodies. The TSI antibodies, rather than 
causing Graves' disease, in this case cause your thyroid hormone levels, 
FT4 and FT3, from falling too low and they can cause transient hyper 
symptoms. Hashitoxicosis can be an intermediate stage before people move 
into Graves' disease or it can be a chronic condition causing symptoms of 
hypoT that aren't properly diagnosed.

Depression is one of the earliest symptoms of hypothyroidism and is thought
to be present in some degree in all hypothyroid people.

I don't know enough about the histology of the various nodules except that 
various kinds can be septate. Your best bet would be to have a thyroid biopsy.
This can confirm Hashitoxicosis and it can identify the type of tissue that 
your nodule is composed of. According to the College of American Pathologists,
much nodules are benign and most will shrink by 50% in about one year of 
being on a low-iodine diet. 

Best, Elaine 


3 of 4 Posted Mar-1 12:44 AM Msg 4365.3 reply to 4365.2 
From capuchin0monkee (capuchin0mon)
To: elaineamoore 

Hi Elaine,

Thank you very much for your reply. I saw the endo again and she agrees 
that I have Hashitoxicosis along with the nodule. She ordered TBII, 
Blocking TR Abs and a.m. cortisol, I'm sure the other Abs will confirm 
the dx of Hashitoxicosis.

I have a couple more questions for you. First of all, my TSH rose to 
0.85 (TT3 96, FT4 1.0). On the day of the draw I felt really good, normal,
no "brain fog". Could this have something to do with the TSH? 

Also, could the TSH be rising due to the fact that I was on a low iodine diet?
(I stopped at the end of January, but I heard that TSH can lag behind for 
6 weeks). If so, should I resume the diet?

Finally, what treatments are there for Hashitoxicosis other than surgery? 
Block and replace? My endo said that if my TSH does not drop again at my 
next labs, she will consider starting me on replacement hormone. Could I 
monitor body temperature and use that to predict when I'm having upswings 
or downswings? 

Thanks again!

Amy




Reply Options 

4 of 4 Posted Mar-1 1:01 AM Msg 4365.4 reply to 4365.3 
From elaineamoore
To: capuchin0monkee (capuchin0mon) 

Hi Amy,

Yes, a low iodine diet will lower your thyroid hormone levels and this will
cause TSH to rise. You're correct in that there is usually at least a 6 
week lag before TSH reflects new stable thyroid hormone levels, but it'll 
start to rise before then.

Hashitoxicosis can be treated with block and replace because the ultimate 
goal is to slow down your immune system and reduced thyroid antibody 
production. Surgery may be needed if your gland has scar tissue from 
long-term hypothyroidism and inflammation or if your nodule was suspicious
for malignancy. Most people, though, don't need surgery.

Body temperature does reflect thyroid status for most people. You'd 
especially want to avoid becoming hypothyroid because your thyroid 
speeds up its activity trying to correct the hypothyroidism. This 
increased activity encourages thyroid antibody production. 

What's important to consider, too, is that your TSH will be falsely 
decreased by both blocking and stimulating TSH receptor antibodies. 
As these levels increase, your pituitary recognizes them as if they 
were TSH molecules. Thinking you have adequate TSH in your blood 
circulation, the pitutiary slows down on or stops secreting TSH. Brokken 
has written articles describing this. And for this reason it's important 
to evaluate your thyroid status with FT4 and FT3 levels and realize that 
TSH levels can be misleading. Best, Elaine



Hello

I am a 40 yr old male who has had a partial thyroidectemy 3 years ago.

Left lobe and isthmus removed because of nodule. Once removed a minimally 
invasive follicular carcinoma was found.

My endo and GP advised taking thyroxine for life to kill off the rest of 
the thyroid and prevent regrowth of nodules.

However my surgeon post surgery stated that doing nothing post surgery was 
also an option and that the thyroid gland may cope on its own.

It was really only the fear of the nodule returning that i took the thyroxine
option.

