Question about alternatives for potential hyperthyroidism..
I was recently diagnosed with Grave's Disease and told to start a Methimazole regimen and "check back in" in 2 months with my primary care physician. I have a history of clinical depression, and panic attacks, and currently take 20mg of Lexapro daily to keep both under control.
I have a family history of both Grave's (father) and Hashimoto's Thyroiditis (maternal grandmother) but, at 26, have never had issues with my thyroid before. Besides an elevated heart rate, and the mild goiter my doctor "felt", I have zero symptoms of hyperthyroidism (no insomnia, no diarrhea, no eye problems). If anything, I have gained weight in the last 2 months (close to 8 pounds), while still using the same Spark People nutritional plan and exercise regime that helped me shed weight three years ago. I have also had no increased panic/anxiety, and am very sensitive to such things.
So I'd like to ask the group two big questions. One, are my "elevated levels" of a critical nature (i.e. how elevated is dangerously elevated)? And second, is it possible to forgo medication/the radioactive iodine oblation.. does this stuff ever abate on its on?
I am quite concerned that "killing"/slowing my thyroid will cause my depression to flare up, and would like to avoid that at all costs. I'm also not eager to put back on the 30 pounds I lost in 2008-2009, and I'm already gaining (without taking the Methimazole!). Is it possible to be "monitored" without being medicated or permanently altered such that I will require medication for the rest of my life?
My levels as of 1/11/12:
T3: 242 (normal range: 80-200)
T4: 12.1 (normal range: 4.6-12)
"FREE T4": 1.9 (normal range: 0.93-1.7)
T Uptake: 1.09 (normal range: 0.77-1.25)
TSH: 0.02 (normal range: 0.27-4.2)
Re: Question about alternatives for potential hyperthyroidism..
Welcome to the board, although I'm sorry for the reason you're here.
Where you tested for antibodies? in Graves that woudl be TSI antibodies?
Some people do gain weight with Graves (although most will think of weightloss) so it's very well possible that that's the cause of it. Just like your depression, if properly monitored and treated, more likely your depression will get better instead of less. Very well possible that's a symptom too, so your doctor stating that you don't display any symptoms, not sure about that. Maybe not the ones he/she thinks off.
Did the doctor mention radioactive iodine? as far as I understand currently you started methimazole (antithyroiddrugs). Normally once you fall within normal ranges, that dosage will be lowered and you'll stay on that lower dose until remission is achieved. (if need be one can add levothyroxine to prevent a person from become hypo and in that case that would Block and Replace therapy) In short with antithyroiddrugs there is no permanent altering. remission after that is possible, although some will become hypo, but that's not due to the antithyroid drugs but due to the auto-immunity as such. radioactive iodine is another story of course.
The Following User Says Thank You to lisa789 For This Useful Post: Deb5887 (03-27-2012)
Re: Question about alternatives for potential hyperthyroidism..
Lisa has already given you some great information.
Please know that your levels aren't considered all-that-elevated.
However, since you are already dealing with an elevated heart rate, it's important to take the methimazole that was prescribed for you. It's more likely that things will get worse without the meds since you do have Graves' (and hopefully, this was confirmed by the presence of TSI)
Now, of the lab tests that were done, only two "count" - the others are outdated and provide inaccurate results.
The FreeT4 level is a thyroid hormone level and is always the level that is used for ATD (anti-thyroid drug) dosing.
Since your FreeT4 level is only slightly over-range, a small dose of methimazole is appropriate. What dose did your doctor prescribe?
The TSH level is a measurement of a pituitary hormone that helps to regulate the production of thyroid hormone. TSH drops in the body's efforts to keep thyroid hormone levels from rising.
TSH will stay suppressed as long as the Graves' antibodies are active. As long as your thyroid hormone levels are in-range, there is no concern. It's out-of-whack thyroid hormone levels that cause symptoms/issues - not TSH.
Please know that the radioactive iodine treatment is contraindicated for Graves'. It can cause or exacerbate thyroid eye disease and can worsen the hyperthyroidism immediately after the treatment. Since a flood of antibodies is released after the treatment and continues for many years, it's very hard to get regulated on the thyroid hormone replacement that is needed for the hypothyroidism that develops as a result of the procedure.
80-90% of Graves' patients go into remission after taking ATD's (anti-thyroid drugs) for the appropriate amount of time needed to achieve remission (not some arbitrary timeframe a doctor might indicate). Remission happens for most patients within 2-4 years after starting meds.
As the endo-author of "Thyroid for Dummies" states, ATD's can be safely taken for life, if necessary. I know of many thyroid forum members that have been taking small doses ( < 10mg and usually 5mg or lower) for many years - one of them for over 30 years.
You can do a few things to help the meds along while your FreeT4 level is elevated.
Increasing your consumption of goitrogens can help. Goitrogens are a class of foods that, when eaten raw, can actually lower thyroid hormone levels.
There's a list of goitrogens on this thread (see post #16):
Also, since iodine can wreak havoc with thyroid function, you'll want to avoid iodized salt and minimize your consumption of fast/processed foods as well as shellfish. This applies even after your levels get back into range.
Soy is also a big no-no for anyone with thyroid disease.
As you will note from my signature, I went into remission from Graves' two years after starting ATD's.
Not only do ATD's lower thyroid hormone levels but, they have an immunosuppressive effect on the antibodies - this will help you heal.
The key to proper dosing with ATD's is to take the lowest possible dose that will maintain the FreeT4 level in the upper half of the range, regardless of TSH.
And, while I joined the 20% of Graves' patients that go hypo after remission, that won't necessarily happen to you.
I have had the pleasure of celebrating remission with countless other members on the various thyroid forums I've been participating on for the past 4+ years.