Forum Replies Created
-
AuthorPosts
-
It takes a good six weeks for the levothyroxine to reach an optimal and stable level. That is why your labs at first are usually 8 weeks apart. I have been on it five years and I very rapidly reached the correct dose and felt normal after starting it. With only a few minor dose changes over the years, I feel exactly like I did before I got Graves.
That being said, my irritable bowel and migraines and anxiety and allergies, all of which I had preGraves, have not changed either! Especially after having been on an antithyroid drug like methimazole for awhile and changing to a hormone, I would not be surprised at a flare in your GI and other pre Graves conditions as your body adjusts and things settle down. There may also be a need to adjust your dose and you will be able to determine that at your first labs.
As Graves seems to be triggered by stress and anxiety, especially in people with other autoimmune issues like allergies, etc., it is sometimes hard to know if symptoms are caused by thyroid hormone levels or anxiety, allergies, IBS, etc. In the meantime, while you wait for your first labs, treat those other conditions like you would have treated them preGraves.
It is usually pretty easy to find the correct levothyroxine dose. Wait an hour before eating after taking meds, no supplements like calcium for 4 hours, no biotin, and be aware PPIs like Nexium will affect absorption also. I have no idea if Miralax affects absorption, but would doubt it; you might take it a couple hours post levo just in case if you can.
Hang in there. You should be back to your baseline normal soon.Increased metabolism will require more hormone so if you have more muscle, less fat and/or exercising, your body could be calling for more hormone. By thyroid ablation, do you mean RAI? If so, maybe your thyroid finally stopped producing any residual hormone, requiring more replacement hormone.
in reply to: Specifics about calcium #1185484Antacids, supplements with calcium, iron, magnesium including vitamins, interefere with levothyroxine absorption if taken within about 4 hours of taking levothyroxine. This does not mean it totally negates your hormone pill, just that less of it will be available to your body. This time frame is a guideline. You should refrain from drinking or eating anything except water within one half to one hour after taking levo. Supplements or vitamins have a lot more calcium than milk on cereal or in coffee so after 1/2 to 1 hour, you eat breakfast, have coffee with cream, cereal, etc. You will hear of other foods that may interfere with absorption, but do not get wrapped up in all that. Dosing levo does not occur in a vacuum. Some days your body may require more or less hormone than others, just like when you had a thyroid. Fortunately, the half life of levo is a week. This means it takes a week for half of the first dose to clear your body. Thus it hangs around a long time, easily accommodating any little variations in your requirements or absorption. I eat whatever I want after about 30 minutes in the morning, but take my calcium supplement with dinner. I take Pepcid if I need an antacid as it does not interefere with absorption. In a very short time, you will not even think about it. I have been taking it for five years. Due to the long half life, if I forget a pill, I just take two the next day. If I accidentally take a second pill, I just skip the next day. In reality, you could take a weeks worth all at once and they actually do this for patients who cannot be relied on to take a pill every day. So relax, you’ve got this!
in reply to: Taking medication on an empty stomach #1185470I often take things like Tylenol or even Pepcid or an antihistamine with my levothyroxine in the morning. You can wait and take after an hour, but if I wake up with a headache or allergies, I just go ahead and take together on an empty stomach, no problem. Obviously, you would not take calcium or magnesium, etc with the levothyroxine. You can also take meds at night four hours after eating which qualifies as empty stomach. It is all about being consistent. I know people who always have coffee first thing in the morning with their levothyroxine. They end up being on a slightly higher dose to compensate for the coffee’s interference with absorption.
in reply to: Specifics about calcium #11854814 hours after levothyroxine before you take calcium supplements but I would not worry about milk, lattes, etc if one hour post levothyroxine. I have coffee with cream and sometimes cereal with milk, no problems. Be aware that proton pump inhibitors, like Nexium, etc can interfere with absorption. Coffee actually interferes with absorption, but as long as you are consistent, like drink coffee every day or do not drink coffee, your dose will stabilize to reflect your habits.
in reply to: TSH: Which way is up? (Provider interaction) #1185477TSH measures your body’s call for thyroid hormone over time, to put it simply. A high TSH means your body has been demanding more hormone, i.e. it is not getting enough and needs more.
