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Old 08-04-2012, 12:53 PM   #1
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Hyperthyroidism - Deciding next step

Hello,

I recently received thyroid test results and was told that I have sub-clinical hyperthyroidism because my TSH was low but others were normal. I am listing my test results below. My doctor gave me two options for the next step: 1) wait for three months and watch for symptoms; 2) do iodine scan/thyroid scan & ultrasound.

At that time, I really had no idea what I should do, so I said "wait for one month, instead of three, pay more attention to my symptoms, and do another thyroid test."
Maybe this was not a good idea, because If I get the same test results, it won't help ruling out anything (as my doctor mentioned).

I don't have any sign of hyperthyroidism-related diseases in my physical appearance (no swollen thyroid gland, no eye protrusion), but I do get anxiety-attack like symptom - not sure how to explain it, but it is a nervous feeling I get when I am not in a situation that would make me feel nervous. For example, when I am walking (moving between rooms, or taking a walk outside), eating lunch, or sitting at computer, etc. It can happen several times a day.

I am gathering more information about thyroid issues on the internet, but it is hard for me to decide what is appropriate to do next as I am just starting to learn about them. Maybe I should do iodine scan & ultrasound, but my doctor told me that iodine scan could be invasive.
I am wondering whether or not I should go for the second option of iodine scan/thyroid scan & ultrasound, how dangerous it can be, how serious I should consider "sub-clinical" is, and what this condition can lead to in the future, what I need to be paying attention to, etc. etc.

I would very much appreciate your input.


My test results:

T4,FREE: 1.0 (ref. range: 0.8-1.8 ng/dL)
TSH: 0.11 (ref. range: 0.3-4.7 mIU/mL) ____ (I had one TSH test two weeks prior to these tests, and it was TSH: 0.18)
T3,FREE: 3.0 (ref. range: 2.3-4.2 pg/mL)
TSI: 37 (ref. range: <140)
THYROGLOBULIN ANTIBODIES: <20 (ref. range: <20 IU/mL)
THY PER AB-R: <10 (ref. range: <35 IU/mL)


Thank you very much in advance.

 
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Old 08-04-2012, 03:55 PM   #2
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Re: Hyperthyroidism - Deciding next step

Welcome!

Sorry for the reason you're here but, glad you found us.

As you will note from my signature, I started my thyroid disease journey with Graves' (most common cause of hyperthyroidism). I went into remission after taking anti-thyroid drugs and then joined the 20% of Graves' patients who go hypo after remission.

A quick Thyroid 101 lesson: the pituitary gland produces TSH (thyroid stimulating hormone) in response to the body's needs for thyroid hormone which fuels every single cell in the body. The thyroid produces two main hormones: T4 which is a storage hormone and T3 which is our active hormone. The hormones that are available for our body's use are measured by the FreeT4 and FreeT3 tests, respectively.

Antibodies can interrupt this feedback look and can cause thyroid function to diminish or they can cause the thyroid to over-produce hormones. Antibodies can also affect TSH levels.

The Thyroglobulin Antibody and Thyroid Peroxidase Antibody (THY PER AB-R) tests are measurements of antibodies seen in elevated levels in patients who have Hashimoto's Thyroiditis, the most common cause of hypothyroidism. Obviously, you don't have it.

Your other labs present an interesting scenario. You have measurable TSI which is the Graves' antibody that can cause hyperthyroidism. However, your level isn't at the level (140) that would cause hyperthyroidism in most people.

Your actual thyroid function labs are hyPOthyroid...and that is why you don't have any hyper symptoms.

You see, per thyroid textbooks, healthy people have FreeT4 levels near the high end of the range and FreeT3 levels above mid-range, if not in the upper third/upper quarter of the range.

As you can see, your FreeT4 level is closer to the low end of the range and your FreeT3 level is below mid-range.

The anxiety you describe is typical for someone dealing with hyPOthyroidism.

I suspect that you might also have another type of Graves' antibody which is called TBII (thyrotropin binding inhibiting immunoglobulin).

Just like TSI, TBII can cause TSH to be low. However, TBII block the production of thyroid hormone (remember, TSI can cause hyperthyroidism).

