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Old 08-23-2008, 08:32 PM   #1
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Hyperthyroid Update

27/M

The original highlights from when I was first diagnosed on June 12, 2008. . .

TSH: 0.02 ulU/ml (Low)
Total T3: 4.32 ng/ml (High)
T4: 18.9H ug/dL (High)
T3: 539H ng/dL (High)

Neutrophil: 44.1% (Low)
Lymphocytes: 42% (High)
Monocyte: 11.9%

Metals (Ca2+, Na+, K+, Cl- MEQ/L) in blood all at high levels
CO2 21.5 MEQ/L (Low)
Total Protein: 8.0 G/dL (high)

Last edited by Psychofan; 08-23-2008 at 08:50 PM.

 
Old 08-23-2008, 08:41 PM   #2
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Re: Hyperthyroid Update

The update after 6 weeks of PTU and proprandolol therapy. . .

Therapy consisted of 3 x 50 mg PTU tablets every 8 hours (so 450 mg PTU a day) and initially 1 x 80 mg Inderal (long-acting Proprandolol) then became 1 x 20 mg Proprandolol every 8 hours (so 60 mg Proprandolol a day).

Results after 6 weeks. . .on Aug. 22, 2008
TSH: 0.018 uIU/ml (0.450 - 4.50)
T4: 8.6 ug/dL (4.5 - 12.0)
T3 Uptake: 32% (24-39)
Free T4 Index: 2.8 (1.2 - 4.9)
T3: 100 ng/dL (85 - 205)

Thyroid Antibodies
TPO Ab: <10 IU/mL (0 - 34)
Antithyroglobulin Ab: <20 IU/mL (0 - 40)

Hepatic Functions:
Pretty much all normal. The only potential concern was ALT (SGPT): 62 IU/L (normal range is 0 - 55).


New therapeutic dosages:
2 x 50 mg PTU every 12 hours (so 200 mg PTU a day) and 1 x 20 mg proprandolol every 12 hours for two weeks (so 40 mg proprandolol a day). after two weeks, proprandolol dose will be lowered to just 1 x 20 mg proprandolol every 24 hours for 1 week. After this 1 week of only 20 mg proprandolol a day, I can stop taking it. PTU dosage remains the same for six more weeks before follow-up blood works.


In any case, does not appear to be Graves Disease and also not thyroid cancer.

Last edited by Psychofan; 08-23-2008 at 08:50 PM.

 
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Old 08-24-2008, 05:13 AM   #3
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Re: Hyperthyroid Update

Hey psycho,

Good to see you back. David's looking for you on his thread. Anyhow, how you feeling?

I'm getting a little confused. Who said it doesn't appear to be graves? TSI or TSAb and a couple other obscure antibody tests are the antibody tests that are specific for graves. Yeah, sometimes TPOAb or TGAb's are positive in graves but not very often. I'm also wondering why they're using the old thyroid panel. I know it's cheaper but the new agreed upon protocol is to test TSH, FT4 and sometimes FT3. But then again, if you're feeling better, that's all that counts and as long as they stay consistent on which labs they're drawing and you learn your feel good numbers, the end result will probably be the same.

That liver enzyme isn't a huge concern. It's not in a danger range. Just something to watch. It will probably start coming down with the lowering of the PTU dose.

Now how bout giving us an update on how you're actually feeling. That counts a lot more than lab results.

 
Old 08-24-2008, 05:59 AM   #4
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Re: Hyperthyroid Update

Can you explain to me the reason for the metals testing? I find this interesting because I am beginning to wonder if there is a relationship between metals and thyroid dysfunction. I will go into details later but first I would like to hear your response.

 
Old 08-24-2008, 06:10 AM   #5
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Re: Hyperthyroid Update

The endo was the one that said it doesn't look like it's Graves. I have confident in this guy, he has been recognized a few times as one of five top endo in the D.C. Metro area by patients and other docs. In any case, I feel fine, never really had any bad issues with the hyperthyroidism during and even before medication. I have even gained about 9 pounds since going on the meds (I'm going to cut down on my caloric intake now) and it doesn't appear that I have gone hypo yet. The joint-stiffness are improving well and energy level was never really an issue. In any case, I'm feeling just fine.

