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Wednesday, February 08, 2012

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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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going much slower this time

7/23/2010 12:34 PM

Joined: 3/11/2009

Posts: 16

going much slower this time

Hi Elaine,

I found out I had Graves Disease in Dec. of 2008, took PTU for awhile and by summer of 09 my levels (TSH and FT3 and FT$) were all normal. In Oct. my doctor took me off the meds, and in Dec. my levels were great, but by Jan., I was back hyper again, started meds w/ a new doctor (had moved). This time I am on Methimazole--and am down to 2.5/day.

That said, I am just not making progress like I did last time. My TSH is still not normal, and my T3 and T4 are not going into the hypo zone like they did last time. I also moved more slowly w/ the med reduction. My latest labs that have looked about the same for the last 3 times (labs every 6 mo.) are as follows:

T3 125 (71-180 range)

TSH .006

T4 8.6 (4.5-12)

T3 Uptake 37 (24-39)

Free T Index 3.2 (1.2-4.9)

TRAB 3.31 (.0-1.75)

The other piece of this is that before the last 3 labs, I have been sure I was going to show hypo or near hypo numbers b/c I'm constipated, have gained weight, and am totally exhausted, but the near same numbers keep coming back.

I am trying to figure out why this is. The only difference is that last time I was not working, and this year I have been the one worker in the household (very stressful); however, I am off for the summer. Also, I was taking l-carnetine (sp?) last year, and I've been more lax w/ the vitamins this time b/c of living on one income and trying to save money and the increase in what insurance pays the doctor each visit.

So my questions are...

1. Why would I feel so hypo when these numbers are not at the low end?

2. Why would someone respond so quickly to meds one time, and more slowly the next? Is my Graves getting worse?

Thanks!

7/26/2010 2:00 AM

Elaine

Joined: 8/1/2008

Posts: 3174

Re: going much slower this time

Modified By Elaine on 7/26/2010 1:02:21 AM

Hi TB,

It doesn't sound as though you were in remission the first time around. With your TSH and thyroid levels being normal you may have just been on too high of an ATD dose while on meds. Your labs now show a normal T4 and T3 with a low TSH. A low TSH doesn't mean that you're still hyperthyroid when you're on meds. It's expected and shows that you're not on an ATD dose that's way too high. But because T4 and T3 are often falsely elevated, your thyroid hormone levels could be too low for your body's range and responsible for the hypothyroid symptoms. If you begin to produce more blocking than stimulating TSH receptor antibodies, you'll also notice a decrease in TSH (falsely lowered by all TSH receptor antibodies). I'd try to get an FT4 and FT3 with your next labs as the index test is considered obsolete. These levels will give you a better idea of your thyroid status. I don't think your Graves' disease is worse although if you begin to predominantly move blocking antibodies, you could move spontaneously into hypothyroidism.

also, carnitine, while reducing symptoms, increases energy. This can make you less likely to notice the effects of low thyroid hormone levels. that could explain the change in symptoms you're experiencing. best, elaine

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going much slower this time

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