Posted 26 June 2020 - 07:44 AM
I've recently, a week ago, been diagnosed with Grave's disease. I went to my PCP for my annual physical and discussed with him how my anxiety has been through the roof. I had never talked to a physician about my anxiety before. I told him how I've had it basically my whole life, but within the past couple of years has been increasingly frustrating. He put me on Setraline, ordered a lipid panel & thyroid test, gave me a referral for an endocrinologist, and I went on my merry way. That evening, he called me and told me that my thyroid levels suggested hyperthyroidism and to try to get into the endocrinologist right away. He also ordered an ultrasound in the meantime. I called the endo and she wanted to see me next day based on my labs. I went in and she asked me a few questions about weight (I've been pretty steady the past few years but also pay attention to it), checked my hands for tremors, and discussed why I was in and my anxiety. After seeing my labs and talking to me for about 10 minutes she knew it was Grave's. She then counseled me on it for another 15 minutes. She is a great doctor. I got my ultrasound earlier this week and received the results back - consistent with Grave's diagnosis. Early next week I have another test scheduled, the Radioactive Iodine uptake test.
TSH <0.010 (normal range: 0.340-4.820)
Thyroglobulin Ab <1.0 (normal range: 0.0-0.9)
Free T3 20.6 (normal range: 1.7-3.7)
TSI 1.98 (normal range: 0.00-0.55)
Free T4 2.93 (normal range: .08-1.48)
Posted 26 June 2020 - 01:03 PM
Welcome to the forum. Thank you for posting your labs including the lab reference ranges.
It looks like with the Free T3 being high that there is a T3 Thyrotoxicosis involved. Has the Endocrinologist mentioned this? A beta blocker is given to help the T4 from converting more into the T3.
Also as the Free T4 is high as well that an antithyroid drug will likely be given.
The RAIU is to check for cold and hot nodules. The positive TSI test already determines Graves' Disease.
I refused to get the RAIU as it involved radiation and since my antibodies tests were positive.
We are a forum that advocates with using beta blockers and antithyroid drugs as first choice to help lower down thyroid levels. We also advocate with learning about thyroid triggers from the diet as well as from the environment. What is used to put on our bodies from the personal and exposure to household products with looking for safer and healthier products to use. These things will help to get our thyroid and health back into a better shape.
Posted 26 June 2020 - 01:37 PM
P.S. If you haven't yet, please read through some of the things on the forum to help you better understand having Graves' Disease and of the articles.
Posted 26 June 2020 - 02:11 PM
Thank you. I am on Metoprolol now and was to start the Methamizole after the RAIU. I have the ability to message my endocrinologist before the test on Tuesday so I will do that to see why she suggests the test if the bloodwork already confirms Graves.
Posted 27 June 2020 - 01:25 PM
Welcome to this forum; hopefully you will find it helpful in answering your questions! When I was first diagnosed, I was also scheduled to have an ultrasound (which I did) and a RAIU which I declined to have following some research and gathering more information on Graves. It may be that the endocrinologist is scheduling the RAIU so that she can recommend radioiodine therapy treatment (nuking your thyroid gland) or surgery as treatment for Graves. Since you are positive for thyroid antibodies combined with your hormone levels, it's pretty certain you have Graves so the RAIU wouldn't really be needed in addition to avoiding an unnecessary dose of radioactivity!
Do not allow yourself to be pressured nor intimidated into doing something in a rushed way (you are not offending the doctor if you refuse the RAIU) - once you start taking the methimazole, your thyroid hormone levels will decrease in a matter of weeks and you should start feeling more stable and less anxious. Many doctors recommend a "permanent" solution rendering patients permanently hypothyroid which comes with its own set of problems. The best you can do for yourself right now is to educate yourself about Graves, read through this forum (I found it extremely helpful upon diagnosis; I read through years of questions and posts which helped me decide how to proceed and what I wanted to get done and what to refuse) as well as other sources such as Elaine Moore's forum.
Make sure that your doctor orders lab tests 4 to 6 weeks after initiation of methimazole therapy (not later than 6 weeks.) When the hormone levels start decreasing the med dosage should be adjusted downward until you're euthyroid on the least amount of medication - this will probably take months. Always get labs before adjusting dosage. Please know that the TSH will remain suppressed for a very long time (maybe even for good in some cases) so make sure your doctor does not make dosage decisions based on the TSH level. If your doctors haven't done so already, make sure you have your liver enzymes tested before the start of methimazole so you have a baseline.
Many of us, Grave's patients, have realized that many doctors, including endocrinologists (or especially endos) struggle to treat Graves successfully because it's both a very individualized condition and requires a great deal of monitoring, especially in the beginning of treatment. Graves requires us to be knowledgeable and empowered patients; if you do that, then you strengthen your chances of remission, which is, after all, the goal! Let us know how it goes!
Posted 27 June 2020 - 02:56 PM
She did say she would like to attempt to treat with medication first in order to save the thyroid. I already have the lab order for 4 weeks after beginning the Methimazole and she did mention about watching the liver enzymes. Thank you for bringing all of that up, as it reminded me a of a few things her & I had discussed.