Well two years later i am as ill as i was when i first presentd to my GP. 
Of course my labs are within the normal range and all the doctors now 
pronounce me euthyroid. So they are treating me now for anxiety and depression.
Well the depression has gone but nothing can touch the persistent anxiety. 
I am of the opinion that i am still hyperthyroid and would like to ask your 
opinion on this.

I am currently taking 175mg thyroxine built up in 25mg steps over two years.

If i am hyper would this just be making me more hyper ?

Would it still be an option to stop thyroxine all together and let my gland 
do the job or are the risks too high or maybe i have killed the gland?

Please help.


Reply Options 

2 of 2 Posted Mar-1 12:52 AM Msg 4372.2 reply to 4372.1 
From elaineamoore
To: alan65 (alan6511) unread 

Hi Alan,

Usually, with a partial thyroidectomy, you gain thyroid function over 
time. Taking thyroid hormone doesn't destroy your gland, but it slows down
cellular growth if your pituitary stops producing TSH. The idea here is 
that since TSH causes thyroid cells to grow and produce hormone, without 
TSH any malignant cells will not continue to grow.

But, usually thyroid function still improves. People on replacement hormone
after partial thyroidectomy are usually able to cut their dose of 
replacement hormone about 6 months to a year after the procedure. It could 
just be that your dose of thyroxine is now too high for you. It's important
that you have both FT4 and FT3 levels when you're monitored. If either of 
these levels are too high for your body's needs you can have symptoms of 
hyperthyroidism. I'd ask for a copy of your lab results and see if your 
dose of replacement hormone may be too high for you. Best, Elaine



Hi Again Elaine-

After a year I was informed that my TSH is now 4.0 and FT4 is normal, 
so my Endo took me off of my Tapazole that was at 5 mg/day. What do 
I wait for now? Should I expect Thyroid Storm or Tachacardia if my 
Hyper/GD kicks in again? I'm nervous about this b/c of my PAC Arrythmias. 

Thanks, Kaz


Reply Options 

2 of 4 Posted Feb-20 6:48 PM Msg 4363.2 reply to 4363.1 
From elaineamoore
To: jessegirl01 

Hi Kaz,

It's always a good idea to wean off meds slowly. This helps your immune
system adjust to the change from being suppressed or slowed down, and 
it helps gauge if you're truly in remission or if your dose is just too
high for you. The usual protocol is to move to 2.5 mg for a week or 
two, and if you don't notice hyper symptoms you move down to 1.25 mg daily.
Then after a week or two you can cut down to 1.25 mg every other day and 
continue on this dose or whatever low dose you decide to stick with for at
least 6 weeks. At this time you'd want to repeat labs and see what your 
labs look like at a minimal dose. If you're secreting TSH normally, then 
remission is likely. You could also ask for a TSI level to help determine 
if you're in remission, but you'd still want to stop meds slowly. 
Because your TSH is high according to the new ranges, it wouldn't hurt 
to stop your dose for a few days before resuming the lower ATD dose. 
Why don't you call your doctor and mention that you're concerned and 
ask about weaning off meds slowly and then repeating labs. Best, Elaine



3 of 4 Posted Feb-20 8:54 PM Msg 4363.3 reply to 4363.2 
From jessegirl01
To: elaineamoore 

Thanks for the advice, the Dr. said if I wasn't comfortable with ending 
I could do 5 mg 3X a week, but your dosages sound better. However, is 
the two conditions I mentioned a reality for me? How will I tell if 
the Hyper-T is coming back? p.s. - My Dr. doesn't believe in "remission". 
Thanks, Kaz 

Reply Options 

4 of 4 Posted Feb-28 5:10 AM Msg 4363.4 reply to 4363.3 
From elaineamoore
To: jessegirl01 unread 

Hi,

Thyroid hormone levels rise slowly. Before you'd reach the point of 
thyroid storm, you'd have noticeable symptoms of hyperthyroidism. 
There are some conditions, though, that could make you more susceptible 
to the effects of thyroid hormone. These include respiratory infections, 
particularly pneumonia, but problems are more likely to occur in elderly 
people who haven't been diagnosed or received treatment for hyperthyroidism. 
In the elderly, symptoms of hyperthyroidism are often apathetic where 
patients seem withdrawn and somnolent rather than nervous or anxious. 
Best, Elaine



About 20% of people with GD will start producing blocking TSH receptor 
antibodies rather than the stimulating variety that causes hypothyroidism. 

