[AnnaLeigh]

#1018299

Hello all…I received I131 when I was a young woman. I was around 23. The treatment knocked me into a hypothyroid state very quickly. At one point in time, my T4 was less than 2 and my TSH soared to 65. I began lifelong T4 supplementation…Synthroid. Over the next ten years, my dosage gradually increased, up to 150 mcg. I stayed on that dose for the next twenty years (I’m now in my early fifties).

For many years, I’ve done TSH only testing to monitor my thyroid status. It has worked well for me. That is, keeping my TSH between one and two has worked well, and so I never bothered much to check T4/T3. However, a few months ago, I began to feel unwell. Tired. Really tired. Irritable. Had a TSH run…very suppressed 0.03. I usually see the nurse practitioner, and we both agreed that I needed to cut my dose and see what happens. So, it was cut to 125 mcg. Retested a few weeks later…TSH was still low but had come up (0.2). Dose has now been cut to 100 mcg, and I’ll be getting a full thyroid panel done in a couple of weeks.

My question…could declining female hormone levels (I’m not technically menopausal yet…but I’m close) account for this decreased need of thyroid hormone? Estrogen binds to T4…I’m sure my estrogen levels have dropped…could this be playing a role? That pre-menopausally, my estrogen was binding up well that T4, making it less available…presently, less estrogen might mean more free T4?

I shudder to think that Graves’ Disease autoimmunity has returned. I would think it would have to be some really strong autoimmunity operating in order for those stimulating antibodies to juice enough hormone out of that almost totally destroyed gland to necessitate dropping the dose from 150 to 100 mcg (and, who knows, after testing, I may have to drop the dose even lower).

I’ve also wondered if perhaps I have some occult, but serious, nonthyroidal illness going on…that Euthyroid Sick Syndrome mechanisms might be suppressing TSH. But that could very well be my overmedicated status making me slightly neurotic in my thinking ).

It’s very perplexing and am curious to know if any of you ladies have experienced something similar when you approached/entered menopause.

Thanks for your input,

Anna

[Bobbi]

#1063838

Basically, Graves autoimmunity is never gone for us. The antibody levels typically rise and fall for no well-understood reason, but the antibodies are persistent once created. And, even after RAI, the antibody levels can have an impact on our replacement hormone needs. There are other factors as well — and not necessarily euthorid sick syndrome — that can cause us to need more, or less, replacement hormone. Over the years, my replacement dose has been adjusted at least two or three times — both up and down. It’s an easy fix.

[Ellen_B]

#1063839

Hi Anna,
Your looking into changing estrogen hormone levels possibly effecting the levels of different forms of thyroid hormone is very interesting and should be investigated. I do not have an answer to that. I hope someone in the audience does. I am sure someone must be doing work on menopause and hyperthyroidism.
Another question you are sort of hinting at is, Does an irradiated gland ever recover any function? According to Dr. Douglas Ross (Thyroid Associates Massachusetts General Hospital, Boston) there are two instances when it does.
“First, shortly after radioiodine treatment, some thyroid tissue may become “stunned, “and for a short period, approximately one to six weeks, the thyroid may fail to produce adequate thyroid hormone. A few months after treatment the stunned tissue may recover.
[This is not your case since 30 years have gone by.]
“Second, over the long term, it is possible for small remnants of unaffected but normal thyroid tissue to grow and begin to produce sufficient thyroid hormone to allow either a reduction or elimination of the levothyroxine dose. RARELY, THE GROWING TISSUE WILL PRODUCE RECURRENT HYPERTHYROIDISM.
In general, however, once thyroid tissue has been destroyed by radioiodine, hypothyroidism is permanent.
The conditions which produce euthyroid sick syndrome are a variety of non-thyroidal illnesses including infections, trauma, surgery, myocardial infarction, malignancies, inflammatory conditions and starvation. It is highly unlike you have anyone of these conditions. If you have any questions ask your doctor.
I hope you start to feel better very soon.
Ellen Brightly
Administrative Assistant
Graves’ Disease Foundation
400 International Drive
Williamsville NY 14221
Toll-free — (877) 643-3123
Email: Gravesdiseasefd@gmail.com
Website: http://www.NGDF.org

[Ski]

#1063840

I have heard at several conferences that hormonal status (puberty, pregnancy, menopause) can change our need for thyroid hormone replacement, precisely for the reason you state ~ thyroid hormone binds to estrogen and the chemical reactions change, so the dose needs to be adjusted.

If we still had our thyroid, the feedback loop with the pituitary would automatically solve these issues, but since we no longer have a thyroid to react, we need to be tested and adjust our replacement dose. I do hope you’re feeling much better soon! Try not to worry, at least. ” title=”Very Happy” />

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