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THE Q & A

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.


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 2/23/2012 9:31 AM
 

Thank you so much for this forum, Elaine. It's most helpful. I hope I can provide enough information to you as I don't have copies of all of my labs.

I was diagnosed with GD in August of 2011. My symptoms at the time were minor and that was consistent with my numbers (TSH was .125). My endo and I discussed not using ATDs at all, but my blood pressure has historically been low normal and my doc was afraid to use a beta-blocker instead.

I started with a daily does of 5 mg of methimazole in mid-August. On 9/30 my labs were FT4 of 1.2 and TSH of 3.41. From there, I cut my dose to 2.5 mg daily. On 12/30 my FT4 was 1.1 and my TSH was 3.13. From there, I was to cut my dose to 2.5 mg every other day. I almost immediately starting feeling kind of edgy with that dose and decided on my won to instead alternate between 2.5 and 1.25 mg daily. On 2/22, my FT4 was 1.0 and my TSH was 4.34. My current instruction is to take 2.5 mg every other day. I'm not confident that that reduction will do the trick.

For a number of reasons, my doc has not given me much confidence in this process. Based on a few of our conversations, I'm fairly certain that she has based her decisions to cut my dosage based solely on my TSH numbers. It's hard to get her attention.

As far as my symptoms go, I've felt mildly hypo since beginning ATD (goiter, constipation, minor fatigue, hair loss, dry eyes, minor weight gain and inability to lose weight). But, my heart rate worries me at times, too. At rest, it's fine, but I still feel it racing at night sometimes and it increases rather quickly with any degree of activity. I'm back to exercising again, but I'm anxious about whether I should be.

My next appointment with my doc is in late March, and I'm not due to have new labs done until then. I'd like to talk to her about block and replace, but am not sure if I should even wait that long to do that and/or if I should seek a consult with another doctor.

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 2/23/2012 1:38 PM
 

Hi,

In your case, your doctor is right to look at the TSH because an elevated TSH suggests that your thyroid hormone levels are too low for your body's needs. With a usual range of 0.8-1.8, an FT4 of 1.0 would be too low for most people.

Palpitations can occur in both hyperthyroidism and hypothyroidism. There's quite a few overlapping symptoms. For instance, panic and anxiety are more likely to occur in hypoT although they can occur in both conditions.

It seems that based on your TSH you started out with a mild subclinical disorder and didn't need any treatment. You've consistently been hypothyroid from your meds and would likely be better off without them. Subclinical disorders typically resolve on their own, and making dietary changes and adding supplements can help move things along.

Palpitations and heart rate changes can be more noticeable at night. Ideally, you'd look at your resting heart rate (resting for 10-20 min) once a week or so. Hypothyroidism (drug-induced) can be responsible for the symptoms you're experiencing.

Why don't you ask for a TSI level if you haven't had one to see if transient spikes in TSI may be causing your symptoms. If your TSI is high, block and replace may be helpful in providing stable thyroid hormone levels, lowering antibody levels, and ensuring that you have adequate thryoid hormone. If not, a dietary approach (avoiding excess dietary iodine and other environmental triggers) may be all you need. take care, 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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