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Thyroid  (Expert Forum)
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Back from endo appt...confused!
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida Sarasota - FL
Questions in the Thyroid forum are answered by Dr. Mark Lupo. Topics covered include goiter, graves disease, Hashimoto's thyroiditis, hyperthyroid, hypothyroid, thyroid cancers, thyroiditis, and thyroid stimulating hormone (TSH).
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MedHelp Member's Question

Back from endo appt...confused!

by abcsoup, Oct 05, 2005 12:00AM
I posted a few days ago regarding feeling hyperthyroid again even though I've been on methimazole since the beginning of August.  My labs are as follows:



10/5/05

TSH .46  (.4-4.5 normal range for our lab)

FT4 1.04



8/23/05

TSH 0.19

FT4 1.3



8/2/05

TSH 0.19

FT4 1.21



My endo said that sometimes when the thyroid is stabilizing you can have little blips where you are hyper again.  He is going to recheck labs again in 2 weeks, plus a fasting glucose. Should I also ask for a FT3 test?  He said that if I continue to have symptoms, pounding heart (although I'm on 50 mg of atenolol), jello-like legs, shakiness and etc. despite normal labs, then we'll have to dig deeper to see what could be causing it.  I was also wondering if an I-123 uptake scan shows nodules or not? Or can only an ultrasound do that? My four hour uptake scan was 24.7%.  I guess I just wish I knew whether or  not my symptoms were still due to Graves since my labs are normal. I really hate feeling this way!!!
Doctor's Answer

by Mark Lupo, M.D., Oct 05, 2005 12:00AM
Check a t3 - but the labs are looking fairly stable.  An I-123 can sometimes show nodules - particularly if they are over-functioning ("hot") or not-functioning ("cold").  Ultrasound will show the anatomy of the thyroid and identify any nodule but will not determine if they are hot or cold.  



Other causes of symptoms....adrenaline over-production (pheochromocytoma -- very rare), anxiety, not enough atenolol (can be dosed 2x/day), heart condition.....



Graves can sometimes produce more t3 than t4 - so start there....
Member Comments (6)

by Mark Lupo, M.D., Oct 07, 2005 12:00AM
Menopause can start as early as 45 or late as 55+ -- sometimes people with auto-immune thyroid disease enter menopause early and sometimes thyroid conditions mimick symptoms of menopause.  It's hard to say what will happen - to document ovarian function check FSH and Estradiol and interpret with your GYN.

by layla, Oct 07, 2005 12:00AM
To: M.D.
I am wondering how loss of thyroid function or thyroid meds (I use levoxyl) would or could affect premenopause.  I am 46 yr old active female and have had no reason to think I am starting menopause until the thyroid problem. I exercise regularly and eat very well. Could this start it early? Are thyroid meds a problem with menopause and if so how? I have been tested for all the labs having to do with premenopause and all came back normal. Thanks you for any information. It's so hard to take it all in. LL

by layla, Oct 07, 2005 12:00AM
To: adscoup
I hope it was ok to tag into your post. There are not many here to use and since the doc answered you I was hoping it was ok. LL

by DooDaa, Oct 08, 2005 12:00AM
To: abcsoup
What is the dosage of atd's your on and how long at that dose?   If your dr is not aware that TSH can and will stay suppressed when atd's are started.  If you've never heard of Elaine Moore's book, Graves Disease A Practical Guide, it's a great buy, or you may even be able to check it out at the Library.  I find that her info was more helpful on Graves Disease and what should be tested over any info I was given by anyone.  To this day my TSH has to stay under 1.0 and FreeT3 and FreeT4 have to stay in the upper 1/3 range, and that is normal for me. TSH is not a good test while you're being treated for the hyperT. Since FreeT3 and FreeT4 are the unbound thyroid hormones, it's in your best interest to have those tested while on the atd's.  I did not do that, or request copies of my labs during the first year or better of treatment for my hyperT/graves and it brought with it many repurcussions.  After about 14 or 15 months being left on 30 mgs of atd's, there is nowhere to go but hypohell and that was my destination due to a dr being fixated only on TSH.  



I came off atd's after two years, and requested a TSI antibodies test be ran to ensure that I was in remission. The two years of being on atd's taught me a lot about the lack of knowledge in the Medical community about Graves and how it affects us, and how we end up being sick unnecessarily.  If you've been on too high a dosage of atd's for more than 6-8 weeks, after starting Methimazole/Tapazole, then hypo will be imminent. Breathlessness, weight gain, lethargy, constipation, depression, carpal tunnel were all hypo symptoms for me, and once I learned that, things ran a lot smoother. Usually by the 6-8 week mark of starting atd's, they should be reduced, gradually. I was taken off them after 5-6 months cold turkey, along with my bp meds, and that's not good.  Don't let that one happen cuz it was no fun at all. If left on a large dose as I was, (my dr only focused on TSH) it just made my antibodies run amuck and did nothing for my health other than allow him to get the TSH up at the risk of my feeling like death warmed over.    



I am now hypo, which I suspected long before the hyperT/Graves kicked in. I would imagine that all the testing that was done in previous years before, if I had copies of labs from all dr's who just couldn't figure out what was wrong, I'd guess only TSH was tested, which to me is just a diagnostic tool. I've been told I'm normal for my TSH to fall anywhere in the range of .50-5.50 and that just does NOT work anymore. Find out where you feel best at and work to keep that level.  



Just remember, FreeT3 and FreeT4 in the mid to upper 1/3 range, and make notes on specific symptoms and you'll find where you feel best at while on atd's and once you gain remission.  And if they are not reduced and you are not kept with stable blood levels, that is when RAI is suggested because unfortunately, you'll be told you're not repsonding to treatment. Taking the atd's every 8 hours in even doses works good too, although most scripts say X-amt of pills a day, not in split dosages.  



DooDaa

by layla, Oct 08, 2005 12:00AM
To: drmark
Thank you. That is a good idea. It's been two years since my last appt. I'll make an appt Monday morning.  I do believe I've had those test and everything is normal. I did stop having periods when my meds were to low but as soon as I increased them they started again. It could just be a timing issue and it seems related to meds. Have a good weekend. LL
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