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Hyperthyroidism and Symptoms
Hi Dr. Mark,
I was diagnosed with hyperthyroidism a little over 1 month ago. My bloodwork showed that my TSH = .178, T3 Uptake = 25, and T4 Free Direct = 1.24. I'm currently taking 20 mg of Methimazole and 75 mg of Toprol XL (just for the past week. For the 2 prior weeks, I was taking 10 mg of Methimazole and 25 mg of Toprol XL). My endocrinologist is telling me that my labs "aren't that bad", so she doesn't quite understand why I continue to have some of the symptoms that I'm experiencing (I feel quite anxious all of the time and have a hard time in certain settings (meetings, going to lunch with friends, etc.) I also feel shaky all of the time, dizzy, have significant neck pain which is causing tension headaches, pressure in my ears, etc. Is this normal? Should the Methimazole and Toprol help with these symptoms (given more time), or do I need to address these separately (such as taking anxiety medication, or muscle relaxants for the neck pain)? I obviously would prefer not to be loaded up on medication, but I haven't really seen any relief with the current medication I'm on.
I was diagnosed with hyperthyroidism a little over 1 month ago. My bloodwork showed that my TSH = .178, T3 Uptake = 25, and T4 Free Direct = 1.24. I'm currently taking 20 mg of Methimazole and 75 mg of Toprol XL (just for the past week. For the 2 prior weeks, I was taking 10 mg of Methimazole and 25 mg of Toprol XL). My endocrinologist is telling me that my labs "aren't that bad", so she doesn't quite understand why I continue to have some of the symptoms that I'm experiencing (I feel quite anxious all of the time and have a hard time in certain settings (meetings, going to lunch with friends, etc.) I also feel shaky all of the time, dizzy, have significant neck pain which is causing tension headaches, pressure in my ears, etc. Is this normal? Should the Methimazole and Toprol help with these symptoms (given more time), or do I need to address these separately (such as taking anxiety medication, or muscle relaxants for the neck pain)? I obviously would prefer not to be loaded up on medication, but I haven't really seen any relief with the current medication I'm on.
You are right. You need a new doctor for sure. The antibody test is really important right now and then an ultrasound, etc.. You also should not take any anti anxiety meds unless you want to open a whole new set of problems for yourself as they will never be your answer. I know this first hand as they are very, very, addicting and not the answer to what you have going on. You just need a good thorough docter right now. Dawn
MEDICAL PROFESSIONAL
The best way to document Graves is a thyroid uptake of I-123 (nuclear medicine test) -- this is normal/elevated in Graves, and low in thyroiditis.
But -- the above only applies if the patient is HYPER -- the low tsh and normal t4 is usually subclinical hyperthyroidism and the uptake would be helpful.
Regarding antibodies - TPO and Tg can be positive in Graves AND Hashi. TSI is more specific for Graves.
Nomenclature in thyroid disease is complicated -- usually Hashi refers to destructive lymphocytic thyroiditis (chronic) from immune system attack and causes HYPO.
Hashitoxicosis is confusing as well -- I believe this to be a situation where there are both blocking and stimulating antibodies that attack the thyroid causing a flucuation between hyper and hypo (relatively rare).
But -- the above only applies if the patient is HYPER -- the low tsh and normal t4 is usually subclinical hyperthyroidism and the uptake would be helpful.
Regarding antibodies - TPO and Tg can be positive in Graves AND Hashi. TSI is more specific for Graves.
Nomenclature in thyroid disease is complicated -- usually Hashi refers to destructive lymphocytic thyroiditis (chronic) from immune system attack and causes HYPO.
Hashitoxicosis is confusing as well -- I believe this to be a situation where there are both blocking and stimulating antibodies that attack the thyroid causing a flucuation between hyper and hypo (relatively rare).
