[Bobbi]

#1062725

I am not sure I understand your questions completely, but I will try to answer at least some of them.

When someone has an autoimmune disease like graves, the antibodies are, typically permanent. That said, antibody levels do rise and fall for no well-understood reason. That is why someone with rheumatoid arthritis, for instance, can have extended periods of time that are relatively pain free, and then have a surge of symptoms for months on end. For us, with Graves, if the thyroid is removed, as yours has been, fluctuating antibody levels are, essentially "unemployed." Antibodies are specific to a set of proteins (a tissue in the body), and if their target tissues are no longer there, they cannot cause a problem. In our case, that means they no longer have any impact on thyroid hormone levels. So using the antibody levels as a guide is probably not useful at all to you now that you have removed your thyroid.

Replacement hormone IS thyroid hormone. It is chemically identical to the T4 (thyroxin) that your thyroid used to produce. So, if you are taking too much of it, you will have a suppressed TSH (be hyperthyroid). If you are taking too little of it you will be hypothyroid. And it has nothing to do with antibody levels any longer. It is controlled by your dose, and whether or not there are other medications you are taking, or foods you are eating, that would interfere with the ability of your body to absorb the chemical. Or, conversely, enhance the absorption of the chemical. Some medications do indeed affect absorption one way or the other. If it is a medication we need, constantly, then the blood tests will show a need to alter our dose of replacement hormone. The key is, typically, to be consistent in taking the other medication. If we take it at the same time every day in relation to our replacement hormone, then whatever impact it has will be consistant, and we’ll be able to adjust our dose of replacement into the proper levels. Problems typically arise when we are not consistent, and then there can be fluctuating levels of thyroid hormone in our bodies, which isn’t good for us.

[Maria598]

#1018105

Good morning
I am a 40 year old female
My previous test results on 08/01/2011 was the following
S-TSH 0.05 uiu/ml range .35 to 4.9
S-FT4 10.3 pmol/l range 9.0 to 19.0

The GP suggested lowering medication ( Diotroxin ) to 3/4 of a tablet. But because Seroquel suppresses T4 and I felt Hypothyroid, I changed my medication time from the evening ( when I take Seroquel 300 mg) to the morning. Hypothyroid symptoms have just about disappeared. Dr wanted new test in 4 weeks time.

New test results – done on 05/02/2011
S-TSH <0.01 uiu/ml range .35 to 4.9 (decrease from previous test )
S-FT4 12.5 pmol/L range 9.0 to 19.0 ( increase from last test )
S-FT3 3.8 pmol/L range 2.6 to 5.7
Anti TG AntiBody 3.24 iu/mL range 0.31 to 4.11
Anti TPO AntoBody 17.00 iu/mL range 0.16 to 5.61
Thyroid scan on 17/01/2011 shows no abnormailities at all.

History –
I had a partial thyroidectomy in 1993 in which they removed the isthmus and small parts of each lobe. Then in 1995 I had to have Radioactive Iodine treatment because what was left of the thyroid again went overactive. They mentioned Grave’s disease after the iodine uptake test, but I cannot remember if they did an antibody test back then. Started Eltroxin in 1996 and changed to Diotroxin in 2007. I have been diagnosed in 2009 as Bipolar Manic, but if I look at my history and past bloodworks for thyroid, my manic episodes seem to coincide with times that my test show a low TSH.

Questions I have now
1. Does the high Anti TPO antibody level indicate Grave’s disease?
2. Does Grave’s disease not stop after the thyroid is destroyed?
3. Does the high anti TPO antibody level have anything to do with the low S-TSH level or is it just a case of overmedication as the dr (GP) says?
4. Could the high Anti TPO antibody and low TSH indicate a possible pituitary gland problem, because as far as I know the TSH is produced by the pituitary gland.
5. The GP changed my meds from Diotroxin ( 1 tab p/d) back to Eltroxin .05mg 1tab p/d. He wants me to retest in 8 weeks but only TSH because the FT4 and FT3 are in normal range. Should I wait the 8 weeks or rather go and see and Endo.

99% of the Hypo symptoms I had , have disappeared, but I have now got more hyper symptoms than I had previously. I have started to develop serious low blood pressure during the last 3 weeks (80/60 and at times even lower). My heart at times stop beating and then jump starts with a hard thud, at times I also have a hard time to feel my pulse because it is so soft and at other times my heart just wants to run away.

Please help me understand the results of the latest test and what would be the best for me to do – wait for the next test or go see and endo.

Any input that you can give in this matter will be highly appreciated.

Thanks
Maria

[Maria598]

#1062726

Hi Bobbi

Thanks for your reply. So, if I understand correctly, I don’t need to be worried at all about the antibody level, but more about the dosage of medication.
To clarify that a bit, I was put on Diotroxin in 2008 by my GP coz it seemed I reacted negatively to the Eltroxin ( I came out in a rash after he doubled my dosage). Since the change I have been having a hard time balancing the TSH levels.
FT4 and FT3 are in range, but the TSH is too low. So, the Diotroxin (90 mcg t4 and 10mcg t3) dosage is too high then? Am I correct? That is then also why I am having all these hyper symptoms?
I changed GP because of this and the new dr changed me back to Eltroxin, but a lower dosage, .05mg per day.

Would a change in dosage and type of medication make a difference then?
There was a few weeks ago when I ran out of tablets and could not get more ( I did not take any for 2 weeks) and then my TSH went up to .05. ( tested after I took it again for 1 week) Slight increase but still.

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