Thyroid Levels Trending Towards Hyperthyroidism
Posted 23 August 2021 - 10:40 AM
I was previously diagnosed with Graves' Disease and was treated with methimazole. I responded pretty well and went into remission. I think I stopped taking the methimazole around 2016 after being on it for maybe 2 years. I had my yearly appointment with my endocrinologist to have my thyroid levels checked. I received a note from him saying that my thyroid levels are trending towards hyerthyroidism. My results are as follows:
TSH - 0.051 (Range 0.270-4200)
FT4 - 1.52 (Range is 0.82-1.77)
T3 - 140 (Range 85-130)
TSI - 213 (Range 0.00-0.55)
The doctor wants to see me again to discuss the results. I suspect he will want to take some action. He was always pushing the radioactive iodine treatment and I suspect he will be pushing for it again. I understand that the methimazole might be an option. I didn't have any problems with it for the most part, but i didn't like taking it as I noticed some strange things happening when I was reducing the dose, and so I am not too excited about that option either. Right now I don't feel great, but I don't feel bad, at least like when I was originally diagnosed, but I kind of realize that I am a little off.
Is there any chance that this trend towards hyperthyroidism could reverse itself or is it just a matter of time before things get worse? If there is a chance that it could reverse itself, is there anything to help with that. I am pretty good with diet and exercise, but the precipitating factor for me now and before his stress.
Thanks in advance for any information
Posted 23 August 2021 - 02:51 PM
Hello minlad12 and welcome:
Only one of the thyroid levels is hypER which is the T3. Is the T3 a "FREE" T3 test? The FT3 test is a better test since it would not be affected by one's hormones, diet, etc.
In the case that the FT3 is high, a beta blocker is taken to lower this down.
The FT4 is within the normal lab reference range for you. Taking Methimazole, which is a T4 med, will lower down the normal T4 even more. The Methimazole is not currently needed.
I find that needing to eat clean and healthy (organic, non-GMO) to avoid chemicals, toxins, and preservatives helpful in healing my thyroid. I also use green household and personal products to heal. These have been helpful in keeping my thyroid levels stabled. I have been in a remission for a year and a half now.
Posted 23 August 2021 - 03:24 PM
Thank you very much for your response.
I assume the T3 number from my results is not the "Free T3 test" since there is no "F" in front of the T3 like there is with the FT4 in my readout which I assume equates to the "Free T4" test.
Thanks for your suggestions regarding eating and household and personal products.
I look forward to seeing what my doctor has to say
Posted 24 August 2021 - 04:35 PM
It could well be a temporary blip, but since a high FT3 can be uncomfortable and put unnecessary strain on our organs (including the heart) it's probably a good idea to do something to try and help bring it down. Some beta blockers, such as propranalol effect the conversion of FT4 to FT3 (which can effect FT3 levels), but I think the dose needs to be reasonably high so you'd have to consider your blood pressure and heart rate before taking beta blockers. As Mmztcass mentioned antithyroid drugs mostly effect the production of FT4; less FT4 production might result in less FT4 being converted into FT3, but sometimes the thyroid compensates for lower FT4 (or low iodine) by creating more FT3. I'm not aware of any way in which we can predict if that might happen. PTU (polythiouracil) has more of an effect on FT3 than methimazole based antithyroid meds, but would still primarily reduce FT4. PTU is generally reserved for pregnant women who can't take other antithyroid meds - as it has a higher risk profile for non-pregnant people.
Of your results it possible your doctor might look primarily at the low TSH and declare a hyperthyroid state from that alone. Unfortunately TSH receptor antibodies (TRAB), but especially the stimulating type (TSI, aka Thyroid stimulating immunoglobulin) bind to the TSH receptor and can effect whether or not TSH can bind there, this has a knock-on effect on TSH production. Guidelines for the treatment of Grave's recommend that TSH is viewed with caution because of this. I always think we don't have testing that is comprehensive enough, but the reality is that in many places neither the TSI or T3 would have been tested. In a perfect world an FT3 test would indicate how much of your T3 is active (although an increase in symptoms might suggest that your FT3 is at least a little higher than your body likes). The low TSH alongside elevated T3 and TSI (but not by itself!) does suggest a hyperthyroid phase of Grave's disease which may be mild and may be temporary.
If stress is your primary trigger, then stress reduction might help, and I realise as I type that how hard it is not to be stressed out in the current situation. Various slow breathing techniques are thought to help with anxiety or pacic - I often forget that - although it did seem to take the edge off an anxiety attack in the supermarket last week Observing our thoughts and our 'self talk' can be eye opening too - we are often much harder on ourselves than we are with others; we really probably should be kinder to ourselves Then there are things like meditation, minfulness, gratitude, yoga or pilates - none of which are likely to hurt and may just help
In the distant past (1940s or 1950s from memory) a series of 'starvation' trials were conducted that showed T3 dropped significantly in response to either fasting, calorie or carbohydrate restriction. Carbohydrate restriction was shown to have a slightly stronger effect than calorie restriction. The drop in T3 lasted for as long as the various interventions. Of course we know now that it's possible to eat very few carbs without starving. My own T3 toxicosis resolved shortly after adopting a low carb diet, but that could be purely coincidental and I've not been in a position to try that again to see if I get the same results (specifically I was mostly following a low carb, paleo version of the Wahls protocol at that time, so I certainly wasn't starving!)
Many health promoting diets do have some common ground: reduce or eliminate highly processed foods. Which is basically a fancy way of saying the same as Mmztcass - aim to eat wholefoods, preferably ones that haven't been drenched with chemicals or been genetically modified.