Both blocking and stimulating antibodies can cause a drop in TSH. But 
when thyroid hormone levels and TSH both start to fall, it's usually 
blocking antibodies that are contributing to hypothyroidism and interfering 
with TSH production. You could ask to have a test for blocking TSH receptor 
antibodies or ask your doctor about thyroid replacement hormone if you have 
any hypothyroid symptoms. Best, Elaine
Hi Elaine, it's me again.

I'm so confused. As I've said in previous posts, I have Subclinical Hyper 
T w/nodular goiter. My numbers now - as they have been since Septemter - 
are TSH <0.01; FT4 1.3 (range .8 - 1.8) TT3 1.91 (I forget the range, but 
it seems to be mid-range) The only symptoms I have are slight palpitations
(never higher than 93 bpm) lots of anxiety & depression; sleep problems - 
all of which could be menopausal, too. I had the Thyroid Scan & Uptake and 
it was 30% after 24 hrs. My PCP prescribed Inderal 80 mgs, but I didn't 
want to take that much. I saw an Endo who agreed that my symptoms were 
primarily caused by menopause and that the thyroid problems should correct
themselves. She changed the Inderal to 10 mgs PRN and she said that we 
should just do blood work every 6 weeks and meet again in 6 months.

Well, after my first round of blood work (with the results as listed above)
she now wants me to start Tapazole 10 mg and come back next month. Why 
the change in treatment plan? Is she expecting the numbers to change faster?
Aren't the T4 & T3 in the normal range? I haven't taken any of the 
beta-blocker because I just don't feel the palps are that bad and I'm 
afraid to lower my blood pressure. And I'm not sure I want to start ATDs
mostly because I feel bad enough without putting on weight. Which also 
reminds me: why do I have more symptoms of Hypo? Will Tapazole help w/the
goiter?

I really want to do the right thing, but I just don't know what that is. 
Any suggestions?

Lola


Reply Options 

2 of 4 Posted Feb-23 7:20 PM Msg 4368.2 reply to 4368.1 
From elaineamoore
To: Lola51 (Lola518) 

Hi Lola,

The reference range for FT4 is usually 0.8-2.0 and for total T3 it's 
0.9-1.8 pg/dl, and total thyroid hormone levels are usually elevated 
in women. Because we have much more T4 relative to T3 it's standard 
practice to use the FT4 for monitoring therapy. Because your FT4 
isn't even on the high side, a Tap dose of 10 mg could easily move 
you into hypothyroidism. Your doctor may not realize that T3 is often 
falsely elevated and she may not know that TSH stays low or suppressed 
for a long time. It's also possible that you had a FT3 rather than TT3 
since the range for FT3 is 2.3-4.2 and in most labs T3 is measured in 
ng/dl with the range being 80-180. You might want to clarify the range 
on this test result and see if you had an FT3.

Hypothyroidism and hyperthyroidism cause some overlapping symptoms. 
Palpitations and sleep disturbances show up in both disorders. However,
if your bpm of 93 is when you're at rest at least 10 minutes, this 
would more likely be related to hyperthyroidism. If you're not at rest
when your heart rate rises, this wouldn't pertain. Have you tried a 
low iodine diet? That's usually the first line approach for nodular 
goiter and also subclinical disorders? Best, Elaine




3 of 4 Posted Feb-24 8:55 PM Msg 4368.3 reply to 4368.2 
From Lola51 (Lola518)
To: elaineamoore 

Elaine,

I called the Endo today to ask about why she wants to start the 
Tapazole and she said that my numbers have gotten so much higher. 
I said that actually, they hadn't. She disagreed and said my TSH 
was .02 when I came in Jan 24th, and now it's back to .01. Then 
she said my FT4 was normal, but that my TT3 (yes, it really is the 
Total T3) was 1.9 which was indicative of thyroid toxicosis (or 
something like that) Then I quoted your post saying that I understood
that therapy was done by FT4 and she said I was absolutely wrong and 
was I getting my information from the internet. When I said that I 
was corresponding directly w/Elaine Moore, she said that she doubted 
you had time to sit and answer questions, that this is exactly how a 
"50 year old man corresponds with little girls" and tells them he's 
someone else. I could just scream!! (You aren't a 50 year old man, 
are you?)

