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Old 09-25-2011, 02:29 PM   #1
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Thyroidism, ITP, Diabetes

MY CASE:
Other than below, in rather good health
Diagnosed with Type 2 diabetes early 2011
Metforium 1000 mg/day
Lost ~40 lbs, watched diet (all wt. loss not desired)
A1C started at 7.3, then 6.8, 5.8, 5.3
Fasting blood sugar levels 85-100, even now

Diagnosed with ITP about 6 mos ago (went to hematologist)
Platlet count 40, then in 70's for several weeks, then dropped to 30 in one week
Began predisone 80mg/da for 3+ weeks (increased Metforium to 1500 mg)
Platlet count since: 121, 169, 135, 119
Began tapering off 3 days ago (14# more weight loss)
Since predsione symptons: sugar spikes (high of 297 ), high BP (150-170), nervous, sweating, weakness

Diagnosed with thyroid 1 week ago (TPO AB 518 [<34], FREE T4 1.99 [0.9-1.70], T3 1.6 [0.8 - 2.0])
Believe to have had problem for at least 1 yr. from ongoing symptons (wt. loss +)
Family doctor recommending me to Endocrinologist with analysis of Hashimoto's disease
Disease does not appear consistent with symptons -- more like Grave's.
None of local Endodrinolighsts are rated very good -- probable will look in B'ham, AL
Find no medical speciality that addresses all my "autoimmune's"
COMMENTS/RECOMMENDATIONS PLEASE

 
Old 09-25-2011, 03:57 PM   #2
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Re: Thyroidism, ITP, Diabetes

I have both ITP and Hashimoto's myself. As you probably know, autoimmune diseases like these 'cluster'. Thyroid disease - either Graves' or Hashi's - is a common companion to ITP.

You may find the ITP to be a bigger pain to treat than the thyroid. Hashi's doesn't require that dreaded prednisone or other harsh chemical treatments.

Your above-range free T4 is puzzling. It might be a manifestation of early Hashi's, but it's a hypERthyroid level. That means it also might be Graves', not Hashi's at all. You absolutely need a TSI antibody test to rule it out (or in).
You don't mention a TSH level. What was that?

No, there's no specific MD who can treat all of these. Be aware that your primary doc can treat thyroid just as well - probably better, actually - than the typical endo. Endos are arbitrary and stuck in their ways about the treatment of thyroid, but these are diseases that don't lend themselves well to one-size-fits-all treatments.

Welcome to the board.

 
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Old 09-25-2011, 05:51 PM   #3
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Re: Thyroidism, ITP, Diabetes

Sorry, left out the initial platlet count was 63 which was 8 March. TSH at that time was 4.77 [0.27 -4.20]. Nothing was said about that number.

What is your ITP status and what has worked for you?

Thanks, and will try to give a hug.

 
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Old 09-25-2011, 10:08 PM   #4
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Re: Thyroidism, ITP, Diabetes

A healthy person with no thyroid disease has TSH of around 1 - 1.5. Yours was above range, a clear indication that this is almost surely not Graves', but Hashi's. Your above-range FT4 is the likely result of the thyroid gland spilling extra hormone during the antibody assaults. Eventually, the FT4 will become deficient and your symptoms will take a turn toward more hypo.

You may be able to reduce your TPO titer by supplementing with a daily selenium tablet, which in turn may help your hyperish symptoms.

My ITP seems to be in remission - knock wood. My platelet count isn't normal, but it's perfectly adequate. The first below-range count of 79 went unnoticed for a full year by my MD, and I didn't catch it either. At the next year's physical, the count was 51 and doc finally paid attention. A re-test resulted in the lab being unable to arrive at a count at all because of platelet abnormalities, but doc pronounced everything "perfectly normal". (What the???) The bruising was bad at this point, so I took myself to a hematologist who made the diagnosis. On that day, my count was 27, but I refused to accept the prednisone that was offered. I managed to hover just above 30 for a long time after that. Dr. Hema agreed that was okay as long as I was asymptomatic. About 2 years ago, following a viral illness, the count plunged to 4, so I had to accept a very small dose of prednisone. Luckily, it worked wonders; took me right up to 125 within days. I never had to take more than 20 mgs, but I did have to take it for 10 months. Was very lucky that the tiny dose had no side effects to it at all. That was the only time I've had to treat it. I've managed to stay in the 60-80 area for the past 2 years or so. The Platelet Disorder Assn. has been the best source of information I've found on ITP. Just remember... Don't try for a "normal" count, just aim for a safe count. My Dr. Hema considers 10 unsafe and insists on treatment at that point.
I'll keep my fingers crossed for you that your count holds as you taper off the pred.

