Graves' Disease Support Group
Graves-Basedow disease is a medical disorder that may manifest several different conditions including hyperthyroidism (over activity of thyroid hormone production), infiltrative exophthalmos (protruberance of one or both eyes and associated problems) and infiltrative dermopathy (a skin condition usually of the lower extremities). This disorder is the most common cause of...
I saw a new endo in December and immediately she recommended RAI as did the 1st endo. I left her office saying ok this is what I am going to do but now my gut tells me this is not the right thing. My question is where do I go from here? I am seeing my general dr. today and am going to see if he will order the antibodies testing which I have never had. I know I need TSI but what else do I need? I was started on Tapazole last year at 5mg 1 x day and after 4 weeks liver enzymes were up and started itching. Endo does not want me to have anti thyroid med. These are my last labs.
Free T3 3.1 (2.30-4.20
Free T4 1.29 (0.80-1.80)
TSH 0.03 (0.40-4.00)
Any advice would be greatly appreciated. I would like to work with my reg Dr. for a while if possible but don't think he knows much about Graves. Thanks so much!
Free T3 3.1 (2.30-4.20
Free T4 1.29 (0.80-1.80)
TSH 0.03 (0.40-4.00)
Any advice would be greatly appreciated. I would like to work with my reg Dr. for a while if possible but don't think he knows much about Graves. Thanks so much!
Other antibodies tests are: TRAb, TPOab, and TgAb.
If Tapazole caused problems for you, would it be possible to consider PTU? Ask your doctor.
What were your labs at the time of starting on 5 mg once per day of Tap? Sometimes changing thyroid levels can cause itching as well as being on too much.
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If these are your latest labs, it doesn't look as though you need any ATD (antithyroid drug) as you are in range.
How are you feeling right now?
I suspect your endos were looking at pituitary hormone TSH and declaring you hyper.
If Graves' was the cause of your hyperthyroidism, the Graves' antibodies will cause a below-range TSH.
Thyroid status is always confirmed by the actual thyroid hormone levels so, I agree with mm - it doesn't look like you even need meds now.
Please don't let endos bully you into a treatment you don't need.
My first two endos pushed RAI but "gave me" two years on ATD's to achieve remission. My third endo pushed surgery after reading the large study that showed an increase in cardiac and cancer mortality rates in post-RAI patients.
None of them knew how to properly interpret thyroid labs. I finally found a thyroid-savvy doctor in the form of an internist who supported my decision to stay on ATD's.
You have a right to choose your treatment so, if one doctor doesn't support your treatment choice, I suggest you find another one that will.
Your regular doctor just needs to understand that thyroid status is determined by the FreeT4 and FreeT3 levels and not to worry about TSH.
If you need documentation from medical resources to share with him, just let me know and I'll provide some links for you.
http://elaine-moore.com/Articles/GravesDisease/WhatstheRushinTreatingGravesDisease/tabid/169/Default.aspx
http://elaine-moore.suite101.com/graves-disease-treatment-antithyroid-drug-rxs-on-the-rise-a370917
You'll really want to get that TSI test because, if you do indeed have Graves', those TSI antibodies skew your TSH results.
If you do indeed have Graves', I'll share a medical reference link that you can share with your doctor to show him there is no harm associated with a below-range TSH.
Free T3 5.6 (2.3-4.2)
Free T4 2.22 (0.6-2.0)
TSh 0.01 (0.30-5.00)
4 weeks after Tapazole
Free T3 3.7 (2.3-4.2
Free T4 1.4 (0.6-2.0
TSH 0.02 (0.6-4.2)
This is where I get confused. My Free T3 & Free T4 have only been out of range twice since diagnosis in Dec 2006. So based on that would I have only taken meds twice to bring it down? My TSH has always been low out of range. Both endos are looking at my TSH. The past few weeks I haven't felt well. I have had a lot of muscle weakness, headaches, swelling, heartburn, lack initiative. I lead a normal life and function well but never seem to feel great. I also take Klonopin 1 mg daily and atenolol 25mg daily. I wonder if these meds affect me at all?
This usually means that the patient will require decreasingly lower doses as he/she moves forward until he/she is taking 1.25mg Tapazole every third day.
Now, if you're not taking any Tapazole now and the labs you shared in your very first post on this thread represent no Tapazole, then I would say your current levels are too low for your body's needs.
Your symptoms are common hypothyroidism symptoms.
Most people need their FreeT4/T3 levels in the upper half/upper third of the range.
Based upon the ranges used for your most recent labs, this would mean FreeT4 1.3 - 1.6 and FreeT3 3.4 - 3.8.
The fact that your TSH remains low is due to your Graves' antibodies.
Now, I'm not trying to make things confusing but, I think you are in a similar place that I've been in for the past two years.
You see, there are a couple different types of Graves' antibodies.
In the early stages of Graves', the stimulating antibodies are most prevalent.
The stimulating antibodies stimulate the thyroid to produce hormone - too much hormone.....and they suppress TSH.
Some of us (me for one and I think you) can develop another type of Graves' antibodies further down the line. This type of antibody is a blocking antibody.
The blocking antibodies are very strong - they can negate the effects of the stimulating antibodies and make the patient euthyroid (normal thyroid function) but, again, suppressed TSH.
Or, they can overpower the stimulating antibodies and make the patient hypo...with suppressed TSH. This is where I've been.
Since your current levels are a bit lower than the types of levels healthy people would have....and you are reporting hypo symptoms, you would probably benefit from some thyroid hormone replacement (as in Synthroid/levothyroxine).
I've been taking replacement since March 2010 - thank goodness I had already partnered with a thyroid-savvy doctor by this time.
I knew she was a keeper when she told me "We know to ignore TSH in Graves' Disease".
On a "good" day, my TSH is .011.
Endo#3 looked at my TSH, declared me hyper and wanted me to start 5mg!!!
I then met my current doctor, an internist, the following month.
She agreed that I should stay off methimazole and that I should keep getting labs every month to see what happened.
5 months later, my FreeT4/T3 dropped a little lower and the hypo symptoms got really bad - my TSH was still .011.
That's when my doctor started me on replacement.
Now, I don't know how long you've been off Tapazole but, right now, you don't need it.
You might want to monitor your symptoms and continue getting labs every month or so.
If your symptoms get worse, I suspect your FreeT4/T3 levels will have dropped further.....then it would be time to start some thyroid hormone replacement.
http://elaine-moore.suite101.com/uk-study-shows-that-low-tsh-doesn-a264769
It's only FreeT4/T3 levels that are over-range for an extended period of time that puts the person at risk for cardiac issues/bone loss.
You will need to tell your doctor the exact names of the thyroid antibodies tests. The TSI is: Thyroid Stimulating Immunoglobulins. The TRAb is: Thyroid Receptors antibodies. The TgAb is: Thyroglobulins antibodis.
The TPOab you had done only tells how inflammed the thyroid is.
Whenever I want to recheck my thyroid antibodies, I tell at my doctor's office the full names along with the initials because you'd be surprise how the new people working for the doctor do not get a clue.
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