Normally I would just look for another doctor, but I've been fighting 
my PCP over this, too, and quite frankly, I'm worn down. My heartrate
is normally 74 - 78 bpm - when it's running rapid it only gets to 
about 85 - 95 bpm resting. I have the propranolol, but I've been 
nervous about taking it because it doesn't seem like my heartrate 
is all that fast and I don't want to slow it down to comatose. Is 
that silly?

Actually, the anxiety and depression and joint pain have gotten to 
be the worst they have ever been, and I just want to feel better. 
I just can't put on weight - I would love to try the low-iodine diet,
but I'm just too tired and worn down to do any kind of diet - and I 
heard Tapazole will put on weight. I could just cry.

What's next? I appreciate your help,

Lola


Reply Options 

4 of 4 Posted Feb-25 6:32 PM Msg 4368.4 reply to 4368.3 
From elaineamoore
To: Lola51 (Lola518) unread 

Hi Lola,

You're right. I'm not a 50 year old man. And treating hyperthyroidism 
is primarily influenced by the FT4 level. If you reall had thyrotoxicosis
with an FT3 that was quite elevated, a low dose ATD (lower than 10 mg) 
would make sense. And as far as test sensitivities go, a TSH result isn't
significantly different than a level of .01. We can repeat the test on 
the same specimen and get results ranging from .01 to .03 and this wouldn't
be statistically significant. If your TSH had fallen from .02 to less than
(<) .01 that would be considered a drop in TSH but still not much of a drop.

The low iodine diet isn't complex. You don't have to read charts or study 
labels. You just want to avoid fast and processed foods. When you do eat 
them, you want to add foods known as goitrogens (raw broccoli, almonds, 
peanuts, cabbage, etc) that help block iodine absorption. But if you can
focus on nutrient-rich foods with adequate, but not excess, protein, 
like salads, stir-fry, grilled fish, chicken, etc and avoid saturated 
fats and sugars, you'll most likely see improvement. 

Beta blockers are helpful in reducing cardiac symptoms and symptoms of 
anxiety if you need them. Using a low dose, you shouldn't notice side 
effects. And propranol has the advantage of mildly lowering thyroid 
hormone levels without causing hypothyroidism. 

Graves' disease can cause weight gain when it increases our appetite 
yet makes us too tired to perform light exercise. In this case, a low 
dose of an ATD, like 2.5-5.0 mg, can actually help people lose weight. 
If you're not feeling as good as you should, you may want to give a 
low dose of the meds a try, especially the propranolol if that's what 
you were prescribed. Best, Elaine



HI Elaine

First bloods TSH 0.01 and T4 27 second bloods TSH 0.01 and T4 24.4 
Have terrible symptoms all of them including runs and weight loss but 
since second bloods palps have got slightly better but may be due to 
high anxiety drugs. Just been put on Carb thingy 15 mg Is this OK 
is this the right thing she has worried me because she says it can get
rid of my white cell count. How can I stay away from colds etc - 
i have children! I wont be able to go out! This is really scary with
all the side effects. PLease reassure me that this is the best course.
My dad died of heart attack at 50 (I am 36) so I want to protect my 
heart but Grandmother died at 38 of liver diesese. Does this matter? 
Very confused and scared


Reply Options 

2 of 5 Posted Feb-19 1:50 AM Msg 4360.2 reply to 4360.1 
From elaineamoore
To: kat3az 

Hi,

A dose of 15 mg carbimazole is a low starting dose. The problems you 
mentioned, such as white blood cell decreases and liver problems, are
seen in less than 1% of people using anti-thyroid drugs. And these 
effects are most likely to be seen in people on inappropriately high 
doses of meds.