in reply to: Advice on anxiety 20 months post diagnosis #1185473I admit I am totally biased in favor of total thyroidectomy. I was miserable the six months I was on methimazole, not the least of which was the anxiety caused by the frequent blood tests and never knowing if and when the diseased thyroid was suddenly going to chug out more hormone or less hormone. That all changed within a couple of weeks of thyroidectomy. It has been five years and I have felt normal from the beginning. I do not even think about what my TSH may be doing! Labs are on average every nine months or so, whenever I get labs for other things, like cholesterol mainly. Other people seem to cope well with antithyroid medication, but for me, I was glad to put the whole thyroid regulation drama behind me. You are doing the right things, but in my case at least, nothing worked except removing the diseased organ.
in reply to: Baffled by lab test results #1185463A TSH that high means your thyroid is producing no hormone which is the object of RAI. In other words, your thyroid has given up the ghost and you need replacement hormone, levothyroxine. I had a TSH of 40 on methimazole early on and I felt the worst of any time during the entire course of the disease. If you do not hear first thing Monday, keep calling until you do. You must be feeling bad with a TSH that high.
in reply to: Weight gain inevitable? #1185459You have only had one set of labs and your levels will be changing as your thyroid stops producing hormone and you become hypo, requiring replacement. Of course, the slower metabolsm of hypothyroid would cause weight gain. Going from being hyper, where you probably could eat anything and not gain due to the faster metabolism, to normal probably will require an adjustment not only in eating and exercise but also your body’s set point. So be patient and see what your next labs say. I am five years post thyroidectomy and am at my normal prior to Graves weight .
in reply to: Thyroidectomy #1185446The thyroidectomy is easy compared to dealing with methimazole! I had my thyroidectomy six months after Graves diagnosis. Surgery was outpatient, no problems at all. Quick recovery, minimal scar. My labs were normal right away. It has been five years and no regrets, no problems. Take my levothyroxine every morning, labs yearly and I feel exactly as I did preGraves. Just be sure your surgeon does a lot of these surgeries, makes all the difference.
in reply to: Rise and Fall of Body Temperature #1185443Normal body temperature is between 97 and 99. Daily variation is not abnormal.
What are your numbers? I go by TSH alone, keeping it between 1 and 2. Since you cannot be hypo and hyper at the same time, your labs will tell you which one if either. Graves does not preclude other problems, like irritable bowel or anxiety, so look for other causes too of your symptoms. If your RAI was not complete and you have remaining thyroid, thyroidectomy is an option.
in reply to: Multiple questions #1185434Do not have a blepharoplasty. Please see an oculoplastic surgeon who is familiar with Graves orbitopathy. TED is caused by antithyroid antibodies mistaking eye tissue for thyroid and attacking ocular muscles, lacrimal (tear) glands and soft tissue surrounding the eyes. It causes dry eye, lid swelling, muscle swelling and scarring causing double vision and eye bulging. It is not something to mess around with and it has to burn out before surgical fixes can be contemplated. It can affect the optic nerve which is the worst case scenario causing vision loss. There are studies suggesting early and complete surgical removal of the thyroid can help, either by preventing or shortening the course of the eye disease. Swollen eyelid is a mild symptom but any facial surgery can exacerbate the eye disease. It took steroids, ocular radiation and 6 surgeries on each eye to restore my vision and cosmetic rehabilitation, so you really need to find doctors with expertise and lots of experience with Graves. The sooner you get your thyroid levels under control and stable, the better. I went the thyroidectomy route and it did halt the eye disease as well as making me feel normal again immediately postop.
in reply to: Still fluctuating after all these years #1185421This article mentions four patients with recurrence of hyper due to thyroid remnants.
https://www.ncbi.nlm.nih.gov/pubmed/22547016in reply to: Still fluctuating after all these years #1185419I had one postop TT checkup at six weeks and he did an ultrasound in the office, even tho he was positive he got it all. He had done it preop too. Thyroid cancer patients get followup to be sure nothing at all is left and my doc felt it was just as vital for Graves patients. I think there may other tests like scintigraphy to look for the tiniest of thyroid tissue left behind.
-
AuthorPosts