Sometimes TBII will negate the effects of TSI and make the patient euthyroid (normal thyroid function) but, with suppressed/low TSH.

Other times, the ever-powerful TBII override the effects of TSI and make the patient hypo with suppressed/low TSH - that's where I'm at now.

Please know that there is no reason for anyone to have the radioactive iodine scan. Once antibody testing joined thyroid ultrasounds for diagnostic purposes, the radioactive iodine scan became obsolete. It never provided conclusive information anyway. Plus, it exposes the patient to unnecessary radiation and can trigger thyroid storm.

A thyroid ultrasound wouldn't be a bad idea so you'll have a baseline.

And, if you haven't figured it out already, a TBII test can fill in some blanks.

I think you might want to review some of the lists of hypothyroidism symptoms out there and see if you are dealing with any.

Knowing whether or not you are dealing with any hypo symptoms will enable me to give you a better picture of your possible disease course.

While people with Hashi's can accurately anticipate their thyroids no longer working properly, people with TSI/TBII stand a chance of healing from thyroid disease.

Avoidance of thyroid disease triggers can lower TSI/TBII and help restore thyroid function. The most common triggers are stress, cigarette smoke, excess dietary iodine, trauma, seasonal and food allergies as well as low selenium levels and estrogens.

Obviously, you can start on the path to healing right now by addressing any of these factors that might be part of your life right now.

I know I've given you a lot to think about - please know I welcome any questions.

We're all in this together.
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Last edited by sammy64; 08-04-2012 at 04:07 PM.

 
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Old 08-04-2012, 04:01 PM   #3
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Re: Hyperthyroidism - Deciding next step

Welcome to the board although I'm sorry for the reason you're here.

subclinical hyper normally is not treated but monitored. BUT your Free levels aren't close to hyper, actually FT4 is quite low and which points at hypo - so it makes sense you don't have hyper symptoms).

Utrasound does not give much additional information as far as diagnosing Graves goes. TSI antibodies are the deciding factor in that regard.

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Last edited by lisa789; 08-04-2012 at 04:04 PM.

 
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Old 08-04-2012, 10:20 PM   #4
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Re: Hyperthyroidism - Deciding next step

Oh wow, thank you very much for your welcome and reply, sammy64 and lisa789.

I am still processing the info you gave me, sammy64. Yes, it is a lot... and I need some time to really digest it.

In a meantime, I collected a long list of symptoms of both hypo and hyper from the internet, and these are what I have:

(They may not be related to thyroid problem, but I tried to write down everything I could because I need help. Any comments/thoughts are appreciated!)

Fatigue (I am a workaholic. Usually my fatigue had a clear reason, but recently I feel like I am feeling fatigue even when my workload is very light. A few times I needed to take a nap in the conference room at work - I really couldn't stay up.)
Depression (I have a reason for that..family issue, marriage issue. But otherwise, I am generally a happy person.)
Sensitivity to cold (I tend to be cold more than other people, I wear more clothes than other people do, but I've been always like that.)
Dry skin (I was diagnosed as seborrheic dermatitis - my face was very dry and itchy)
Acne on face (I rarely had acne problem, but this past couple of years I started to have acne problems. Not so sever however.)
Breakout on chest and arms (not so much, but a little, which I didn't have before)
Other skin problem (I recently had bad skin rashes all over my body - this mysterious skin rashes was the reason I took blood test & thyroid test a month ago, and found that I had low TSH.)
Memory problems or having trouble thinking clearly. (I get this when my period comes)
Inability to concentrate or read long periods of time (I thought I may be slightly dyslexic)
Water retention, swollen legs (I need supporting stockings or socks, otherwise my legs would get swollen and difficult to stay on a chair and concentrate on work)
Breathing problem (I used to have breathing problem. Sometime, I needed to lay down and calm my body to be able to breath. Not any more this past few years.)
Increased appetite (I eat snacks constantly, not gaining weight, lost a few pounds in past several months)
Nervousness & anxiety (as described in the first post)

Otherwise, I usually have good energy and I am active. I sleep well (although I should try to have enough sleep) and eat healthy food. I don't smoke and I don't drink. My menstruation cycle is quite regular, I would say.

