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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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 6/30/2010 2:06 PM
 

Hi Elaine,

Here's a little of my history with GD:

About 5 years ago, I was living in Atlanta and got a hormonal test from my reproductive endo and the TSH was undetectable, didn't follow up on that because I never had any symptoms and was going through a lot of changes in my life.


I had my first thyroid test in December 2009 (as recommended by my reproductive endo). I was pregnant at the time of the test but didn't know it. Here are the results:

TSH: 0.05
FT3: 348 range 180-460
FT4: 1.53 range 0.71-1.85

I had a miscarriage in January about a month later and I started seeing a regular endo who asked that I test my levels in April after my overall body hormones stabilize post miscarriage.

I tested in April 2010, results:

TSH: 0.005
FT3: 1697 range 230-420
FT4: 4.3 range 0.8-1.8
TSI: 160
TPO: 50

The nurse called me back after they received the results and put me on methimazole 5mg two times daily (total 10 mg) and to test in three weeks.

After three weeks, I tested and May 2010 results:

TSH: 0.01
FT3: 352 range 230-420
FT4: 1.1 range 0.8-1.8

The nurse called again and said that my endo is out on vacation but another endo in the group is stunned by how quickly the numbers went down and asked me to stop themethimazole especially after she knew about a small rash I told her about. She asked to test again in three weeks.

After three weeks off the methimazole, I test and the numbers are:

TSH: < 0.01
FT3: 1081 range 230-420
FT4: 3.5 range 0.8-1.8

I saw my endo, who is back from vacation, and seemed not too happy about stopping themethimazole. He told me that my numbers are too high and that I should go back to the same dose of methimazole (10mg total per day) and to test after two months.

Now the part that I'm concerned about is the two months wait, since my numbers went down so quickly, couldn't I get hypo after two months on the medicine?

Also, I have been blessed not to have any symptoms throughout these past 7 months. The only reason GD was diagnosed was because of my miscarriage and difficulty getting pregnant. Does anyone know what it means to not have symptoms?

What do you think I should do? Should I ask the endo to get a test after three weeks rather than 2 months? Should I change my endo?

I also did get the ultrasound, which came back normal and a thyroid uptake which showed 60% activity.

Thank you so much

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 7/6/2010 12:23 PM
 

Hi Dima,

I apologize for the delay. Took my computer along on our camping trip and my wireless connection didn't work. Hope to be all caught up here by tomorrow.

It does look like you have Graves' disease although when it develops in the postpartum period (after miscarriage or delivery) it often resolves easily. With your levels as high as they are you do need to be on meds to bring FT4 and FT3 back in range. TSH will stay suppressed for a long time, and a low TSH doesn't mean you're hyperthyroid while on treatment.

I agree with the endo that the meds shouldn't have been stopped. But since you were euthyroid based on the FT4, your dose should have been reduced to 5 mg daily. It's true that your levels will likely return to normal within a few weeks. Because it usually takes 6-8 weeks for levels to return to normal, perhaps you could ask your doctor to have labs sooner perhaps at 4-6 weeks rather than 2 months. You could also use the 10 mg dose and if you notice any symptoms of hypoT, call the office and report them and ask to have labs then. Since your endo's advice is fairly standard, I wouldn't change endos at this point.

Symptoms in Graves' disease can be very vague. While many symptoms are associated with GD, most people develop a few predominant symptoms and these can sometimes be so ordinary they're not noticed. Some women have scant or absent menstrual periods, mild irritability, increased appetite, and a mild euphoria that makes them feel more energetic. Also, back when TSH was low and thyroid levels were normal, it would have been common not to have symptoms since subclinical hyperthyroidism doesn't usually cause symptoms. Best, Elaine

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