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Avatar universal

Wife diagnosed with hyperthyroidism. Please help me analyze these levels

Hello,

My wife (36) was just diagnosed with hyperthyroidism following a period where she was experiencing rapid heartbeat and very high blood pressure. A blood test was ordered and that was how she was diagnosed. I was wondering if anyone out there that has gone through this could offer some advice during this very scary time for both of us. The Endo has put her on Beta Blockers (Metoprolol) and Methimazole to try to lower the levels. Doc wants to try to control this with food first and adjusting the meds. Said no foods with iodized salt..stay away from shellfish, seaweed, anything from the ocean. They described the options of radiation and removal of the thyroid if it gets really bad. What's the likelihood she can control this with diet? Or that this will go into remission at some point?

Her thyroid profile is as follows:

T-4 Outside Range: 24.9 (CH), Units: MCG/DL, Reference Range: 56 (H), Units: %, Reference Range: 24.3-39.0
TSH,Ultrasensitive: 0.0020(L), Units: uIU/ml, Reference Range: 0.270-4.200
Free T-4 Outside Range: >7.77(CH), Units: NG/DL, Reference Range: 0.93-1.70
Free T-3 Outside Range: 32.550(H), Units: pg/mL, Reference Range: 2.0-4.4

Also found to be low on vitamin D.

Thank You.
5 Responses
Avatar universal
Sorry, left out T-3 UPTAKE. Reposting the levels:

T-4
Outside Range: 24.9 (CH), Units: MCG/DL,
Reference Range: 4.5-12.0

T3-Uptake
Outside Range: >56 (H), Units: %,
Reference Range: 24.3-39.0

TSH,Ultrasensitive:
Outside Range: 0.020(L), Units: uIU/ml,
Reference Range: 0.270-4.200

Free T-4
Outside Range: >7.77(CH), Units: NG/DL,
Reference Range: 0.93-1.70

Free T-3
Outside Range: 32.550(H), Units: pg/mL,
Reference Range: 2.0-4.4
Avatar universal
Hi,
Hyperthyroidism causes faster metabolism in the body and hence causes the increased heart rate and blood pressure.
Lowering the BP is crucial with Tabs and Diet. Salt should be restricted at all times. Reduce the salt intake less than 1gm. Its better not to take at all.
Now for the hyperthyroidism, surgery is usually done and those not fit for surgery is treated with radiation.
The hypertension will subside when once the excess hormones are limited.
Hypothyroidism is the disadvantage in this surgical cause.

Hope she does well,
Thank You
649848 tn?1534637300
COMMUNITY LEADER
Have they done any antibody testing to determine whether your wife has Graves Disease or Hashimoto's Thyroiditis?  Both are autoimmune thyroid conditions that have no cure, but can often be controlled via medication...

Graves Disease is the most prevalent cause of hyperthyroidism; however, Hashimoto's is often characterized by periods of hyperthyroidism in the early stages, before finally settling into permanent hypothyroidism... It's also possible that she may have a hyper-functioning nodule that's producing hormones on its own, independently of the thyroid...

In order to determine the cause of her hypothyroidism, she will need certain tests.  Thyroid Stimulating Immunoglobulin (TSI) is the definitive test for Graves Disease.  Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb) are the tests she will need to determine if she has Hashimoto's... Both are necessary to confirm/rule out Hashimoto's; they can also be present in smaller amounts with Graves Disease.  Some people have, both Hashimoto's and Graves Disease, with one or the other dominant at a given time.  

A thyroid ultrasound is necessary to determine whether or not nodules are present that could be functioning independently of the thyroid.  

Beta blockers are often used to bring the heart rate and blood pressure down to normal, so the doctor is right on track with the Metoprolol... Anti-Thyroid meds are given to stop the thyroid from producing so much thyroid hormones, so, again the doctor is on track with the Methomazole... The restricted diet is to prevent too much iodine from being ingested, since iodine is a major building block to thyroid hormones.  

There is also a list of foods called goitrogens that disrupt the production of thyroid hormones by interfering with iodine uptake, which may also help slow down hormone production, though it may not be significant.  These include things like broccoli, cabbage, cauliflower, etc...The goitrogenic properties are destroyed when the foods are cooked, so they're best eaten raw.  You can do a search for "goitrogenic foods" and get the list.  I advise staying away from soy, though it's on the list...

It's impossible to say whether she will be able to control the hyperthyroidism with the medication and diet or not... some people do very well with med and some don't... often it depends on the cause of the hyperthyroidism.  It's worth a try, because Graves Disease can go into remission, and as noted, Hashimoto's, often, swings back and forth between hyper, hypo and normal for many years before settling into permanent hypo... this is why it's necessary to determine the cause.  