I was going to call my doctor next week and confirm my next step. Now I am wondering if I should ask for TBII test, instead of re-doing all these 6 tests. Or, if I should re-do all these tests anyway, in addition to TBII test.
Ultrasound test seems ok to do, but sounds like I should avoid the iodine scan.

Thank you so much again, for reading and responding!

 
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Old 08-05-2012, 05:26 AM   #5
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Re: Hyperthyroidism - Deciding next step

Happy to help.

Fatigue, depression, sensitivity to cold, dry skin, acne/other skin issues, edema, anxiety, concentration and memory issues are "classic" hypo.

Nervousness/anxiety can be either hypo or hyper.

Increased appetite is usually hyper but, in 5+ years of participating on thyroid forums, I've also seen it in hypo. You'd really need to evaluate your total calorie consumption to determine if the weight loss is unexplained or due to lower overall calorie consumption. (sometimes, people just "switch" the types of calories they consume)

Those TSI can be problematic for some people to the extent that they can erratically stimulate the thyroid to produce excess hormone. This can cause hyper symptoms even though the patient has basically hypo labs.

However, in situations such as this, the patient would also have elevated Hashi's antibodies which you don't have.

The fact that you have hypo thyroid function labs (FreeT4/T3) with suppressed TSH leads me to believe you have TBII as well.

Also, please know that some people will have a period of mild hyperthyroidism before going hypo so, that alone could explain your earlier breathing issue.

I don't know if the doctor offered any treatment to you but, without a doubt, you do not need anti-thyroid drugs. Depending on the severity and duration of your symptoms, you might benefit from some thyroid hormone replacement (most common is Synthroid).

Best of luck to you moving forward - please keep us posted!
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Old 08-05-2012, 09:32 AM   #6
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Re: Hyperthyroidism - Deciding next step

sammy64: Thank you so much for your support, and taking the time to explain. I really appreciate it.

Now that I did a couple of readings also, I better understood what you explained to me. I have a few questions in your first reply:

- "You have measurable TSI which is the Graves' antibody that can cause hyperthyroidism."
what does "Graves' antibody" mean exactly? Am I understanding it correctly saying, "High level of TSI is a sign of Graves disease."?

- What did you mean by "people with TSI/TBII", when you said "people with TSI/TBII stand a chance of healing from thyroid disease."?

- "Avoidance of thyroid disease triggers can lower TSI/TBII and help restore thyroid function. … Obviously, you can start on the path to healing right now by addressing any of these factors that might be part of your life right now." Great advice, thanks!


 
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Old 08-05-2012, 12:55 PM   #7
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Re: Hyperthyroidism - Deciding next step

Quote:
Originally Posted by GreenFeet View Post
sammy64: Thank you so much for your support, and taking the time to explain. I really appreciate it.
As I mentioned previously, I'm happy to help. I know how difficult it can be in the early days of thyroid disease. It's especially hard when the person doesn't know what terms to use when searching for information and doctors are sometimes providing conflicting information.

Quote:
Originally Posted by GreenFeet View Post
- "You have measurable TSI which is the Graves' antibody that can cause hyperthyroidism."
what does "Graves' antibody" mean exactly? Am I understanding it correctly saying, "High level of TSI is a sign of Graves disease."?
Most cases of thyroid disease are autoimmune in nature which means that our immune systems have gone wacky and start producing antibodies that attack the thyroid.

There are two types of autoimmune thyroid disease: Hashi's (which you don't have since you tested negative for TPOab's and TGab's) and Graves' (which usually results in hyperthyroidism as a result of TSI (thyroid stimulating immunoglobulin).

Based upon your lab's range for TSI, people who have levels of 140 or higher will usually develop hyperthyroidism.

You are obviously not hyperthyroid yet have measurable TSI.
Healthy people would have TSI <2.

Because your FreeT4/T3 levels are actually hypo, I speculated that you also have the other type of Graves' antibody - TBII.

If you do indeed have TBII, a thyroid-savvy doctor would say you have Graves' hyPOthyroidism.