I will ask about the TSI test (I think he didn't order it because I don't have the "protruding eyes").


Quote:
Originally Posted by accessn12 View Post
Hey psycho,

Good to see you back. David's looking for you on his thread. Anyhow, how you feeling?

I'm getting a little confused. Who said it doesn't appear to be graves? TSI or TSAb and a couple other obscure antibody tests are the antibody tests that are specific for graves. Yeah, sometimes TPOAb or TGAb's are positive in graves but not very often. I'm also wondering why they're using the old thyroid panel. I know it's cheaper but the new agreed upon protocol is to test TSH, FT4 and sometimes FT3. But then again, if you're feeling better, that's all that counts and as long as they stay consistent on which labs they're drawing and you learn your feel good numbers, the end result will probably be the same.

That liver enzyme isn't a huge concern. It's not in a danger range. Just something to watch. It will probably start coming down with the lowering of the PTU dose.

Now how bout giving us an update on how you're actually feeling. That counts a lot more than lab results.

Last edited by Psychofan; 08-24-2008 at 06:55 AM.

 
Old 08-24-2008, 08:15 AM   #6
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Re: Hyperthyroid Update

Sparkie, imbalances in the concentration of circulating metals are typically the first symptoms of something being wrong with the body's homeostatic functions. For example, anemia, kidney failures, thyroid dysfunction, etc. Metals are not usually the initial cause of a problem, but can induce other problems once an initial disorder unfavorably tip the equilibrium of circulating metals.

Quote:
Originally Posted by sparkie View Post
Can you explain to me the reason for the metals testing? I find this interesting because I am beginning to wonder if there is a relationship between metals and thyroid dysfunction. I will go into details later but first I would like to hear your response.

 
Old 08-25-2008, 04:22 AM   #7
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Re: Hyperthyroid Update

So what did he say he thinks it is? I'm always one for explanations and whys. People don't just go hyper for no reason.

Actually, the protruding eyeballs can only be used to confirm a diagnoses without any antibody testing. The lack of protruding eyeballs just means the patient doesn't have protruding eyeballs. Happens quite often. Just depends on how hard the antibodies are attacking the eyes. They have found that all graves patients have some degree of protrusion but a lot of them can only be detected by u/s or other scanning methods which measure it cause it isn't always visible to observation. Don't quote me on the figure but I think it's only about 30% of graves patients that have visibily protruding eyeballs.

Wow! A one in five! I just saw a top doc in all of America. You outta see what he did to me. I'm sorry. I'm in doctor bashing mood again.

It would be good to know if you do have graves. It can have future implications not only for you but other members of your family as well. Autoimmune disorders are often a family affair and also some people who have one autoimmune disorder are more prone to developing others and if that should happen, it's a quicker diagnosis if the docs are aware of it.

Sorry to hear that it's time to cut back on calories. It's the one part of hyper I've always enjoyed. I'm glad you're feeling good though. That's wonderful to hear.

Hi sparkie

Metal toxicity from external sources can have an effect on the thyroid and other organs. Which path are you pursuing? I know a couple women who suffer from heavy metal poisoning who have developed thyroid and other issues that are very likely directly related to that.

 
Old 08-25-2008, 07:11 AM   #8
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Re: Hyperthyroid Update

Sparkie--I think what Psychofan was talking about is not "metals", but the list he gave in parentheses was "minerals". And yes, when they get imbalanced, they can be a clue to malfunctioning organs or glands.

Psychofan--with your high calcium, did your doctor look into hyperparathyroid? Did he already check your PTH?

Last edited by sue1234; 08-25-2008 at 07:13 AM.

 
Old 08-26-2008, 02:11 AM   #9
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Re: Hyperthyroid Update

sue, hypercalcemia in a hyper is almost to be expected. The increased metabolism causes a rapid bone turnover which in turn causes an increase in calcium in the blood. It's very rarely a parathyroid problem and the level almost always comes down when the thyroid settles down.