While your wife is on the Methomazole, her thyroid hormone levels will have to be checked periodically, to make sure they aren't going too low, because the medication can cause her to go hypothyroid.  In that case, she will get symptoms of hypothyroidism, which include, slow heart rate, weight gain, constipation, fatigue, cold intolerance, etc.

Surgery includes removal of the thyroid, which would leave your wife permanently hypo and dependent on thyroid meds for life.  Radiation "kills" the thyroid so it can no longer produce hormones, which also will leave her dependent on replacement thyroid meds for life.  IF she has Hashimoto's, she will, ultimately, end up hypo, which will also leave her dependent on replacement thyroid meds for the rest of her life...

Just to put your mind at ease... it all sounds pretty daunting, but many/most of us, here on the forum, have Hashimoto's and are either already dependent on thyroid meds or getting there...
Avatar universal
Wickedwolf and Barb 135, many thanks for your words of comfort and advice so far. It's great to be able to share thoughts with others who have went through this as your words offer comfort to us especially during this difficult time.

Barb135, after reading another of your very helpful posts last night I checked the blood results and did not find tests for TSI, TPOab, or (TgAb). So unfortunately we do not know what the cause is. We will ask that these tests be included in the next blood test.

An ultrasound was performed and the Endo seemed to think the imaging work understated the actual size of the thyroid. She is upping the dosage of meds to try to bring this down and did share that if this gets worse the two options are radiation or removal. Doc also suggested that at some point a biopsy would need to be performed to understand whether it is cancerous. Very scary to hear that! For now its meds/diet and a blood test in 2 weeks to see how she is responding. Thank you for the tips on food as we are still learning everyday what can be done from various angles that might help.

From reading other experiences, it seems that careful monitoring of levels + adjustment of dosages is the medical response. Our doc can seem a bit opinionated (Can't tell if it's experience or stubbornness) at times. Does it makes sense to get a second opinion to ensure we are attacking the issues in the best way?

I thought I'd mention that we have 3 beautiful children and she has never experienced any issues with her thyroid or difficulties during pregnancy. A few months ago she became pregnant and the Gyno did measure a high blood pressure and pulse rate. She was very tired and we just thought it was a symptom of the pregnancy. About 6-7 weeks in she had a miscarriage. Generally she did not experience the full force of all symptoms she now has until after the miscarriage. Could it be that her body is confused and overproducing thyroid hormones (as it typically does during pregnancy?) leading to this condition? The timing of this + the fact that she never had issues in the past is making me wonder. Doc says it's unrelated and that the hyperthyroidism likely caused the miscarriage. I guess I'm wishing that this just goes away at some point.

To top it off, throughout this whole thing she has had a very bad cough. Normally she rebounds from colds in a few days. It's lasted at least 2 weeks and her general doc believed it to be unrelated and prescribed z-Pak, Tylenol+Codeine. She's finished the entire dose of antibiotics and I'm starting to get concerned that her "cough/virus and sore throat" is more related to the thyroid being swelled etc.... She often has cough attacks that get pretty bad although it has been getting better albeit slowly.

Many thanks again for all the help....
649848 tn?1534637300
COMMUNITY LEADER
I would agree with the endo, that the miscarriage could very possibly have been caused by being hyper.  

I don't think the condition will "just go away", but it can be managed if your doctor is willing to work on it with you, though, unfortunately, management may end up being removal or radiation.

The cough, too, could very well be caused by the swollen thyroid.  The fact that it's getting better could be attributed to the methomazole bringing down the thyroid hormone levels.  

I don't understand how the endo could believe that the imaging "understated" the size of the thyroid... that's the whole point of having an ultrasound - to find out the size and characteristics... when the technician does the ultrasound, s/he actually takes measurements of the thyroid and any nodules that are present, plus making note of the various characteristics of the thyroid and/or nodules.  Your doctor saying that and increasing the methomazole on that basis makes me somewhat distrustful...

Of course, you should always get a second opinion any time you feel the least bit uncomfortable with the testing/treatment being given or if you think there might be something else to be done.   A second opinion is often helpful simply to corroborate the treatment being given... I would never discourage anyone from getting a second opinion, especially, if I feel there might be reason to feel distrustful or uncomfortable with something being done.

If you have a copy of the ultrasound, you can post the results here and someone can help interpret them... If there is a dominant nodule and/or unusual characteristics, then, yes, a biopsy will need to be done.  If you don't have a copy, you should get one... Always be sure to get copies of any tests, including imaging, that are performed and keep them for your records...
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