MEDICAL PROFESSIONAL
I agree that your labs are less severe than your symptoms, but every individual is different. It takes the methimazole 2-4 weeks to have a significant effect, so hopefully with the higher dose you will lower your thyroid levels soon to the point your symptoms abate.
The toprol is great for lowering heart rate, but some of the older beta-blockers (propanolol or atenolol) may be better for the shakiness -- would consider trying that before adding anti-anxiety meds (although I do sometimes use xanax, etc in graves patients initially as we are waiting for the anti-thyroid treatments to work).
Did your doc check the Free (or total) T3? The T3Uptake is a different test (not used much anymore, but still part of the "thyroid panel"). Often Graves patients will make much more T3 than T4, so checking it may help draw a parallel between your labs and your symptoms.
If the levels "normalize" completely and you still have symptoms, ask your doctor to help you look into other causes.
The toprol is great for lowering heart rate, but some of the older beta-blockers (propanolol or atenolol) may be better for the shakiness -- would consider trying that before adding anti-anxiety meds (although I do sometimes use xanax, etc in graves patients initially as we are waiting for the anti-thyroid treatments to work).
Did your doc check the Free (or total) T3? The T3Uptake is a different test (not used much anymore, but still part of the "thyroid panel"). Often Graves patients will make much more T3 than T4, so checking it may help draw a parallel between your labs and your symptoms.
If the levels "normalize" completely and you still have symptoms, ask your doctor to help you look into other causes.
TSI antibodies will confirm Graves Disease. I can make a suggestion on this because I was treated for hyperT/Graves in late 2001-late 2003 with atd's. Mine was methimazole. Starting dose is 30 mgs or less, depending on severity. TSH will stay suppressed, so you can't go by TSH. What tests the dr should be doing are FreeT3 and FreeT4. T3 and T4 which are the older, less usefull test just show what's circulating in the blood, and are considered bound hormones.
FreeT3 and FreeT4, which are the unbound hormones are best to dose by. About 4-6 weeks after the starting dose of atd's, if the FT3 and FT4 are going down, then it's time to reduce accordingly until you're on a maintenance dose. In the mid to upper 1/3 range while on atd's is where most of us felt best while on atd's. I could write a book on the mismanagement of anti thyroid meds due to a TSH test alone! This is a big mistake a lot of dr's make. Elaine Moore has a book on Graves Disease called Graves Disease, A Practical Guide, and she's also on www.thyroid.about.com under the hyperT/Graves board. Also, TSH lags behind 6-8 weeks but a lot of dr's have no knowlege of this.
Doodaa
Formerly HyperT/Graves, now in remission and on thyroid replacement. Oink! :-)
FreeT3 and FreeT4, which are the unbound hormones are best to dose by. About 4-6 weeks after the starting dose of atd's, if the FT3 and FT4 are going down, then it's time to reduce accordingly until you're on a maintenance dose. In the mid to upper 1/3 range while on atd's is where most of us felt best while on atd's. I could write a book on the mismanagement of anti thyroid meds due to a TSH test alone! This is a big mistake a lot of dr's make. Elaine Moore has a book on Graves Disease called Graves Disease, A Practical Guide, and she's also on www.thyroid.about.com under the hyperT/Graves board. Also, TSH lags behind 6-8 weeks but a lot of dr's have no knowlege of this.
Doodaa
Formerly HyperT/Graves, now in remission and on thyroid replacement. Oink! :-)
Interesting! I have another dr's appointment one week from tomorrow. Should I ask that I have an antibodies test? Are there any other tests I should ask for? I had blood drawn last week, but I believe my doctor only ordered TSH, T3 and T4.
Hi tvfan. You know, you are the second person who's come on recently who's been put on anti-hyper meds, and the doc never did antibodies labs to CONFIRM that you have Graves! Granted, you could very well have Graves, but when you mention that you have neck pain, it makes me think you could also have thyroid anti-bodies for Hashimotos disease, or thyroiditis! And your symptoms would be from being on the hyper swing.....IMHO.
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