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Thyroid (Expert Forum)
grave's or hyperthyroid?
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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grave's or hyperthyroid?
by vickidugg, Jan 22, 2006 12:00AM
I was just dx hyperthyroid most probably Grave's. My endo said my thyroid was enlarged and TSH 0.009, T4 free,direct 2.51. I had a scan and there was increase uptake found out by calling on Friday. I saw the endo for initial eval with all the symptoms wt loss, heart palpatations, heat intolerance, anxiety/depression (is bad), tremors, brain fog, focus problems. It is getting harder for me to function on a daily basis. I want to start treatment quickly b/c I know there is no quick result.
He explained all 3 options but of course favors RAI. He made my next appt in May 06. So I guess I just decide and tell him over the phone. His asst. asked if I had decided on treatment. He scared me with all the side effects with ATDs'.
What treatment at the beginning is best course? And how do I know if it is Grave's?
He explained all 3 options but of course favors RAI. He made my next appt in May 06. So I guess I just decide and tell him over the phone. His asst. asked if I had decided on treatment. He scared me with all the side effects with ATDs'.
What treatment at the beginning is best course? And how do I know if it is Grave's?
Doctor's Answer
by Mark Lupo, M.D., Jan 22, 2006 12:00AM
, Jan 22, 2006 12:00AM
Increased uptake without a hot nodule and the labs you mention are all consistent with Graves. There are three options - usually I start with ATDs and discuss RAI as a back-up and quite frankly a more definitive/effective treatment in many cases. May is a long time for the next appt -- I think you need another appt to discuss this in more detail. Make sure you mention any eye symptoms as you are discussing this treatment -- RAI can make eye symptoms better in the long term but worse in the short term (witout adequate steroid therapy).
Dr.s still are not recognizing how common this sub-clinical form of adrenal fatigue is. CFS in my opinion is also an "adrenal fatigue" syndrome and I've recently listed the link on this forum, for the NIH who has done studies, proving conclusively that CFS patients present with low cortisol levels.
Just to add this to the mix, there were also studies done by other reputable Academies and Centers, with results published by The American Psychiatric Association. These other researchers, that include Board Certified M.D.s, concluded the same thing about low cortisol (sub-clinical adrenal insufficiency) and that IN CONTRAST, depression & anxiety, cause "elevated" cortisol, QUOTE; "...suggests that the underlying physiology is different.."
If you want to find this article, go to google and put search words in; "Researchers Offer Theories On Chronic Fatigue Causes Christine Lehmann". (the THEORY part, is trying to find the triggers, like viral-bacterial infections).
It's hard to believe many Dr.s will not offer treatment suggestions for anything short of full blown adrenal insufficiency!
http://pn.psychiatryonline.org/cgi/content/full/36/1/20
Let me add this opinion; With research conclusions like these, it's hard to understand why Dr.s believe there is nothing to medically back them up, documentation-wise, for treating sub-clinical forms of hypoadrenalism, that plainly shows up on tests. There ARE DR.S WHO DO, but only ones who are Osteopaths and Holistic Doctors. Osteopaths are just as licensed as other MDs, plus can be Board Certified, so I wish the other mainstream Dr.s would take this more seriously and give treatment options to people suffering serious forms of adrenal fatigue. Antidepressants are commonly suggested but for some of these patients, the reaction is very adverse. ALSO: Patients with low adrenal, that's not treated before starting thyroid med, or at least treated similtaneously with thyroid med, will also have adverse reaction.
Mshypo, you were right in saying they can have "hyper" reaction like rapid heart rate, anxiety, I found many souces stating this but originally thought it would only exaggerate the "hypo" type symptoms. I sit corrected.
I hope Med-Help didn't get upset at anything we did. We got a little heated in that one debate.
I appreciate them and don't want to cause a problem and know you feel the same.
Also; I appreciate you replies in that debate thread we had going!
Blessings,
Jim
I'm want try to switch my medication from Armour to Synthroid or Levoxyl w/ Cytomel as I have Thyroid Eye disease & I think the natural hormones may be contributing to it. My f/p has never really used Armour that much & did not become familiar with it until I requested it. He really listens to me & takes my advice into consideration. Why I don't know @ times, LOL.
I am on 3 grains @ this time & my labs are as follows ...Remember I'm post RAI so you can't go by the TSH ...OK ... TSH 0.21 (0.40=5.50) Free T-3 270 (230-420)
Free T-4 1.0 (0.8-1.8) TSI antiboties 198 (125 or less).
I will be having orbital decompression surgery on my Rt.eye probably sometime in Febuary or early March.so I definetly do not want to go back into the hypo phase because that makes the TED much worse. I also would like to know if you or Tabtools knows anything about having this surgery when my TSI is still elevated. As I have Graves, will it always be somewhat elevated? Boy. I'm really testing your knowledge here. LOL...
If your expertise isn't in this area, can you tell me how to get ahold of Tabtools. If Dr. Mark was available I'd be asking him, but you know how that is right now...
Thanks for the kind words above. Sometimes the attitudes of some posting on this board is alittle overwhelming & I don't have the temperment or finase (spl?) to quell it the way you do.
I give Dr. Mark credit too. He keeps his direction & has a wonderful dispostion & attitude.
Keep the Faith & God Bless You Too, Jean
That is an area I have really limited knowledge in, which is true on a lot of thyroid subjects. My guess though is that the elevated TSI antibodies will not have an effect on the surgery or post surgery because antibodies are not a factor when thyroid patients have other type surgeries. It might be important if the ABs were causing significant inflammation, other than in yours eyes, in which case they might give a patient a short round of anti-inflammatory or a steroid like Prednisone, before performing the surgery but I'm not really even sure about that.
I have an e-mail for Tabtools, so will tell her you are wanting to correspond. She has a non-profit, really well put together website for informing about thyroid disease. I hope she can post that link on here soon, in case this forum is about to change for some reason. Med-Help has never minded when others have listed links and as I say, hers is non-profit and really well done.
I'll pass along the message and I'm sure she'll post to you soon. Thanks again for all the positive uplifts.
Jim
Without Dr. Mark -- My suggestion is Elaine Moore who answers questions at another forum. You can find my website, and my e-mail address if you just do a google on tabtools.
Elaine Moore co-authored a book on Graves, which she herself has dealt with. I always direct the people with questions on hyperthyroidism to her, as she is the best informed -- besides the doctors of course.
~ M