Heart conditions are often genetic, but fatal liver conditions aren't.
Liver disease is more likely to be caused by viral or toxic hepatitis 
and progression to cirrhosis. Heart problems can occur in both 
hyperthyroidism and hypothyroidism. The carbimazole takes a good 6-8 
weeks for full effects and at this time the dose is usually lowered. 
It's best to monitor your levels with free T4 levels (FT4 test). Total 
T4 levels are often falsely elevated in women since these levels measure
inactive hormone and are influenced by estrogens. Until the carbimazole
kicks in, many doctors use beta blockers like propranolol to help reduce
any cardiac symptoms. Best, Elaine

Author of Graves' Disease, A Practical Guide; Autoimmune Diseases and 
Their Environmental Triggers; Encyclopedia of Sexually Transmitted 
Diseases; Encyclopedia of Alzheimer's Disease; and an upcoming book 
on hepatitis. 

Reply Options 

3 of 5 Posted Feb-19 3:56 PM Msg 4360.3 reply to 4360.2 
From kat3az
To: elaineamoore 

Hi Elaine
Thank you so much for your reply. I started on the Carbimazole this
weekend and hten had two nosebleeds and panicked and went to the 
hospital! They sent me home saying it was very unlikely it was the
Carb and go to Dr on Monday. I can see this is going to be a recurrent
thing with me! I said this to my husband about rushing to the hospital
every week and he laughed and said he was thinking every day! He knows 
me too well. Heart rate is still a little high probably between 80 and 
95 so I am not on any beta blockers. Is this OK? Thanks again for 
your reply it helps a lot to know there are friends out there. Should 
I be taking any vitamins etc or any specfici foods to help with symptoms
until drug kicks in? Thanks again K


Reply Options 

4 of 5 Posted Feb-20 4:52 PM Msg 4360.4 reply to 4360.3 
From mrsgraves
To: kat3az unread 

Hi Kat try not to panic weve all been there here on this board it is so 
scary and the bes thing you can do is learn about the condition and try 
and relax l know easier said than done but it really does help. As 
Elaine says your on a low dose alot of us start of on higher does and 
some like myself sty on a high dose.. my heart rate has got up as high
at 160 something but thats another story its mainly between 75 and 87
these days with meds good luck to you and take care Elaine is the best
x ps l was on beta blockers a short while they didnt agree with me. 
(joint pain and triedness ) just try not to worry we are all here for you 

Reply Options 

5 of 5 Posted Feb-23 7:43 PM Msg 4360.5 reply to 4360.3 
From elaineamoore
To: kat3az unread 

Hi Katz,

I hope the nosebleeds haven't returned. I can't imagine them being from 
the Carbimazole. We get a lot of people in the ER this time of year 
because it's so dry here and the forced heat makes it even drier. A 
good multiple vitamin free of iodine is a good way to correct some of
the nutrient deficiencies associated with hyperthyroidism. Until 
the ATDs kick in, beta blockers are great for reducing any cardiac 
symptoms especially if your heart rate is high. At a low dose, any 
side effects are rare and usually mild. Best, Elaine


Hello:I've been feeling really sick for awhile, but just finally got
tested.I thought I might have hypothyroidism - but now I'm thinking
hyper orGrave's? My doctor said he'd never seen free T3 as high as 
mine andall of my female hormones are out of whack too - registering
aspostmenopausal even though I am only 32 and still get my period. 
I'mreally scared and would appreciate any input. Thanks!!TSH 
1.35 .40-5.5Free T4 1.3 .8-1.8Free T3 1000 230-420IGF-1 
363 126-291 (growth hormone)estraadiol <32 postmenopausal
progesterone 29.7LH 11.5FSH 32.8 postmenopausalDHEA 433 
0-325cortisol 12.2 3-17insulin 39 <17All of these are out of 
whack except the cortisol fell within thenormal range.


