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Tuesday, February 07, 2012

..:: Q & A ::..

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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The Q & A with Elaine Moore

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2/26/2009 9:29 AM

laura

Joined: 10/3/2008

Posts: 13

burn out

Background: Went to the GP 6 months postpartum with rapid heart, hot sweaty, nauseous, etc. Dr suspected thyroid problem, so ordered TSH. TSH came back low at .03. Dr. suspected postpartum thyroiditis, but ordered an ultrasound and uptake after told him about grandmother's thyroid cancer. Ultrasound showed 4 nodules from 5mm-1.1cm in size, uptake scan showed no nodules and 85% at 24 hours. Here is a list of all of my labs so far:

8/21/08
TSH .03 (.34-5.60)
Free T4 1.84 (.58-1.64)

09/24/08
TSH <0.01 (.34-4.82)
FT4 1.79 (.61-1.25)
TSI 271 (0-129)
TPO 151 (0-34)

09/29/08
Uptake 85%

10/03/08
FT4 2.25 (.61-1.25)

10/15/08
FT4 1.75 (.70-1.80)
FT3 4.48 (1.50-4.10)
TSH <0.01 (.34-4.82)

11/21/08
FT4 .80 (.58-1.64)
FT3 3.3 (2.0-3.5)
TSH .01 (.34-5.60)

1/12/09
FT4 .56 (.58-1.64)
FT3 2.6 (2.0-3.5)
TSH .96
TSI 2.4 (<1.3)

2/19/09

TSH 1.54, FT4 .64 (.58-1.64), FT3 2.9 (2.0-3.5), TRab 10 (<16 negative)

I thought for sure my levels were going to come back way hypo, because thats how I feel. Very cold, muscle aches, joint aches, NO libido (maca didn't work), very irritable, bad acne, some hair loss.

I was taking 10mg of methimazole a day before the January labs, it was reduced to 7.5mg (though I would often forget the 2.5 in the morning, so I was really only taking about 5 a day). I have also been taking birth control for the last 4 months, Ortho Evra and then Yaz.

Went to the endo yesterday and he said something about my thyroid might be burning out. He ordered more labs at their office and said if they've moved even slightly toward more hypo he may have me come off the methimazole to see, especially since I'm feeling hypo.

Oh, I also had another ultrasound since its been 6 months and it was very quick and the report said no nodules, but it was heterogenoious (or whatever that word is). SO now I don't know what to think about the nodules.

I just wanted to get your opinion on whats going on. I have a consult with a surgeon scheduled in a couple weeks as I was getting sick of feeling terrible, but the endo thinks I shouldn't have the surgery soon (see if I go hypo first).

Thanks for your information.

Laura

2/27/2009 9:35 PM

Elaine

Joined: 8/1/2008

Posts: 3166

Re: burn out

Hi Laura,

Your early labs confirm Graves' disease. Ideally, your methimazole dose would have been reduced as soon as FT4 fell into range and then gradually reduced further over time. Your FT4 is probably too low for your body's needs resulting in symptoms of hypothyroidism.

The gland doesn't actually burn itself out. Long-term, over many years of untreated hyperthyroidism, the gland might atrophy, but this rarely happens. Because Graves' disease is a self-limiting disorder that resolves as TSI levels fall, thyroid function eventually returns to normal. Until then, the lowest dose of methimazole needed to keep FT4 at least at mid-range is used. The maintenance dose ranges from 2.5 to 10 mg daily although some people get by with a dose of 1.25 mg daily.

Graves' disease that develops in the postpartum period is similar to postpartum thyroiditis in many ways and it often resolves within 12-18 months. Usually, patients stay on a low dose of methimazole until they start secreting TSH normally. TSH takes a long time to rise and a low TSH while on meds doesn't mean someone is still hyperthyroid.

I wouldn't worry about the nodules. Sometimes shadows can make imaging studies hard to determine. Since they're not showing up now they're either very tiny or don't exist. Best, Elaine

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