[Carito71]

#1059551

I found this article very interesting and wanted to share it with you.

http://www.eje-online.org/content/155/6/783.full

Figure 2 was very interesting. You can click on the figures to enlarge them.

It was published in 2006. I wonder if there is more recent information about this out there (about breaking the loop/cycle, perchlorate as a possible treatment).

Caro

[Carito71]

#1175665

General information from ncbi about Perchlorate. Very interesting. I wonder if Graves cases are less in parts on earth with Perchlorate in drinking water.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681191/

[Kimberly]

#1175666

Hi Caro – The study that is referenced in the EJE article was done close to 30 years ago. As far as I know, perchlorate has fallen out of favor as a treatment option for hyperthyroidism, with the widespread availability of drugs like methimazole and PTU. I’m guessing the concerns over an increased risk of thyroid cancer (which is mentioned in the ncbi article) was probably what shifted the balance away from perchlorate and towards the drugs that we use today.

[Carito71]

#1175667

Thank you Kimberly. I thought that it was newer than that … Oh … we don’t want cancer on top of GD. It is interesting about the cycle theory though. Has there been any more studies about that? One would think that after almost 30 years there would have been other studies regarding the cycle theory.

Thanks again,
Caro

[catstuart7]

#1175668

Interesting article Caro! It gets a few ideas churning. If their conclusion is right hyperthyroidism itself increases the autoimmune reaction and euthyroidism reduces it, I wonder what hypothyroidism does? Over and over I’ve read (and experienced) that endos often make their patients hypothyroid by keeping them on a dose of anti-thyroid drug that is too high for too long. My guess is that it is probably easy to overshoot the mark too. Yet hypo is considered a lesser evil than hyper, but there’s an autoimmune process going on there too for some of us – I haven’t been tested and hope to be, but I’m fairly sure I also have Hashi’s antibodies. I noticed my TED symptoms flare when my thyroid levels fell to their lowest during my initial round on methimazole. I had actual pain behind the eyes and with certain eye movements. Before that while hyper, I never had pain but gradually got some protrusion of one eye which I hope will behave and go back in now. I am quite motivated to find the ideal euthryoid state!

So anyway, my layman’s proposal is that endo’s need to be more careful about not only ending the hyper state but also not creating the hypo state as autoimmunity is aggravated in either case.

[Kimberly]

#1175669

@Caro – The article itself from Laurberg was more recent, but the specific study that was mentioned involving perchlorate was from 1984. There has actually been quite a bit of controversy as to whether anti-thyroid drugs have a direct immunosuppressive effect that is responsible for causing remission — or whether they work by creating a euthyroid state, which subsequently reduces antibodies. There have been quite a few studies supporting either viewpoint. The latest ATA/AACE guidance notes that ATD’s “might” have an immunosuppressive effect, but these agencies lean more towards the theory that it’s the euthyroidism that has the biggest effect.

@catstuart7 – I’ve never seen any studies that specifically looked at levels of antibodies in patients in a hyper vs. hypo vs. euthyroid state. However, there is research to support that the eye disease occurs most commonly (although now always) in patients who are hypERthyroid, and that hypOthyroidism causes a worsening of the eye disease.

[HelenYH]

#1175670

Kimberly wrote:

@catstuart7 – I’ve never seen any studies that specifically looked at levels of antibodies in patients in a hyper vs. hypo vs. euthyroid state. However, there is research to support that the eye disease occurs most commonly (although now always) in patients who are hypERthyroid, and that hypOthyroidism causes a worsening of the eye disease.

Thanks Kimberley. Did the research say that the worsening of eye disease happens after hypOthyroidism, regardless of whether it’s RAI, Anti-thyroids or surgery? Or is it just from hypOthyroidism after RAI?

[Kimberly]

#1175671

Hello – A very small percentage of patients who are hypo actually get the eye disease, even if they don’t have Graves’…this is why we are seeing more and more docs refer to the condition as “thyroid eye disease” rather than “Graves’ eye disease”.

I have not seen specific research related to patients who become temporarily hypo on anti-thyroid drugs or after surgery. The biggest concern seems to be with hypothyroidism following RAI. In fact, the latest medical guidance notes that hypothyroidism following RAI is a “risk” factor for worsening of the eye disease.

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