Reply Options 

2 of 6 Posted Feb-18 3:35 AM Msg 4356.2 reply to 4356.1 
From elaineamoore
To: amyjoy21 

Hi,

Your FT3 is most likely falsely elevated. If it was truly this
high, you would have a low TSH. The most common cause is antibodies
to T3. However, because so many of your other assays seem to be 
falsely elevated, you probably have heterophile antibodies that are 
causing false positive results with the immunoassays that we use to 
run these tests. Your doctor can call the lab and tell them he 
thinks something is interfering with the test and request the tests
to be repeated at a reference lab after testing for heterophile 
antibodies. You can do a google search on heterophile antibodies 
for more info, but they're not harmful.....just annoying when they 
skew lab results. Let us know how things turn out, Elaine



3 of 6 Posted Feb-18 3:47 AM Msg 4356.3 reply to 4356.2 
From amyjoy21
To: elaineamoore 

Thanks for the response! But then what do you think is wrong with 
me? I have many symptoms of hyper - the biggest of which it is 
almost impossible for me to sleep on a daily basis. I also have 
trouble breathing, tightness in chest, extreme anxiety, and nausea.
I've read online that a high free T3 level can be indicative of 
Grave's even with normal TSH and T4 levels - do you think that's 
possible? I originally thought I was hyperthyroid - the only reason 
I didn't initally think so is because the first TSH test I took did 
not indicate so, as you stated. 


Reply Options 

4 of 6 Posted Feb-20 6:37 PM Msg 4356.4 reply to 4356.3 
From elaineamoore
To: amyjoy21 

Hi Amy,

Your FT3 is higher than what we usually see, which makes a false 
elevation likely. Whether it's from T3 antibodies or heterophile 
antibodies, you could have a similar false elevation with the TSH
result. Usually in falsely elevated TSH levels due to TSH 
antibodies the results are much higher, but heterophile antibodies
and also antibodies to mouse, hamsters, goats or whatever the 
source of the monoclonal antibody in the test is made from can 
cause these interferences. These false elevations appear to be 
affecting your FSH and other results. Estradiol may not be 
affected since it's often run on a different type of assay---
levels are low though in people on oral contraceptives, in 
ovarian failure and in some women during the early follicular 
phase of the cycle. 

See www.palpath.com/serohetero.htm for more info on heterophile
antibodies. There are also studies showing that there can be a 
genetic component influencing production of these antibodies, 
and there are studies showing the antibodies also influence the 
immune response in a way that protects against type 1 diabetes. 
More importantly for you, there are other testing methods available,
particularly methods that use a dialysis step to remove interfering 
proteins. Quest performs a T3, Free, Tracer Dialysis Test and a Free 
T4 by dialysis assay. These are more expensive and aren't run locally
but this is probably the fastest way of determining if you're truly 
hyperthyroid. Dialysis methods aren't available for TSH or at least I
don't know of any. Same with the other tests you had. But if you 
were tested for heterophile antibodies, you could have these tests
performed at a reference labs that uses a reagent that can remove
these proteins. Then you could have the other tests performed. 

It's true that you can have a high FT3 with a normal TSH if you 
have just started producing FT3 and the pituitary gland hasn't 
yet reacted to the high level. But it would be odd for your level
to rise this high. If your doctor agrees that you may be 
hyperthyroid based on symptoms he might use beta blockers to 
reduce symptoms until he gets the other results and even start 
a low dose of ATDs after your blood is drawn for the new tests.
Best, Elaine



5 of 6 Posted Feb-20 11:11 PM Msg 4356.5 reply to 4356.4 
From amyjoy21
To: elaineamoore 

Hi Elaine,

Thanks for your response! I saw an endo today and he wasn't very 
much help - he said he'd never seen T3 so high and insisted it
was a lab error. Even though I insisted I had symptoms of 
hyperthyroidism, he said he didn't see any symptoms. I asked 
what he expected to see and he said velvety skin and racing pulse
(even though he did not even take my pulse). He said I "looked 
like a smart girl who read too much." I have been feeling increasingly
sick for awhile and I'm concerned that I'm not going to be able to 
find someone who knows how to treat me. Should I ask for a low-dose
of an ATU even though the endo insists I'm fine and it's not my 
thyroid? When I suggested it might be my pituitary, that seemed 
to be beyond the scope of his knowledge. I will share the testing
information you provided at my next appt. Thanks again!