Quote:
Originally Posted by GreenFeet View Post
- What did you mean by "people with TSI/TBII", when you said "people with TSI/TBII stand a chance of healing from thyroid disease."?
People with TSI have Graves' Disease - most of them have hyperthyroidism that can go into remission after taking anti-thyroid drugs and making dietary and lifestyle changes.....

People with both TSI and TBII would also be considered to have Graves' disease.

They can have different things going on with their thyroid function based upon what those TSI and TBII are doing (I explained that earlier).

TSI and TBII are called "TSH receptor antibodies" and they actually attach themselves to the TSH receptors of the thyroid (areas of the thyroid that are stimulated to produce thyroid hormone).

Rather than destroying thyroid cells, TSI and/or TBII cause the thyroid to "misbehave".

Therefore, a person can heal from TSI-induced hyperthyroidism and/or TBII-induced hypothyroidism by trying to reduce antibody levels.

The ways we can reduce antibody levels are by avoiding thyroid disease triggers.

Antibody level reduction can result in remission from either/both hyperthyroidism and/or hypothyroidism.

Not only does avoidance of thyroid disease triggers lower antibody production but, so does maintaining appropriate thyroid hormone levels (FreeT4/T3).

When a person is either hyper or hypothyroid, this causes stress on the body. Stress is a big trigger for thyroid disease.

Since you are dealing with mostly hypo symptoms, that tells us your FreeT4/T3 levels are too low for you.

Remember - most healthy people have FreeT4 towards the high end of the range and FreeT3 in the upper third/upper quarter of the range.

Unfortunately, based upon the fact that your doctor thinks you have subclinical hyperthyroidism when you are actually dealing with hyPOthyroidism, I doubt he would offer thyroid hormone replacement.

I say this because my FreeT4/T3 levels were very similar to yours when I started replacement only my TSH was more "hyper-looking" (as in lower).

Since my current thyroid doctor (#5 after 4 clueless ones) knew I had Graves' and she also knows how the Graves' antibodies affect TSH, she prescribed thyroid hormone replacement for me when I needed it.

I know that, without a doubt, my former doctors wouldn't have offered it. In fact, my labs at the time I started replacement were very similar to the labs I had when I went off anti-thyroid drugs and met endo #3. After seeing my "hyper" (not) TSH, she wanted me to resume anti-thyroid drugs at quadruple the dose I had been taking when I went off of them.

The TSH test is the bane of every thyroid patient's existence....you'll see that as a recurring theme on other threads here.

Have you ever had thyroid testing before the most recent tests?
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Last edited by sammy64; 08-05-2012 at 01:22 PM.

 
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Old 08-05-2012, 07:29 PM   #8
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Re: Hyperthyroidism - Deciding next step

Quote:
As I mentioned previously, I'm happy to help. I know how difficult it can be in the early days of thyroid disease. It's especially hard when the person doesn't know what terms to use when searching for information and doctors are sometimes providing conflicting information.
Thank you - Lucky to have found this webstie. It is absolutely a great help. English is my second language, but when my doctor told me the thyroid problems, it sounded like a third language - I had no idea!

Quote:
Healthy people would have TSI <2.
I wasn't sure that TSI / TBII were something that a healthy person don't have to have?

Quote:
Stress is a big trigger for thyroid disease.
Just needed to hear this probably. I was going through something very difficult in my life. It seems very much to explain my recent horrible skin rashes of unknown cause coincided with the thyroid problem.

Quote:
Therefore, a person can heal from TSI-induced hyperthyroidism and/or TBII-induced hypothyroidism by trying to reduce antibody levels.
The ways we can reduce antibody levels are by avoiding thyroid disease triggers. ... Not only does avoidance of thyroid disease triggers lower antibody production but, so does maintaining appropriate thyroid hormone levels (FreeT4/T3).
If avoiding thyroid disease triggers can help lower the TSI/TBII antibody levels, and therefore adjust the thyroid hormone levels, it seems to make more sense for me to give a little more time and work on reducing the thyroid disease triggers. I'm getting the idea of what I want to do:

1. Do TBII test soon.
2. Wait for a few months, and work on reducing the thyroid disease triggers.
3. Do another series of tests, and see if there are any changes without medication.
4. Do ultrasound test.
5. From the blood test and ultrasound test results, decide next step (medication, etc)

I am actually not feeling very comfortable going for a medication so soon. I hope waiting for a few months won't exacerbate any thyroid-related problems.