You haven't said, but I get the sense that you're a younger person. I hope I'm wrong, because it isn't fair that a young person should have so many health issues.

 
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Old 09-26-2011, 02:31 AM   #5
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Re: Thyroidism, ITP, Diabetes

Another symptom -- insomnia. Well, I'm not a young person (76) and I don't think that is fair. Thought age was a normal data display.

I've never shown and bruising or other abnormal bleeding. The ITP just showed up in a routine annual physical.

I have been taking 100mg selenium -- will increase to 200. Of course with the count jumping around, its difficult to know the effect of any moderate change.

 
Old 09-26-2011, 09:17 AM   #6
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Re: Thyroidism, ITP, Diabetes

Well, you present a much younger cyber-face. And you're right... It isn't fair for anyone, regardless of age.

As for the ITP... You know, if your count stays above 30 and you show no signs of bruising/bleeding, you probably don't need to put yourself under the stress of that prednisone. From all I've read, stroke risk from ITP does increase after age 60, but is it so much higher that the risks from the pred are fewer? I'm 61, medically considered "elderly". I've thought about it hard and long, concluding that I'll take my chances without treatment. Doctors exhibit a wide range of thought on the subject. There are some who still want to yank the spleens of senior adults, even though the chance of it reversing the ITP even temporarily is only around 40%. Be careful... It's an ITP madhouse out there.

Hypothyroidism from Hashi's can indeed cause insomnia, even weight loss (instead of the more common gain/failure to lose). But it's probably your hyper-level FT4 that's causing your hyper symptoms. It's known as Hashitoxicosis. Eventually, as the gland fails, that will change, and symptoms will become more hypothyroid. As a layperson, I'm not entirely sure how Hashitoxicosis is treated. Hopefully, your endo will know. One thing is pretty sure, he is likely to be extra conservative about starting treatment with supplemental hormones due to your age.

As for the selenium, don't exceed 200 mcgs/day. It becomes toxic in doses higher than that. If you take a multi-vitamin, check the label to make sure there isn't any there that will add to the total. And just to be clear.... The selenium is to combat the thyroid antibodies and doesn't do anything for the ITP.

Hope you'll report back after you see the endo.

 
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Old 10-06-2011, 05:40 PM   #7
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Smile Re: Thyroidism, ITP, Diabetes

Began 2 wks ago on reduced prednizone (80 to 40mg/da), 1st wk went from 121 to 80, but this week up to 93. Went to hemo today - we were both encouraged. Will go to 30mg for wk or two.

Early this wk, family dr put me on 40mg/da propranolol. Feeling better - BP down, energy up, fasting glucose below 100 but spikes with almost any nourishment. Uncertain as to driver of "better," propranolol or prednizone, but will gladly accept.

Getting to Endo is like pulling hen's teeth -- almost 2 wks to get records to him. Maybe an appt in the next couple weeks.

Last edited by billco; 10-06-2011 at 08:47 PM.

 
Old 10-06-2011, 10:06 PM   #8
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Re: Thyroidism, ITP, Diabetes

Endos are generally very hard to get appointments with. There's a shortage of them in the US, actually, so it can take months to get in to see one.

So glad to hear you're able to taper down the prednisone and that your platelet count is holding as you do it. If you can manage to feel better while taking prednisone, that's really saying something about your perseverance!

Last edited by midwest1; 10-06-2011 at 10:07 PM.

 
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