Subclincal hyperthyroidism at age 55?

[kimmjmc]

I had cataract surgey in 11/2011 at age 55 and the eye specialist said that I also appeared to have Grave's disease.

I went to my PCP and had testing 3/2012:

Nuclear medicine thyroid scan: dx thyromegaly with marked increase uptake in six and 24 hours (31.5% and 45.6%).

Blood work:
TRAb 2.90
Thyroglobulin 60.3 out of reference range of 1.3-31.6

TSH was 0.04
Free T4 was normal at 1.39 in a reference range of 0.40 - 1.40

For over the past year I have been suffering from extreme dry eye with preorbital swelling and the "stare."  This winter I enjoyed feeling warm and having regular bowel movements after a history of feeling cold with constipation.  My primary care physician said I had subclinical hyperthyroidism that may not need to be treated.

These past few months, however, I find myself exhausted after working the typical eight-hour workday.  It's all I can do to not go to bed to sleep right after I get home.  Is that a symptom of hyperthyroidism?  I thought hyperthyroidism imparted energy.  Now that summer has arrived I find myself having a hard time dealing with heat.  I am also noticing some mental status changes.  I feel impatient, where my nature is to be mellow.  I used to read all the time at home, but now am having problems concentrating.  I never had unintentional weight loss until very recently, just a few pounds, which I'm not complaining about, as I haven't been able to stop myself my eating like a pig this past year and ended up gaining weight.  Two years ago I was normal weight.   My blood pressure has been up just this past year, but my PCP hasn't prescribed anything.  I've been 160/100 to 150/90-something.  My mother died at age 69 from a ruptured thoracic aneurysm.

Should I ask for a referal to an endocrinologist?  I don't want to rush into treatment if I don't need it, have no desire to become hypothryoid for the rest of my life.

[kimmjmc]

Thanks for the suggestions.  I do want to try anti-thyroid meds first as from what I understand RAI and surgery both usually result in hypothyroidism.

I'm not sure about beta blockers, even though I do need to get my BP down.  I need a BP med that won't cause additional fatigue.  I have to work fulltime.  The last several months I have been in bed to try to sleep the rest of the night just two hours after getting home from work.

Thanks for letting me know I should see an endocrinologist even though my free T4 level seems to put me in the "subclinical" category of hyperthyroidism that isn't necessarily treated.

I went back my eye specialist in May.  I am growing what he called secondary cataracts that will need to be treated with a laser.  Is there a downside to this procedure if someone also has Graves' disease?

[Mark Lupo, M.D.]

Yes - see an endocrinologist as you have symptoms and high blood pressure that should be addressed/treated.  Would use methimazole and beta-blockers in such a case.

[Red_Star]

Hyperthyroidism lists fatigue as a symptom. This can be due to insomnia and difficulty sleeping, a rapid pulse, and/or higher blood pressure.

Conventional treatment options for Graves' disease include:

* Anti-thyroid medication:

In the US:
- Methimazole [brand name Tapazole]
- Propylthiouracil [PTU]

Approximately 30% with Graves' disease will have a remission after prolonged treatment with anti-thyroid drugs.

* Betablockers

The two following treatment options usually cause permanent hypothyroidism requiring lifelong thyroid hormone therapy:

* RAI therapy

* Surgery [most or all the thyroid gland is removed]

***

Common herbal remedies used to treat the symptoms of Graves disease include:

Bugleweed (Lycopus virginica)
Gypsywort (Lycopus europaeus)
Lemon balm (Melissa officinalis)
Stephania root (Stephania tetranda)
Motherwort (Leonurus cardica)

Out of this list, Bugleweed (Lycopus virginica) seems to be the most promising herb to re-establishing normal thyroid levels.

In 2011, a study demonstrated that selenium supplementation (200 mcg per day) can slow the progression of eye disease and improve quality of life in patients with Graves' disease with mild ocular involvement (Graves' ophthalmopathy).  Dietary wise, brazil nuts have the highest selenium content. Each brazil nut contains between 50 - 80mcg of selenium depending on the soil.