Quote:
Have you ever had thyroid testing before the most recent tests?
Yes, the first test was in June this year. It was only the TSH test, for the purpose of diagnosing my mysterious skin rashes all over my body. The most recent tests, whose results were the ones I posted here, were done in July last month. TSH was lower in the second test.


Thank you also for sharing your story, and sorry to hear that you needed to see 5 doctors!

 
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Old 08-05-2012, 07:34 PM   #9
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Re: Hyperthyroidism - Deciding next step

Quote:
As I mentioned previously, I'm happy to help. I know how difficult it can be in the early days of thyroid disease. It's especially hard when the person doesn't know what terms to use when searching for information and doctors are sometimes providing conflicting information.
Thank you - Lucky to have found this webstie. It is absolutely a great help. English is my second language, but when my doctor told me the thyroid problems, it sounded like a third language - I had no idea!

Quote:
Healthy people would have TSI <2.
I wasn't sure that TSI / TBII were something that a healthy person don't have to have?

Quote:
Stress is a big trigger for thyroid disease.
Just needed to hear this probably. I was going through something very difficult in my life. It seems very much to explain my recent horrible skin rashes of unknown cause coincided with the thyroid problem.

Quote:
Therefore, a person can heal from TSI-induced hyperthyroidism and/or TBII-induced hypothyroidism by trying to reduce antibody levels.
The ways we can reduce antibody levels are by avoiding thyroid disease triggers. ... Not only does avoidance of thyroid disease triggers lower antibody production but, so does maintaining appropriate thyroid hormone levels (FreeT4/T3).
If avoiding thyroid disease triggers can help lower the TSI/TBII antibody levels, and therefore adjust the thyroid hormone levels, it seems to make more sense for me to give a little more time and work on reducing the thyroid disease triggers. I'm getting the idea of what I want to do:

1. Do TBII test soon.
2. Wait for a few months, and work on reducing the thyroid disease triggers.
3. Do another series of tests, and see if there are any changes without medication.
4. Do ultrasound test.
5. From the blood test and ultrasound test results, decide next step (medication, etc)

I am actually not feeling very comfortable going for a medication so soon. I hope waiting for a few months won't exacerbate any thyroid-related problems.

Quote:
Have you ever had thyroid testing before the most recent tests?
Yes, the first test was in June this year. It was only the TSH test, for the purpose of diagnosing my mysterious skin rashes all over my body. The most recent tests, whose results were the ones I posted here, were done in July last month. TSH was lower in the second test.


Thank you also for sharing your story, and sorry to hear that you needed to see 5 doctors!

 
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Old 08-05-2012, 07:44 PM   #10
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Re: Hyperthyroidism - Deciding next step

Quote:
As I mentioned previously, I'm happy to help. I know how difficult it can be in the early days of thyroid disease. It's especially hard when the person doesn't know what terms to use when searching for information and doctors are sometimes providing conflicting information.
Thank you - Lucky to have found this webstie. It is absolutely a great help. English is my second language, but when my doctor told me the thyroid problems, it sounded like a third language - I had no idea!

Quote:
Healthy people would have TSI <2.
I wasn't sure that TSI / TBII were something that a healthy person don't have to have?

Quote:
Stress is a big trigger for thyroid disease.
Just needed to hear this probably. I was going through something very difficult in my life. It seems very much to explain my recent horrible skin rashes of unknown cause coincided with the thyroid problem.

Quote:
Therefore, a person can heal from TSI-induced hyperthyroidism and/or TBII-induced hypothyroidism by trying to reduce antibody levels.
The ways we can reduce antibody levels are by avoiding thyroid disease triggers. ... Not only does avoidance of thyroid disease triggers lower antibody production but, so does maintaining appropriate thyroid hormone levels (FreeT4/T3).
If avoiding thyroid disease triggers can help lower the TSI/TBII antibody levels, and therefore adjust the thyroid hormone levels, it seems to make more sense for me to give a little more time and work on reducing the thyroid disease triggers. I'm getting the idea of what I want to do:

1. Do TBII test soon.
2. Wait for a few months, and work on reducing the thyroid disease triggers.
3. Do another series of tests, and see if there are any changes without medication.
4. Do ultrasound test.
5. From the blood test and ultrasound test results, decide next step (medication, etc)

I am actually not feeling very comfortable going for a medication so soon. I hope waiting for a few months won't exacerbate any thyroid-related problems.

