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THE 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.
Copying of any posts is prohibited without permissions.
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| tt167 |
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Joined: 2/6/2010
Posts: 1
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Recently, I received RAI treatment for hyperthyroidism/Grave's disease. My radioactive uptake was 56.1% after 6 hrs. After 9 yrs of being in and out of remission from the disease, I decided to move forward with the RAI treatment. Within the 9 yrs., my disease has been controlled with Methimazole and PTU (for 2 pregnancies – one ended in miscarriage at 19 wks and the last one in a successful birth of my wonderful 2 yrs old son). Interestingly, nearly every time I experience the below symptoms, my TSH levels always drop, but my Free T3 and T4 usually stay in normal range and always seem to occur during or after a stressful situation…just seems as though, my body/thyroid does not know how to process stress. Any ideas why is this?
So in deciding to move forward with the RAI treatment, I had been off Methimazole for approximately 3 wks, when I started to experience my regular unbearable symptoms when out of remission, including fatigue, insomnia, severe headaches (pressure in the head) - is this symptom consistent with hyperthyroidism, irritability, no appetite, weight lost, fast heart rate, muscle weakness, confusion, poor concentration, etc. Not sure how a thyroid storm feels, but I felt my symptoms were spinning out of control, in so much, I felt I was losing my mind. So, I decided to move forward with the RAI treatment. I was given 16.2 mCi of RAI and I hope this was the right choice, since I have always been a little scared about taking a radioactive medicine (sounds scary in itself). However, my questions/concerns are: 1) how long do I have to avoid contact with my husband and my 2 yr. old son, 2) when should I start feeling some positive effects of the treatment, 3) how long do I need to wait before conceiving again (was advised 6 months), 4) is it really better to control hypo vs. hyper during pregnancy & is synthroid safe during pregnancy and breastfeeding, 5) have you ever heard of someone being diagnosed with hyperthyroidism/Grave's disease and POTS (Postural Orthostatic Tachycardia Syndrome - I was recently diagnosed with this due to fast heart rate and low blood pressure via symptoms and Tilt table test)? Your perspective is greatly appreciated.
My labs Pre-Iodine Uptake and RAI treatment (Are these labs indicative of hyperthyroidism/Grave’s disease?)
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Jan. 9th
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Jan. 23rd
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Feb. 3rd
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TSH (mIU/L)
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0.63
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0.32
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T4, Free ((ng/dL)
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1.4
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1.3
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T3, Free (pg/dL)
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360
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326
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Iodine Uptake (%)
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56.1% (@ 6hrs)
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| Elaine |
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Joined: 8/1/2008
Posts: 3174
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Hi,
Your labs look good without meds and you would have needed to be off meds longer for your uptake to be reliable. It's very possible that you were already in remission but you would have needed to be off meds longer to confirm this.
Your symptoms weren't characteristic for hyperthyroidism but are symptoms that can occur in both hyperthryoidism and in hypothyroidism. For instance, loss of appetite isn't seen in hyperthryoidism--an increased appetite is. Mental fog is more common in hypothyroidism. Headache can occur in hyperthyroidism but it's rare.
Some doctors say to avoid contact for a few days after RAI but you will be emitting radioiodine for up to 12 weeks. It's especially important to avoid cradling your child near his neck because your radiation can affect his gland and the gland in children has a much faster cell turnover.
Most sources recommend waiting at least 1 year after RAI to conceive.
How you feel varies but most people experience an increase in hyperthyroid symptoms after RAI. This is caused by antibodies and hormone released from dying thyroid cells. This can last up to 2 months although some people, especially people like you who had normal thyroid hormone levels and a high dose of RAI, may become hypothyroid very quickly. Some people need to start replacement hormone after a week with nearly everyone becoming hypothyroid within a year. In your case, I'd expect hypothyroidism to occur soon.
Hypothyroidism is much worse for the developing fetus than hyperthyroidism. It's important to get on adequate replacement hormone before becoming pregnant and then you'll need careful monitoring. Most people need an increase in their thyroid replacement hormone mid-way through pregnancy because changes in estrogen affect thyroid levels.
POTS is more common in hypothyroidism although it can occur in anyone. I think what's important is that you watch for any symptoms of hypothyroidism such as joint pain, depression, constipation, weight gain, etc. and ask to have thyroid function tests if you notice any symptoms. Because thyroid antibodies increase dramatically after RAI, your TSH level can be falsely decreased. Be sure to have FT4 and FT3 levels as well as TSH. Your replacement hormone should be based on your FT4 and FT3 levels. Best to you, 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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