It's one of them thar clues that there's a malfunction going on.

 
Old 08-26-2008, 06:35 AM   #10
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Re: Hyperthyroid Update

Yea, I realize ca++ is high in hyperthyroid, but I'd hate to know I had assumed it was nothing and turned out to be elevated for another reason.

 
Old 08-27-2008, 04:54 AM   #11
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Re: Hyperthyroid Update

I totally agree with your concern. However, with a normal hyper, the level comes down very quickly as soon as you start treatment. If the level remains high once the thyroid hormones come into range, then it's time to look further. It isn't something to ignore. It's something to watch.

This is one of those things where you get into a cost/resource issue. I wish that something like that would never come into play when it comes to a patient's health but it does, and, at times, it has to. If every hyper had their PTH level tested cause their calcium level was high at diagnosis, that cost would eventually trickle down to all the patients in the form of higher premiums. The same thing would happen if they did a blood culture on every hyper just cause their wbc count often goes high too. You have to look at the primary disease first and compare it to the norm. When the patients falls outside that norm, then it's time to say be damned the cost.

Neither you, nor I, or probably a lot of the other people on this board, fall within that norm. Periodically someone wanders thru here that does. What's the solution???

 
Old 11-10-2008, 07:14 AM   #12
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Re: Hyperthyroid Update

I apologize for being away so long, have had quite a few of those week long business travels and am thoroughly exhausted. Okay, so after a progressive decline in the PTU dosage (now onto 1x50mg PTU daily), the last test results are showing normal numbers. . .

TSH: 2.367 ulU/ml
T4: 6.4 ug/dL
T3 Uptake: 32%
Free Thyroxine Index: 2.0
T3: 135 ng/dL

Unfortunately, TSI shows 262%.

Endo is recommending I go for radiation now. Any thoughts?

 
Old 11-11-2008, 03:44 AM   #13
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Re: Hyperthyroid Update

Hi psycho! Good to see you back.

You ask for thoughts? If it were me, not yet. If I was feeling well, I'd give the medications a full two years to see if I couldn't bring about remission before even thinking about anything else. I did it for a full three years not feeling at all well but I'm a bit stubborn. When I finally caved, the endo backed out and wanted to wait. This was back in '94. I'm still waiting for my ablation but he retired. BTW, I'm feeling pretty good.

Another thing you might consider is asking about block and replace. That's where they suppress the thyroid function entirely with anti-thyroid meds and give you thyroid hormones to replace it. Might give you a good feel for what it would be like to live without your own thyroid. I tried it and it was hell for me. But, the benefit would be that there's a better chance of going into remission with block and replace than there is with anti-thyroid meds alone. That's cause anti-thyroid meds have a calming effect on the antibodies and the higher the dose they can give you, the better the odds. They use it overseas all the time.

Most of the decision should lie in how you currently feel. If you feel good, why change things? Some people do real well with RAI, other's have a lot of problems afterwards. The other thing to consider is the eye disease and the effects of RAI on that. There's lots to consider but there's also no hurry. Consider your decision carefully cause once you've chosen RAI or even surgery, there's no changing your mind afterwards.

 
Old 11-11-2008, 04:32 PM   #14
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Re: Hyperthyroid Update

One thing, doesn't the high lymphocytes she had show something to do with the tsi,someone just said something about that to me, like they're always changing or words to that effect. Psychofan, I don't have the protruding eyes either, my eye doc says no sign of TED. Not everyone has them, although I do have the other antibodies too.

 
Old 11-11-2008, 04:54 PM   #15
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Re: Hyperthyroid Update

Thanks for the replies. I'm going to try to get some second opinions before RAI. I'm just wondering if I'm feeling so fine at such a low dosage (100 mg PTU a day and now going onto just 50mg a day) then is it prudent to go for drastic options of RAI/surgery at this point. The endo seems to be pushing the RAI option right now, but I want to see what another endo would say based on my test results.

 
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