[belldandy112]

#1072599

I can only respond to 3).

Before going into the paralegal field, I trained as a concert pianist. Beta-blockers are commonly used by performers to inhibit the adrenaline rush that accompanies feelings of nervousness prior to getting on stage. Little known fact, eh? But it’s true. There were certain doctors that students on the performing track were sent to for this very purpose.

I took Atenonol (never can spell these meds right) a long, long time before I had Graves, but only on an as-needed basis before performances. It steadies the heart rate and eliminates tremors and sweaty hands caused by excessive adrenaline. The reason why I could not get shot therapy for allergies was because if I had a bad reaction to an injection, epinephrine — which causes an adrenaline surge — would not have been successful.

That I know of, beta-blockers do not affect the hyper-functioning thyroid in any way.

Melissa
Austin, TX

[omoplata]

#1019573

Hello Everyone and So Glad to Have Found This Board,

I am a 33 yr old male and all signs point to me having GD. I was intending to post my story as well as blood results tonight, but it is very late already and since numerous things came up, I wanted to start with another post. If you don’t mind me breaking the rules of logic, let me ask some more technical and conceptual questions that I cannot find answers to anywhere. So with apologies in advance for the poor organization, here are some issues that continue to baffle me despite a fair (though as yet inadequate) amount of reading. Very soon, hopefully tomorrow, I will introduce myself more properly and share blood test results with you.

1- I have read on numerous occasions that ATD treatment works only for some patients with success rates quoted at around 20-30%. I am also reading conflicting statements, however that imply that ATDs will almost certainly reduce thyroid levels in the blood. Can you please shed some light on this concept? When it is quoted that ATDs have a 20% chance of success, does that mean only around 20% of people can manage GD symptoms with only ATDs without experiencing any relapse at all (even though ATDs work in the beginning), or does that mean only 20% of patients experience some relief of symptoms from ATDs, while the remaining 80% or so are completely unresponsive to these drugs and experience no reduction in serum thryoid levels?

2- As I will explain in greater detail in another post very soon, the severity of my symptoms fluctuate greatly. The extreme heat intolerance comes and goes (though is here at some degree of intensity almost all of the time) and so do other symptoms such as shortness of breath, fatigue and hand shaking. If I understand correctly, this is not so uncommon. If a person like me starts to use ATDs, how does he reconcile the fact that ATDs take a long time to work with the fluctuations in the symptoms? In other words, let’s say someone is suffering moderately and gets on a certain dose of Methimazole. His symptoms improve and he is doing fine. Then, he gets extreme heat intolerance and palpitations and so on, and if the past is any guide, this heavy period will last no more than 2-3 weeks. What do you do at this stage? Does it make sense to increase the dose of methimazole? The drug normally takes 2-3 weeks to work anyways, so by the time the higher dose kicks in the symptoms will likely have gone back to a more moderate level, no? So what is the solution? Or am I thinking wrong in the sense that, once methimazole kicks in, an increase in dose works much faster than it took for the initial treatment to take effect?

3- I know this is real basic but still confuses me. How does propranolol help with GD? I understand that beta blockers will reduce heart palpitations if the problem lies with adrenaline / noradrenaline, but how come they help with GD? Do beta blockers have some kind of blocking action on thyroid hormone, or does T3/T4 have some kind of potentiating effect on adrenaline (just like cortisol turbo-charges adrenaline) thus a reduction in adrenaline binding helping indirectly? Also, is it true that beta blockers help more if the issue is excess T3 as opposed to excess T4?

4- Is there a solidly established connection between GD and cortisol disorders -or to express it better, abnormal cortisol levels?

Thank you so much and talk to you all again soon….

[mamabear]

#1072600

Omoplata,
There are others on here that will be able to explain in great detail the answers to your questions. I just wanted to say welcome and be patient as some of them work and dont’ come around till later.

Hoping that you find the things you need and work on healing.

[James]

#1072601

omoplata wrote:1- I have read on numerous occasions that ATD treatment works only for some patients with success rates quoted at around 20-30%. I am also reading conflicting statements, however that imply that ATDs will almost certainly reduce thyroid levels in the blood. Can you please shed some light on this concept? When it is quoted that ATDs have a 20% chance of success, does that mean only around 20% of people can manage GD symptoms with only ATDs without experiencing any relapse at all (even though ATDs work in the beginning), or does that mean only 20% of patients experience some relief of symptoms from ATDs, while the remaining 80% or so are completely unresponsive to these drugs and experience no reduction in serum thryoid levels?

Wow! Lots of great questions, I have time to address question #1 right now; and hopefully some of the others will assist you as well.

The 20-30% “success rate”, I believe that you are referring to has to do with those individuals that eventually go off of ATD, and sustain a long term remission (more than one year). Those numbers seems to vary depending on who you talk to and the study involved. These figures often cause confusion for many. Someone I personally know who was recently diagnosed was quoted this “20%” figure and was equally confused; thinking, “why bother if there is only a 20% chance that I will respond to the drug”.