Beyond stress and diet, avoiding environmental chemicals can help to settle an immune response (and again is highly unlikely to make matters worse) - we have don't have any control over the endocrine disrupting chemicals in the outside environment, but we can contol what we use in our homes and on our bodies
That was rather long! I hope you found something useful or at least interesting in amongst all that
Posted 25 August 2021 - 06:32 PM
Thank you very much for your reply Allies.
Like the response from [color=rgb(40,40,40);font-family:helvetica, arial, sans-serif;]mmztcass, it has lot of good information.[/color]
[color=rgb(40,40,40);font-family:helvetica, arial, sans-serif;]My diet is generally not too bad and kind of corresponds with what [/color][color=rgb(40,40,40);font-family:helvetica, arial, sans-serif;]mmztcass and you mention. In any event, it is not perfect, so I may try to reduce my carb intake a little more.[/color]
[color=rgb(40,40,40);font-family:helvetica, arial, sans-serif;]Also, my cleaning and household products are generally good but I will take stock of what i use and see if can make any improvements in that regard.[/color]
[color=rgb(40,40,40);font-family:helvetica, arial, sans-serif;]One thing I am wondering about now is whether a B12 supplement that my primary doctor prescribed in February is making things worse. He prescribed the b12 upon reviewing my labs from a physical. At that time my TSH and FT4 were in a normal range (neither a T3 or FT3 were evaluated), but I had a normal, but low, B12. At that time I was stressed or perhaps it was just that anxiety feeling that arises when the thyroid is acting up. After seeing my normal thyroid levels i didn't think the thyroid was an issue.[/color]
About a month and half after the physical and on the B12, I was not feeling all that well, and happened to be going to a dermatologist for pernio or chilblains that appeared on my fingers out of nowhere. She was concerned I might have lupus and sent me to a rheumatologist. i saw the rheumatologist in June and she evaluated me for a bunch of things including, but not limited to, lupus and vasculitis. Nothing showed up in her tests. However, I didn't ask her to screen for thyroid levels just because I didn't think it was an issue. Anyways, during that time I stopped taking the B12, and started taking curcumin, a collagen drink since the doctors were hinting at lupus, vasculitis, psoriatic arthritis. The other supplements that i take are a multivitamin that i have been taking for many years, vitamin D3 and fish oil.
In the back of mind, i was wondering whether i should get back on the B12 because the potential problems that can rise if one is deficient. In any event, I held off and decided only to get back on after receiving [color=rgb(40,40,40);font-family:helvetica, arial, sans-serif;]the thyroid levels from my endocrinologist. I thought that maybe it might help with the thyroid, but after two days I feel a little more anxious and now it makes me remember of some the anxiety that i was feeling a few months ago which i wasn't attributing to the B12 supplement. It probably isn't the reason for my bad thyroid results, but i am thinking it is not helpful[/color]
Posted 26 August 2021 - 04:12 AM
It does seem that life can become a constant n=1 experiment as we try to figure out what works for us as individuals. As an example I'd been taking a herbal stress reduction tablet that seemed to be working, but how could I be sure unless I took a break from it? So I did just that and became quite anxious again; but being a rather difficult so and so I decided that wasn't actually concrete proof - any number of things might have caused the increase in anxiety (the general situation or lowish, or highish thyroid hormones spring to mind!) So my next step of course is to reintroduce the supplement and see if it blunts the anxiety. We'll see how that goes
B12 seems like it can be a tricky beast, and I'm not sure I understand all the intricacies around the different forms, the different blood tests and the ways in which our bodies absorb, process and use it. However you know your body best and if after your own n=1 experiment you feel it might be detrimental, then not taking it, or trying a different source might be a good option (either food sources or a supplement with different, or less, fillers maybe?). Mmztcass might have some insight on methylcobalamin (if I've got the name right...), which is more easily absorbed by some people - don't ask me to explain how; whenever I have to think that hard about supplements I usually default to figuring out where I can get said nutrients from the food I eat. My smoothies are sometimes like pure alchemy!
Posted 28 August 2021 - 02:39 PM
Ideally B12 would need to be taken with Folate (not Folic Acid). They work together. Methylcobalamin B12 is used by some people who have not been able to use Cynocobalamin form of B12. That is referred to as Methylation problem. Some people can have what is called a MTHFR gene which taking the B12 form of Cynocobalamin will cause problems such as higher Homocysteine levels.
I noticed you mention taking a multivitamin. Does it contain Iodine? If so Iodine for many people with Graves' Disease often cannot be taken as it will be a trigger for going hypER as in raising the T3. I would find a form of multi (whole foods types are better than synthetic) that doesn't contain Iodine.
I can now tolerate small doses of Iodine. But for many years I was not able to.
And does the Collagen drink contain any other ingredients that may be questionable? What about the fish oil and vitamin D3?
I have always found anything added to the ingredients as the so called inactive ingredients presented problems for me that I needed to go without. Hence whole foods types of vitamins/supplements for me did not cause problems such as the synthetic ones do.
Posted 30 August 2021 - 05:36 PM
Thanks again for your input.
The multivitamin and vitamin D3 are food based.. The multivitamin does have 150 mcg of iodine, and as for the vitamin D3, fish oil and the collagen I do not see anything in the ingredients list that suggests that there is iodine in there.
Even though the multivitamin does have some iodine, i kind of think it is not responsible for my recent thyroid levels as i have been taking this vitamin for all of the previous 6 years in which my thyroid levels were in range.
Anyways, all of your comments are good things for me to think about.
I appreciate your insight.