[cathycnm]

in reply to: Just Diagnosed #1075591

Tiffany – Glad to hear you are headed for continuity. I have a lovely, young female internal med PCP who is so personable and caring. She truly has been concerned about me and it shows. My endo is an older (retirement age) man with years of experience who prefers patient contact to a shiney office and was the only endo in a 100-200 mile radius for many years – now there are a handful. Sounds like an odd team – but they have complimentary strengths and that works well so far!

My daughter/granddaughter are in Montgomery. I live in Colorado but am doing my postmasters online through U South Alabama in Mobile. So, I have a couple roots in your state. Where are you?

[cathycnm]

in reply to: Post-RAI – when do I start feeling better? #1075550

That is a great idea, Ski! I think, in fighting depression, we have to choose to focus on what we can change. If research stands correct – all depression is a form of helplessness. And, we can induce it by just taking control of light switches from people for a few short hours. There is also some research that says optimistic people are more likely to survive a second heart attack – probably because they can control some things about this illness (diet, exercise). It is no fun to be helpless about anything – and I know I keep having to talk to myself about this cause Graves has taken some of what I could control away. But, I cannot focus there and not get depressed. So, not only is physical therapy a great choice (I did that when first diagnosed with osteoporosis and got some great tips) but it is something you can choose! It allows you to feel a little more in control and optimistic about the future.

BTW – I had a bunch of the nurses I was working with say I was going to gain 20 pounds after RAI so I might as well go eat my weight in chocolate cake and enjoy it. I keep my pedometer strapped to my side these days – this gives me a chance to see what I am actually doing each day and to set reasonable goals. The immediate feedback makes in engaging. I do worry about our 3-5 upcoming snow months – as ice and osteoporosis do not mix well. Guess I will be walking Target and Walmart when I can’t get outside. Cathy

[cathycnm]

in reply to: eye prescription #1075574

Jeanette – Are you seeing an opthamologist (an MD) for your eye exams or an optometrist? I shifted to an opthamologist who is watching the "big picture" of Graves eye disease as well as fitting for glasses.

My own eyes have had slightly puffy lids (periorbital edema) since summer and some redness and watering. My right eye, especially, has changed a good deal this year (for the worse) – both distance and close-up. My opthamologist was not surprised by that. I am also color blind (genetically since birth though mild – without testing, I would have never known). Since color vision is often the first thing to go in Graves (and mine was already gone), he wants me to return for visual field testing and to see me every 6 months to be sure my baselines are not changing. Eyes usually settle down in a year or two from first symptoms. I do not know for sure if visual acuity settles down then, too. It is time for my annual insurance eye exam so I will get a new pair. I am tempted to go with less expensive frames until this all settles a bit because I usually buy frames of endurance and only need a new RX every 3 years or so. That does not seem the case currently. I also got an inexpensive pair of computer glare glasses as the screen glare is causing eye strain much easier than before.

[cathycnm]

in reply to: Calcium and thyroid #1075585

Ski – Thanks. I wish I could talk to the HMO pharmacist during the wellness screens. But I know the pharmacist at my pharmacy so next time I stop by for my "supply" of drugs and it is not busy, I will ask him. I am also on thiazide for hypercalciuria and the osteoporosis that is an AM med. And a sleeper plus half dose of an antidepressant. Until 2 years ago – I was on antibiotics maybe once every two years. The shift is hard for me but I with any luck, I can slowly wean of some of this after the thyroid stabilizes. Thanks for your help. This board is great!

[cathycnm]

in reply to: Just Diagnosed #1075587

Tiffany – Welcome. My daughter and granddaughter are in Alabama!

I think some of the moderators know more about eyes than I do – I do think it depends on severity of what is going on. Are your bulging or puffy?

Just wanted to welcome you to the group!

[cathycnm]

in reply to: Attitude #1075602

Jeff – Graves is hard on relationships. I have a stressful, somewhat socially isolated job – which could have played in to my Graves in the first place. This summer and fall, when I was going through diagnosis and treatment, I reached out to my boss for some badly needed TLC. Her response was to get very angry with me for being ill. I am not sure where that came from other than we work on different campuses and rarely see one another. Maybe I came across as lazy, using health as an excuse. Maybe she is more formal in her workplace relationships and saw my wanting TLC as too personal. Maybe "thyroid" is taken too lightly – and even nurses don’t always know how bad we feel for months on end. (Today she called it "a little thyroid thing" to someone we were eating with.) I don’t know – but I do know the relationship was badly hurt and I am re-examining my long term job goals. Why? Because as the Gallup folks have found, people are most engaged if they have a "best friend" at work.

Remember that each of us has different strengths. And different strengths can make us different kinds of friends – some are mentors, some are companions, some are builders, some are collaborators, etc. Spouses are one type of friend (role depends on personality). Everyone needs a balance of different types of friends for support. Often, when we are stressed or isolated, we might expect one friend or spouse to play the role of many types of friends – and this strains the relationship. In my case, I thought my boss was one type of friend and she is another. I need to look elsewhere for the kind of TLC in the workplace I had expected. Perhaps your wife is expecting too much from you – or you from her. In reality, building a support system means being sure everyone is playing a role they do well and that we have a "team" of friends, if you will. My heart goes out to you – I know how this can stress relationships. I wish you and your wife resilience as you attempt to re-weave your relationship.

[cathycnm]

in reply to: Hyperthyroidism vs. Graves #1075665

Lynn – That is interesting. My understanding is that anything over 25% is abnormal uptake and that the uptake helps the endo determine the "severity" of the disease and rule out nodules. My uptake was 33%. When the radiology folks asked me about history, I said my guess was early, mild Graves. In the end, everyone said I had it pegged. I wonder if your endo means more severe Graves requires the 70%.

