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THE Q & A
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Welcome to The Q&A with Elaine Moore. Registered members are invited to ask any question of Elaine Moore on autoimmune diseases, Graves' disease, other thyroid diseases and subconditions, laboratory work, traditional and complementary medicine, triggers and environmental influences, thyroid and immune disorders in pets and animals, and other relevant areas of inquiry.
Each thread represents one question with one answer and will only appear at the time it is answered. Once answered, further replies cannot be made to the same thread since each thread represents only one question. A new thread will need to be started for additional questions.
Questions are answered solely by Elaine Moore, a medical writer and clinical laboratory scientist, MT, CLS, with more than 30 years of experience in immunology. Moore has also authored and edited over a dozen books in the area of health sciences and is an editor for McFarland Publisher's Health Topics Series.
Copying of any posts is prohibited without permissions.
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| Chris |
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Joined: 2/22/2012
Posts: 4
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Hi Elaine,
First, I wanted to say thank you so much for taking the time to answer all these questions. I'm so grateful for your knowledge and help. Here's some background info: I was diagnosed with Graves about 3 weeks ago, was on 20mg of Methamizole, and propranolol 60mg at day (got my Endo to reduce the dose).
I've had a rough 24-48 hours. I caught the stomach virus from my daughter about 2 days ago. I had fever and vomiting. I called my Endo to see if the fever was from the virus or low white blood cell count from the methimazole. I had blood work done the morning that I got sick. My white blood cell count was within the normal range 5.3 (Range 3.8-10.8). Then this morning, I woke up with a rash all over my chest, neck, arms, and legs. I rushed to my Endo and she said it's a reaction to the Methamizole. She's taking me off of the Methamizole, but keeping me on the beta blocker until I see her again in 2 weeks. Now, I'm on benadryl, steroid cream, and the beta blocker. She also mentioned putting me on the PTU when I see her in 2 weeks.
Do people that have allergic reactions to Methimazole also have reactions to PTU? Does PTU take longer to work? Based on my recent labs, would the dosing be the same for PTU (or equivalent of the methimazole)?
Here are my most recent labs- after 2 1/2 weeks on
2/29/12
T4 Free 1.4. Range 0.8-1.8. Non-dialysis
TSH <0.01
T3 Free 4.2. Range 2.3-4.2
TSI pending
Here are my labs before I started medicine:
2/14/12
T4 Free 4.1. Range 1.6-3.7
T4 8.8 4.5-12.0
T3 uptake 46.1 Range 27.8-40.7
T3 total 166 range 76-181
TSH <0.01
TSI 554. <140 Baseline
Thanks for all your help,
Chris
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| Elaine |
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Joined: 8/1/2008
Posts: 3396
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Hi Chris,
Your initial labs show mild hyperthyroidism so it's possible that the 20 mg mmi dose was too high for you. The fact that FT4 is already normal at 2.5 weeks also suggests this, and it indicates that the dose can be lowered. A dose that's too high often causes a rash. Lowering the dose might be a better option than switching to PTU.
Most people who react with a rish to MMI have no problems with PTU. However, PTU in general has a higher incidence of side effects. Right now you could probably get by with a 5 mg--7.5 mg dose of MMI and you could ask about trying this (usually meds are not stopped because of rash). If you switch to PTU you would want to use 50-75 mg PTU.
Why don't you try dietary changes and stress reduction techniques in the meantime? Because your levels were only mildly elevated you may be able to keep your levels in control without meds. If FT4 is normal with repeat labs, even if TSH remains low (it'll stay low for a long time because of your TSI) you could try a holistic approach. People who cut out aspartame, processed foods (high in iodine) and iodized salt and avoid known or suspected allergens are often able to move into remission when thyroid hormone levels are only slightly elevated.
The T3 uptake measures binding proteins rather than thryoid hormone and suggests that your thyroid hormone levels may be falsely elevated.
You wouldn't expect TSI to change yet because these antibodies remain in the blood circulation for 2-3 months before being broken down and excreted. Unless your doctor was questioning the first results there's no reason to have TSI this often. best, elaine
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TO USERS: Q&A posts are visible to all readers. Users can delete their own threads at any time. Users must provide information which is true and correct to the best of their knowledge as well as provide sources or references to any health / medical information if not taken from personal experience. All users including the moderator must behave at all times with respect and honesty. Advertising and self-promotion is not allowed. The moderator or site administrator has the right to ban users with or without warning for not following the basic rules of this site. All posts by default are not to be considered that of medical professionals unless otherwise indicated. As sole moderator, Moore has no conflicts of interest in the sponsorship of this forum.
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