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Tuesday, February 07, 2012

..:: 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.

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Confused about diagnosis?

9/4/2010 9:51 PM

cleskins

Joined: 9/4/2010

Posts: 1

Confused about diagnosis?

Hi Elaine,

My endocrinologist has diagnosed me as have supressed or sub-clinical Graves. But it doesn't make sense to me. Help?

My latest blood test results were as follows:

T4, Free 1.36

TSH 0.013

T3 113

I went to an endocrinologist because my primary care felt "nodules" during a routine exam. I have had 2 thyroid ultrasounds and 1 uptake and scan. The ultrasounds showed 2 small nodules (nothing to worry about per my endo) and the uptake came back with 1 "cold" nodule (not to worry about per my endo, again).

However, my symptoms are very HYPOthyroid and this is why I'm confused. I have gained about 20 pounds in the past 3 months, am tired and sluggish all the time, have constant headaches, and am constipated.

I have had my blood tested for Antibodies as well, as follows:

Thyroid Peroxidase 598

Thyroid Stim Immunoglobulin 614

I have also had 2 other blood tests for TSH, T3 and T4 besides the one listed above. My doctor prescribed Methimazole (5 mg per day), but I am afraid to take it, because I am concerned it will only make me gain more weight and I've already gained so much already, or that it would make me more constipated and I'm having enough problems there as it is. Is there a chance that would happen? Will it make me gain weight or make the constipation worse? Or could the medication actually get my metabolism back on track??

Sometimes I wonder if I should get a second opinion about this suppressed Graves diagnosis because of my symptoms. Any input would be greatly appreciated.

Thank you,

Cyndi

9/7/2010 5:51 PM

Elaine

Joined: 8/1/2008

Posts: 3166

Re: Confused about diagnosis?

Hi Cyndi,

You wouldn't need to take mmi yet. Your thyroid function tests show subclinical hyperthyroidism, and your thyroid antibodies tests show that the cause is Graves' disease. So you have subclinical Graves' disease. Since subclinical disorders can resolve on their own, they're not usually treated. Another reason is that treatment with ATDs can cause FT4 to fall too low.

I think you're in the early stages of Graves' disease, and in nearly all cases the first stage is one of hypothyroidism, that's not usually diagnosed but causes symptoms such as weight gain. Although your TSI level is high, you likely have blocking TSH receptor antibodies that are preventing TSI from causing overt hypothyroidism. So the usual recommendation would be to wait and see what happens by repeating labs in 2-3 months or sooner if symptoms start to change.

Subclinical disorders are usually only treated if symptoms of hyperthyroidism are present and even then, only beta blockers are used to control symptoms. Subclinical disorders often resolve when environmental triggers are avoided. This includes avoiding aspartame, excess dietary iodine in processed foods, cigarette smoke, stress and known or suspected allergens. Best, Elaine

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