[RhondaG4]

#1018603

Hi all,
It’s been a LONG time since I posted. If I started to tell you all everything that has happened since I posted last, you’d look at me like I’ve lost my mind. Which I suppose is possiable.

The last I saw an Endo, she did an ultrasound of my thyroid and said it was functioning just fine, 6 months after RAI. She said it looked to her like the nodule that was on it was shrinking tho.

My last labs I was told are fine, but my thyroid is no longer functioning. Not sure how she came to that conclusion, cause I haven’t seen her in 8 months but have had labs tho. She has recommended to my PCP that she check my TSH every 6 months.

In the meantime, my Neuro doc said that he thought he remembered reading that a beta blocker could prevent the conversion of t3 to t4. Can someone explain if that is possiable, and if it could be throwing off my labs?

Also, I take Dexamethasone for a rescue med for my headaches. I’ve read that it is one of the medications they can use during a thyroid storm. Is this true? Could this somehow be throwing off my meds?

And last but not least, I’ve been told that I now am testing negative for antibodies against my thyroid. I was under the impression that even if you had surgery to have your thyroid removed, that you would test positive for antibodies against your thyroid for up to 5 years.

Needless to say, I’m more confused now then when I first started this journey. Can someone answer the basic questions for me? We no longer have an Endo in our town. The closest one is 3 hours away, and she is the one that I have seen actually in person once. My first Endo used a "National Lab" that has clinics around the country for the testing for the Graves antibodies. They consider anything above 16 positive and mine were 19. My PCP and the new Endo use another Lab that have different values. Thanks Rhonda

[Bobbi]

#1065967

The best person to consult with respect to drugs, their activity and their interactions is the local pharmacist. They may not have all the answers, but their field of study enables them to interpret information for us that might otherwise be murky because of our "amateur" status.

Sometimes people use words to mean one thing, and we understand something completely different. So, I would suggest you make a list of questions, as you think of them, to ask your endocrinologist. None of us here can even begin to suggest what might have been meant by the labs were fine but the thyroid was non-functional. Only the person issuing that statement can clarify it for you, unfortunately. It’s sometimes hard with busy doctors, but I do try to home in on information that I find confusing — right at the time. A simple statement like, "I don’t quite understand what you mean," should elicit an explanation.

Switching labs can indeed create some confusion. Different labs can use completely different testing techniques. So comparing one lab’s result against another’s can be a bit like comparing apples and oranges. What matters, in part, is whether or not our values are elevated/lowered outside of the expected normal range. When it comes to antibodies, their levels can rise and fall — over time — for no well-understood reason. So the fact that you were a bit off normal high for one lab report at one point in time, and back in the normal zone on a second lab’s report recently, does not really mean much. Those values could change again. And it would have absolutely no impact, as far as I know, on your course of treatment.

[waitman192]

#1065968

Man, I had a long response typed out, and it got lost on the computer. Blast. So I’ll try and summarize.
I had a bunch about your thyroid "no longer functioning" but also you’re not hypothryoid, which might not make too much sense (counterintuitive, if you will). My best guess is that the radioactive iodine did what most nuclear medicine people want it to do: knock enough thyroid out to make you go normo-thyroid. So for the most part, your thyroid isn’t working. As for the antibody question, everyone’s a little different. Some people might clear the antibodies a lot quicker than others, and you might just be that person. The good news is, you’ve beat the Graves! It’s really really important to follow up with you doctor though to trend those TSH’s, because they can rise quickly (meaning you’re going hypothyroid.) So just check every 6 months, and you’ll be better off. If you notice yourself slowing down, gaining weight despite eating well, then you might want to get yourself checked out.

Beta blockers. You’re right, there is some potential that they block the T3/T4 conversion process, as the inhibit one of the enzymes in that pathway. But this is minimal. The bigger effect is on the heart and your arteries. When your beta-receptors on your heart and arteries are stimulated, they tell the heart to pump faster, and your arteries to constrict, which results in a higher blood pressure, as the arteries are not as pliable and the heart needs to pump harder to get the blood all the way to your toes. So the beta blocker does what it says, it blocks the beta receptors on your heart and in your arteries, meaning your heart isn’t working as hard which is good, because you don’t want to work really hard for awhile and then poop out before you’re ready for it to die. (Think you can walk for a really long while, but you can only sprint a little bit before tiring out.)

About the dexamethasone, not totally sure, but my guess is that thyroid hormone and dex are similar in shape as they are both steroids (thyroid hormone being a steroid hormone). When you have a lot of dex, it outcompetes the thyroid hormone in thyroid storm, meaning the effects of thyroid hormone are muted. If that’s the way it works (like I said, I’m not sure), when you take dex for headaches, your thyroid symptoms might get better, but I can’t really see it totally effecting your other meds — though I’m not sure what other meds you’re on– you should be off PTU/Methimazole if you had radioactive iodine.

Hope that makes some sort of sense?

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