Most everyone WILL respond to ATD therapy (by resonding I mean, reduce thyroid levels in the blood), there may be exceptions, but it is rare. The point is to get you to optimum thyroid levels the are within a “normal” range but are unique or optimum for you as an individual (normal ranges are quite wide). This does NOT mean that 80% of individuals are completely unresponsive to the drug.

There is however a smaller chance of side effects to the drug; from minor skin irritations to far more serious WBC counts. The later being rare, but still within the realm of possibility. Your Dr. can advise you as to these risks and what to watch for concerning side effects. Hopefully that gives you a little more clarity on your point #1.

Best regards,

James

[Ski]

#1072602

Great answers, everyone! ” title=”Very Happy” />

First just a quick clarification on beta blockers ~ they actually do nothing to treat Graves’, they just make us feel more comfortable until our thyroid hormone levels drop, and they also protect the heart from irregular rhythms during that time. Once the hormone levels are back inside normal range (not necessarily our own "perfect" point), we can wean off the beta blockers. Weaning is important, since a quick, cold-turkey withdrawal can cause a recurrence of the symptoms we’ve been suppressing. Typically we don’t take a very high dose anyway, so weaning is a pretty short process (a week or two).

What’s left? Oh, question 2! Fluctuating symptoms are a complicated issue. While we are sick, the antibody levels rise and fall for rather mysterious reasons, and we can also respond to stress with worsening symptoms, since stress causes an adrenaline rush and a "pumped up" immune system (which, in our case, does us no favors). I do not believe that an instantaneous change in med levels is necessarily indicated when symptoms flare, but that’s really something you should discuss with your doctor as you proceed with ATD treatment. You will likely find that flare-ups are not as pronounced, once you have begun ATDs. Remember that improvements you make in other parts of your life (diet, relaxation, coping) will likely help as you pursue treatment. They won’t affect your thyroid hormone levels, but they may minimize flareups due to stress, and they will definitely help you to feel better, heal better, as you go through the process.

James has it completely right as to ATDs ~ as far as I know, MOST (or all) patients respond to ATDs. They do lower thyroid hormone levels. Not all will achieve remission, which is defined as a period of time with normal thyroid hormone levels while taking NO medication. Remission is usually attempted after at least 12 months on ATDs (more likely 18-24 months). Another thing you should know is that ATD treatment typically involves several dose changes ~ at first, the dose will be rather high, so that levels drop rapidly back into the normal range. After that, there’s a bit of a "dance" to find the right dose to keep normal levels maintained. Once you begin the process, remember that it’s a pretty steady improvement curve (there shouldn’t be wild fluctuations, in other words). You may go back & forth for a while, but vigilance with your blood levels should minimize your discomfort during the process. Ask the doctor for a standing order at the lab, so you can have levels drawn any time you feel unwell and evaluate those with the doctor. Do not self-prescribe or change your medication levels ~ the doctor has been through this before, so they’ll help you through. Monkeying with the doses yourself can create confusion and delay your ultimate relief. Remember, we are all "statistics" for the doctor to draw upon when they treat the next patient, so give the doctor a chance to figure out what’s going on, right along with you. Have a VERY frank discussion with the doctor up front, indicating that you need a team member, and you need them to be responsive, even if they’re busy (endocrinologists are, I think, the busiest doctors there are). Figure out the best method ~ phone, e-mail, text message ~ whatever works for both of you, so you can be in touch during the most complicated part of your treatment, and you get RAPID attention when necessary.

Finally, I’d like to point out, just for the record, that achieving normal thyroid hormone levels does not mean that you will, that moment, feel WELL. Hyperthyroidism affects literally every cell in the human body. Sometimes we compare the process to a hurricane coming through ~ after the storm passes, is everything normal because the wind and rain have stopped? Not by a long shot. The roof is still going to need repair. When you hit normal thyroid hormone levels, that’s when the rebuilding can START. Allow time after hitting normal levels for your body to return to normal, and don’t push yourself too hard. Look for small improvements as time goes by, and don’t feel as though you’ve failed in your treatment because "my levels are normal, why don’t I feel good?" Patience, grasshopper. ” title=”Cool” />

[belldandy112]

#1072603

I ((heart symbol)) beta-blockers. My GP told me the in a few days, all of the really bad symptoms that I was experiencing would go away quickly, and he was spot on. Once my heart rate slowed, BP went down, the "sweats" went away, and the panic attacks abated, I felt very secure with the actual treatment for Graves. Methimazole permitted me to put weight back on — my primary complaint — and this meant far less pain and difficulty sleeping at night. But those beta-blockers were my "woobie" in the first few weeks. They really did help me, at least.

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