The Wellness Q&A with Elaine Moore

Welcome to the Wellness Q&A, where members can ask Elaine Moore health-related questions. Elaine Moore is a medical writer and retired clinical laboratory scientist with over 30 years experience in immunology. Because this is a question-and-answer forum, each post will receive one reply. For additional inquiries, a new thread will need to be started.

Enlarged neck after one week after MMI
Last Post 10 Aug 2017 02:40 PM by Elaine Moore. 1 Replies.
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vivivi525User is Offline New Member New Member Posts:
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08 Aug 2017 04:46 PM
    Hi Elaine,

    Thank you for the blog and forum that you keep maintain. I found it really helpful.

    I was diagnosed with Grave's last week with about 2 month symptoms of lose weight, eat more, soft bowl and heat intolerance. With recently increased heart rate(100/min when sit) and weak, I went to doctors and my levels of FT3,FT4,TT3 are all 3 times higher than the high end reference. FT3 is especially high among these three. TSH <0.01. TSI is around 500 with reference 0-140. TpAB is less than 10 with reference <35. I was put on Mathemazole 10mg 2/day and Atenolol 25mg 2/day right away. Seafood are removed from my diet ans salt switched to non-iodine one.

    After take the medicine a week after, I feel better in weakness and heat intolerance. Hear rate falls to 70 to 80 with the help of Atenolol.

    What really bothers me is that when I was diagnosed a week ago, my thyroid is hardly enlarged and it looks normal to me.(Dr said a little swell by touching). But today, after a week on the medicine, I found the thyroid is much larger than one week ago, especially the left lobe. Either by touching or seeing in the mirror it's obvious that my neck is grow bigger.
    Except from taking meds for a week, I also eat all goitrogen veggies laste week: broccoli, cauliflower, cabbages, thinking it could help to reduce my Thyroid hormones faster.

    I read a lot of your replies about the goiter and learned that it could happen if over-medicated and heading to hypo. But I think with my high level, 20mg/day should be too much and only one week couldn't already make change from hyper to hypo. So my question is why it's still growing even after I already on med and feels better, compared with when I feel really bad and high Thyroid hormone levels? Is is related to all the goitrgens I ate last week? Is there anything I can do to make it stop growing and even shrink?

    Another aspect I want to ask is that my endo said that I don't need specially cut a lot of iodine resources from food(except seaweed of course). She said don't need to switch to non-iodine salt, even once a while sushi is fine as long as not every day. She said the reason is that our body is smart that if it feels iodine is greatly reduced, it will panic and try to create more thyroid hormone. What do you think on the diet limitation? Should I need to cut iodine a lot or mainly keep my food resources except seafood?

    Thank you again for this wonderful place of knowledge and all your kindly replies!

    Warm regards,
    Vivian
    Elaine MooreUser is Online Veteran Member Veteran Member Posts:2213
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    10 Aug 2017 02:40 PM
    Hi Vivian,
    In most parts of the world, the iodine content in food is higher than what we need, roughly 300-700 mcg daily and in people eating lots of processed foods it can be as high as 1,000-2,000. In people with Graves' disease, amounts greater than 150 mcg can cause hyperthyroidism and worsen symptoms so it's best to avoid it. foods known as goitrogens have natural anti-thyroid properties and naturally lower the amount of iodine we can ingest. But eating as much as 1.5 cups of goitrogens is enough to lower thyroid hormone levels and cause hypothyroidism. A mini epidemic of hypothyroidism occurred in Canada in the 1980s from people using a cabbage soup diet for weight loss.

    So it's possible that eating a large amount of goitrogens may have lowered your thyroid hormone levels suddenly and abruptly and caused a slight increase in goiter.

    A 20 mg dose of methimazole is a good starting dose and while symptoms improve within a week it can take 6-8 weeks to feel the full effect of this dose. This is because you start out with a gland loaded with stored thyroid hormone that's slowly released. After 6-8 weeks FT4 should fall within the reference range and your dose can be reduced. At this time you need a lower dose, just enough to reduce production of new thyroid hormone.

    Most people don't notice changes in the size of their gland visually. But if your gland is situated in the very front of your neck, these changes can be apparent. I'd expect things to settle down by the 6-8 week mark unless your levels fall too fast too quickly. You might ask your doctor to have labs sooner to see if this is the case. Best, elaine
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