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Thyroid (Expert Forum)
TSH levels and ATD's/Graves/Integral Doc's
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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TSH levels and ATD's/Graves/Integral Doc's
by jessegirl, Dec 11, 2005 12:00AM
Hi Dr. Mark - I'll try to make this as short as possible, most of my questions have been answered by the CPRN at my Endos. office, but what I still don't understand is my levels. When my GP first noticed an enlarged thyroid he put me on 15 mg of Methimazole/day. My levels were .01, when my Endo. increased to 20 mg it stayed at .01, when put back down to 15 mg (only b/c I complained of nausea) it went to 1.9, at 10 mg my TSH was 2.6. I'm confused why I was more Hypo w/less medicine, shouldn't it be the other way around? She actually said I should be taking more, but... I took myself down to 12.5 mg and now my TSH is 5.0, so I got cut back to 7.5 mg. I suffer from APC arrythmias also (b/4 GD) and they seem to get better when I'm more Hyper - so I am afraid if I get a throidectomy that I will be one of those "reverse-effect" people that take caffiene to go to sleep and my arrythmias will be worse!
I was also told that my RAI-U was 44% and that combined with eating alot and losing weight is why I was diagnosed w/GD, is there any possibility of a mis-diagnosis? Other than that, I have none of the listed "triggers". Also, when I originally went to my GP it was b/c of nausea/dizziness/pressure-type headaches. Are these symptoms part of GD? I still experience them daily. Do you have any patients that used a combo. of medical and alternitive doctors, and do they work-out. My Endo. says they will not work w/Alt. docs. and patients usually come back to them. Also, does an enlarged thyroid ever decrease? My antibodies were never taken, will they matter now?
Thank you!
I was also told that my RAI-U was 44% and that combined with eating alot and losing weight is why I was diagnosed w/GD, is there any possibility of a mis-diagnosis? Other than that, I have none of the listed "triggers". Also, when I originally went to my GP it was b/c of nausea/dizziness/pressure-type headaches. Are these symptoms part of GD? I still experience them daily. Do you have any patients that used a combo. of medical and alternitive doctors, and do they work-out. My Endo. says they will not work w/Alt. docs. and patients usually come back to them. Also, does an enlarged thyroid ever decrease? My antibodies were never taken, will they matter now?
Thank you!
Doctor's Answer
by Mark Lupo, M.D., Dec 11, 2005 12:00AM
, Dec 11, 2005 12:00AM
The 44% uptake in the absence of thyroid nodules confirms Graves. Antibodies are not necessary to confirm it in this case. The TSH takes a while to change, so initially it is not a sensitive way to titrate ATDs -- ie, it stays low until the brain (pituitary/hypothalamus) is comfortable that the thyroid levels are normalizing.
Headaches are common -- should improve with treatment, if not look into other causes. I would titrate the methimazole to keep the TSH 1-2.5 range....the tough part is deciding on methimazole for a year or so vs surgery vs radioactive iodine (I-131). One of the more common things I see is failure to recognize mild Graves eye disease prior to I-131 and then there is a worsening of the eyes -- this is easily avoided with a short course of prednisone. In most cases I-131 is the safest and most effective treatment of Graves.
Headaches are common -- should improve with treatment, if not look into other causes. I would titrate the methimazole to keep the TSH 1-2.5 range....the tough part is deciding on methimazole for a year or so vs surgery vs radioactive iodine (I-131). One of the more common things I see is failure to recognize mild Graves eye disease prior to I-131 and then there is a worsening of the eyes -- this is easily avoided with a short course of prednisone. In most cases I-131 is the safest and most effective treatment of Graves.
I just want to ask you to PLEASE research all of these options before making any decision. I had RAI a few years ago, and went through several years of pure hell. My endo recommended the RAI, saying that the end result would be that I would have to take a pill every morning and I'd be fine. I became very hypo, and was given Synthroid. When he thought I was "normal" again, I did not FEEL normal, and had a number of symptoms that I had never had before in my life (huge weight gain, voice problems, inability to think clearly, concentrate or remember, depression, joint pains, to name a few). But he just told me they couldn't be related to my thyroid. So I started to research for myself. I bought book after book, read article after article. It took many re-readings before some of it would actually become clear and "stick" in my head. Then I found a doctor who would prescribe Armour thyroid and treated my symptoms, not my lab numbers. I am now on 3-12 grains of Armour daily, and finally I am losing weight, I can concentrate, I feel GOOD again.
So please, make sure you find out all you can about the three options, and choose the one that's right for YOU.
So, to answer your question, I don't know why doctors don't prescribe Armour more often - one theory is that it's not as profitable as prescribing Synthroid and, in fact, Synthroid's maker Abbott provides financial support to the AACE. I don't know - I have an opinion, but I don't think I'm allowed to voice that in this forum.