Reply Options 

6 of 6 Posted Feb-21 7:33 PM Msg 4356.6 reply to 4356.5 
From elaineamoore
To: amyjoy21 unread 

Hi,

Your doctor is correct in that your FT3 result is likely a lab error, 
and for this reason, it's important to get a correct result. Why don't
you call the office and tell them you realize that your FT3 was 
probably falsely elevated, but to tell for certain you'd like the
dialysis assay tests done on FT4 and FT3.

Hyperthyroidism causes a constellation of different symptoms, and 
most patients only have a few predominant symptoms. The symptoms 
your doctor mentioned aren't seen in all patients with 
hyperthyroidism. Some people may just feel anxious, irritable, 
have an increased appetite or scanty menstrual periods.

It's not right that you or your insurance pay for a lab test that
your doctor suspects is in error. He could easily request that 
the lab have the test repeated by another method, which involves
sending the sample elsewhere. Or he could order the tests I 
mentioned. To just assume they're incorrect without pursuing this 
isn't a good idea. 

Another article in Laboratory medicine from April 2003 by Mildred 
Fleetwood called Interference in Clinical Laboratory Tests by Human 
Antibodies to Specific and Non-Specific Immunogens," describes the 
problems labs have with interferences in hormone assays by both 
heterophile sand specific anti-human animal antibodies (HAAA). 
The article clearly states that "clinicians should contact the 
laboratory staff with any result that is unexpected (too high or
too low)." Best, Elaine


Hi Mrs. G.

Usually, if you become hyperthyroid while on meds, you just need a 
med adjustment. A dose of 100 mg levothyroxine may just be too high
for you. Rather than increase the PTU, you may just want to cut 
down the levothyroxine. In most cases, over time the PTU can be 
reduced but it could be that you're being exposed to environmental 
triggers. Common ones include cigarette smoke, estrogens, stress, 
aspartame in nutrasweet, and excess dietary iodine in fast/processed 
foods.

Recent studies show that people with low selenium levels are also more
likely to elude euthyroidism. In several studies, selenium, beta 
carotene, and vitamins C and E are being used along with ATDs. You
could try adding 100 mcg selenium if you're not taking a supplement
with selenium. The stress of caring for a sick child could also have
caused you to relapse somewhat. Now that your child has a proper 
diagnosis and treatment, things may improve for you. Best to you, Elaine

Hi Mrs G,

I didn't use the nicotine patch, and I had smoked for around 15 
years when I quit. I did buy some weird herbal cigarettes that I 
told myself I could use if I got desperate. They were pretty 
awful so I only smoked 1-2 of them. But knowing they were there 
sort of helped.

I also told everyone I knew that I quit. And nearly everyone I 
knew told me I shouldn't be saying this since I wouldn't be able 
to do it. This was the first time I ever seriously quit and I was
offended by their negativity. One of my co-workers in toxicology
even said nicotine was more addictive than heroin. I'm stubborn
so this unexpected feedback made me determined to succeed. I 
also told myself that if I ever decided to smoke again some day 
when I was older and the kids grown that I could, but after 25 
years of not smoking I don't expect I'll get the urge again. 

When I quit, I did have an elevated blood pressure for a day or 
two. After that I decided the worst was over and I didn't want 
to go through it again. After 3-4 works I finally found myself 
not thinking about cigarettes all the time. Probably different 
things work for different people but this approach, with the 
help of the vitamins and minerals, worked for me. Best to you, 
Elaine

am on 300mgs a day of PTU after leaving the hospital. I am now 
suffering from itching and hives. Is there anything I can take or
use for some relief?Linda 

Reply Options 

2 of 2 Posted Feb-20 6:40 PM Msg 4362.2 reply to 4362.1 
From elaineamoore
To: Linda34810 

Hi Linda,

Many doctors prescribe diphenhydramine (Benadryl) for itching 
and hives or they lower the PTU dose. Even though the usual 
starting dose has traditionally been 300 mg daily, newer studies 
report good results with starting doses of 100-200 mg. It would 
be a good idea to call your doctor and let him or her know about
your symptoms. Best, Elaine