My own T3 and T3 were normal but TSH very low – but it had been normal 12 months prior so I knew I was early – and my mom had Graves. Honestly, I agree with the information that says different thyroid diseases are more similar than different – and what one is originally diagnosed with will often shift to something else as labs change with progression of the disease.

Let me know how it goes with your PCP. I am interested.

[cathycnm]

in reply to: Hyperthyroidism vs. Graves #1075660

Lynn – Did not mean to confuse you – this endocrine stuff is pretty amazing with that. The follicles ( similar to the follicles our ovaries make under the stimulation of ovarian hormones) are what are present in TMNG (the "nodules"). In multinodular goiter, the TSH is high is response to body need but if it goes on too long, it can cause an actual nodule that might produce thyroid hormone and TSH may drop. With Graves, TSH is low because the autoimmune response means thyroid hormone is made without the need for TSH to stimulate it. I wish you the best – it sounds like a confusing situation. I hope you will let us know what you find out! Cathy

[cathycnm]

in reply to: Graves Disease & other Autoimmune diseases(JCWRN look here) #1075638

JCWRN, Mamabear and Nancy – In the initial question, stroke, etc were brought up. Cardiovascular complications can happen with thyroid disease. Hyper tends to be an overworked heart and things like atrial fib. With hypo, even subclinical (meaning TSH is all that is abnormal) there are some changes with the lipids in the blood that can increase the risk for atherosclerosis. I was at a conference last month and the endo presenting gave a case presentation of subclinical hyper and hypo and why both should be treated due to risk of cardiovascular changes if left untreated.

Interesting on genetics and Graves. My mom had it – according to what I read only a slightly elevated risk (3% I believe) of getting the disease. My sister is hypothyroid. I find genetics fascinating – surely we will know more about that in the coming years. Cathy

[cathycnm]

in reply to: Cushings Syndrome #1075649

Nancy and Diane – Yes, I am a certified nurse midwife, and have done a fair amount of gynecology during my years (yes, they add up too). Of course – thyroid is an issue for many pregnant women. I will never forget a women in full crisis coming in for a new OB when I was at UTMB in Galveston – as she talked, I just though "wow she has a ton of pregnancy symptoms". Then I felt her thyroid and took her blood pressure – got her out of there to our resident’s clinics in under 15 minutes!

That said, I am currently back in school working on a post master’s certificate in psyc – so, Nancy, looks like we have that interest in common. I am plugging through pathophysiology right now with my undergrad patho being almost 30 years ago. It truly amazes me all we have learned in that time – esp about immunity.

Diane – I do some life coaching and did my training though a psychologist – Martin Seligman – who developed what is called positive psychology. Sounds trite, but he is known world wide and his work is backed with tons of very good evidence. For anyone dealing with depression – there are many simple exercises you can do to be happier. One of the most effective is to simply count blessings (or good things, if you prefer) at night – three of them. Write them down just before bed. This one works as well as some antidepressants. There are many others – and they are being developed as we speak. I am not saying you should go off antidepressants – I commend that you are working with your internist on this! I am just saying if we can do simple things that make us happier, why not. There is some growing research that this does make a difference in health and immunity and positive aging. There is lots we can’t control with any illness – but we do control the small things – and they do make a difference. I can post some book references if you are interested, too. (I fought depression with Graves and, again, with my rapid crash to hypothyroid in 5 weeks. I can’t imagine it if I had not been on antidepressants. The exercises helped more with putting joy back in my life – which goes above and beyond what most pills do). Cathy (yes cnm)

[cathycnm]

in reply to: Cushings Syndrome #1075644

Diane – Cushings Syndrome is the result of a high level of cortisol. Cortisol is another endocrine hormone – it comes from the adrenal cortex that is located in the kidney and, at normal levels, they help us deal with stress and reduce inflammatory response. Some people have Cushings disease – that is too much Cortizol stimulating hormone from the pituitary gland – very similar to TSH that also comes from the pituitary gland and thyroid hormone over production. Cushings syndrome – the excess stimulation of cortisol comes from someplace other than the pituitary but causes virtually the same symptoms. Usually, symptoms include things like weight gain, fluid retention, sugar diabetes. So, I am assuming you are on some sort of steroid medication to reduce the inflammation in your eyes – and that the cushings syndrome symptoms are from that.

I had mild issues with my eyes but also have severe osteoporosis – and cortizol can also worsen osteoporosis. So I am keeping my fingers crossed (and seeing an opthamologist and an endo) so I never have to choose between eyes and bones.

I believe the Cushings symptoms will resolve once you go off the med – but please talk to your doctor about this!!! There are risks and benefits to every med and eye sight is such a gift. My best to you!

[cathycnm]

in reply to: Hyperthyroidism vs. Graves #1075657

Lynn- My understanding of multinodular goiter is that the thyroid actually increases its # of follicles in response to INCREASED TSH in response to some external need for more thyroid – such as adolescence or pregnancy. (Hense the term "multinodular" – in actuality that refers to the folicules and not actual nodules, though some folks do eventually develop nodules from the follicles). The follicles generally go back to normal once the external need goes away – but sometimes there is permanent change. Toxic multinodular goiter is hyperthyroidism (or thyroid crisis) caused by the increased thyroid hormone produced if the level gets too high. And, it is true, it does not come with eye symptoms. I am actually quoting a current reference book on this (Pathophysiology by McCance and Heuther). From what I can tell – the main difference between Graves and toxic multinodular goiter is that in Graves the TSH is low because the thyroid can no longer respond normally to the TSH. In multinodular goiter, the TSH is high in response to an actual need for more thyroid hormone. Not sure it that helps but thought I would throw it out there.

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