Interesting read. I hadn't run across it cause I haven't looked too far into the option of surgery. My grandmother very likely had the same condition. She had her thyroid removed at 17. It grew back and she died of a cardiac embolism at the age of 23 back in the 1930's. My mother also probably has the same problem but hers doesn't manifest itself quite as much. She's always had bad hypertension and has been taking betas along with a whole slew of other meds to control that for years. If you're interested in what we are most likely dealing with try [url]http://www.hotthyroidology.com/editorial_79.html[/url] (sites other than .gov can be posted too if they are preapproved). The articles a few years old and there are currently a lot more reported cases and it is now known to be much more common than orginally thought even just a couple years ago.
One of the things that the article you posted caught my eye on was the fact that inderal controls the tremor better than the metropolol or the other non-selective betas. It fails to mention that it's not just the tremor but some of the other weird stuff too. I saw you mention in another thread about the adrenaline rush. Being hyper is kinda like that, and most of the time it's to a lesser degree, only it lasts 24/7. Throw in a couple flutters or missed beats or a little too much stress and you can really be off and running.
I've always felt the inderal controls the symptoms better than the others. I don't like some of the side effects at the higher doses and if I go above 160mg, it starts to affect the conversion of t4 to t3. I also hate the way it makes me feel numb. The atenolol allows me to feel alive but doesn't control the annoying symptoms as well. The inderal actually does a good job controlling symptoms at a pretty low dose. It just doesn't keep the heart rate down low enough until you really crank it up. Have you ever run into anything in your research that says a selective beta cannot be combined with a non-selective to lessen the side effects and still achieve the desired results?
I don't think that the RTR syndrome pertains to you at all. From my reading it is a condition where the BODY refuses to react to thyroid hormones and thus appears hypothyroid even in the presence of adequate or high thyroid hormones. Your body seems to react only too well to thyroid.
Yeah, that casueght my eye too about propranolol crossing the brain barrier where other beta-blockers won't. I have found it one of the "nicer" beta blockers...perhaps that CHS relaxation is the primary reason.
she huffs out of the room saying if I don't do rai, I'm going to end up with a pacemaker
If it were for myself, that RAI is the trreatment I would try...if it grows back, it grows back. But I think it stands the best chance of success (I avoid surgery WHEREVER possible...even with a tooth! )
I must freely admit though, what I DON'T know about the thyroid can fill books.
It's where parts of the body do not respond properly to the hormones. It's almost always partial and the majority of people who have it aren't even aware of it. A person can be hypo, hyper or completely euthyroid. That's one of the reasons they divide it into categories. It depends a lot on each individuals distribution of the various hormone receptors and the degree of resistance involved. When someone presents with the hyper side of things, they are hyper where the alpha receptors predominate (heart, brain, kidney, intestine, temperature, fertility and a few others), but they are hypo where the beta receptors predominate, primarly the pituitary, liver (high cholesterol is the norm), immune system and a few other organ systems.
I've been researching thyroids for 16 years. There is not one test result or clinical symptom or sign that points away from this diagnosis. There's a lot of test results that point away from every other possibility. Biggest problem is the endos I have seen have just glanced at the literature and are under the same assumption that you are. They refuse to look into it further and just label me "atypical" and then drop me like a hot rock. I disrupt their assembly line. My current gp finally is cause he's bothered to do more than just glance at it. I want a correct diagnosis and I want proper treatment. I don't want to end up in the same mess that over 50% of the people with this have ended up in.
One endo gave me a really good chance to see what rai would be like. He wanted to show me how much better I would feel if they would just go ahead and ablate it. They completely supressed the thyroid function with meds and then gave me thyroid hormones to try and make up for it. It was hell.
Oh, metropolol crosses the blood brain barrier too. I personally don't like too much cns depression. I like feeling alive!
But back to my original question. Is there any reason different beta blockers can't be mixed?
Finally got a copy of my echo report. It states that the clinical indication for study is short of breath(???). I thought we were investigating edema and long term hyperthyroid but nothing suprises me any more. There is a note on the report about the procedure/quality: The study is technically difficult but adequate for interpretation.
Estimated ejection fraction is 60%. It says there is mitral regurgitation and tricuspid regurgitation and "unable to accurately estimate the pulmonary artery systolic". Structurally normal aortic valve and aortic root is normal size. It's also got the chamber measurements for the left atrium and left ventricle which are all within normal values.
The pcp has written "ok no ef problem" on it which has always meant the matter is closed and put in the chart. In light of the erroneous "ok" on the incomplete kidney test, would I be safe in letting this one drop?
A little note to add - I've been poking around. Found a really good article called Understanding cardiac "echo" reports - Practical guide for referring physicians located at [url]http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1781094[/url]
The other thing that is really beginning to bother me is I was asked 3 questions. Height and weight, any hypertension, any diabetes? I was not asked if I had any other medical problems or whether I was taking any medications. Little oversights like that, coupled with an erroneous indication for the study often bother me a bit so I did some more poking. The use of atenolol results in a mean increase in EF of 8.6 EF units. The study was interpreted by a cardiologist somewhere way off in the "big city". He doesn't know the first thing about me.
I'm beginning to feel a little paranoid. Any reason why I shouldn't?