Quote:
Have you ever had thyroid testing before the most recent tests?
Yes, the first test was in June this year. It was only the TSH test, for the purpose of diagnosing my mysterious skin rashes all over my body. The most recent tests, whose results were the ones I posted here, were done in July last month. TSH was lower in the second test.


Thank you also for sharing your story, and sorry to hear that you needed to see 5 doctors!

 
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Old 08-05-2012, 07:50 PM   #11
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Re: Hyperthyroidism - Deciding next step

Not sure why my message was posted three times.

 
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Old 08-06-2012, 04:52 AM   #12
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Re: Hyperthyroidism - Deciding next step

Quote:
Originally Posted by GreenFeet View Post
I wasn't sure that TSI / TBII were something that a healthy person don't have to have?
Ahhh...sorry for any confusion. There are "good" antibodies such as those that fight infection......and then there are different types of bad" antibodies that cause various autoimmune disease (such as Type I diabetes, lupus, multiple sclerosis - I believe there are now 100 identified autoimmune diseases)


Quote:
Originally Posted by GreenFeet View Post

1. Do TBII test soon.
2. Wait for a few months, and work on reducing the thyroid disease triggers.
3. Do another series of tests, and see if there are any changes without medication.
4. Do ultrasound test.
5. From the blood test and ultrasound test results, decide next step (medication, etc)

I am actually not feeling very comfortable going for a medication so soon. I hope waiting for a few months won't exacerbate any thyroid-related problems.
This sounds like a very appropriate plan. In fact, besides the TBII test, it would be a good idea to have your Vit D and selenium blood levels checked. Deficiencies in these can also trigger thyroid disease.

You can always re-evaluate things if your symptoms worsen.

For whatever it's worth, you might want to look into taking some rhodiola rosea, an adaptogen. Adaptogens help to modulate various body systems and can be quite effective at lowering antibody levels.

Here's some info:

http://www.ncbi.nlm.nih.gov/pubmed/11410073

http://www.ncbi.nlm.nih.gov/pubmed/15252224

You'll also be able to find information by just searching rhodiola rosea - there's a website that contains much of the information shared in the book "The Rhodiola Revolution" that was written by two doctors who use it in clinical practice and take it themselves.

I only found out about rhodiola rosea earlier this year (and I'm not too quick to start a new supplement). Since taking 100mg/day, my antibody levels are lower, not much bothers me these days and I had the additional benefit of no seasonal allergy symptoms this year.


Many of us did not have thyroid testing before problems developed. Unfortunately, not having thyroid testing done when we are healthy doesn't let us know what is normal for us and won't help identify our optimal levels.

However, all is not lost. The information is out there to help us achieve wellness. Unfortunately, it's accompanied by a lot of misinformation. That's when forums can be very helpful in sorting things out.

Thanks for your kind words about me. My situation with doctors is all-too-common. So many doctors just don't understand thyroid disease.

Those of us who achieve wellness research extensively and are proactive with our care.

Please visit here as you move forward in your journey - best of luck to you!
__________________
Graves' 2007...remission 2009....hypo 2010

Last edited by sammy64; 08-06-2012 at 05:25 AM.

 
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Old 08-06-2012, 10:54 AM   #13
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Re: Hyperthyroidism - Deciding next step

sammy64: It was very kind of you to pay close attention to my postings and actively respond to my questions. Now I have a better picture of the thyroid issues, and I know what I need to/want to look into.

Thank you for all the information. I've been loaded with a lot of information this past couple of days - it's certainly been very helpful.

It was also encouraging to see how you are proactively dealing with the thyroid issues. I'm sure I'll visit the site often, learn more, and post more.

Best of luck to you too!

 
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