Hi, I'm newly diagnosed with Graves, taking propranolol for symptoms with good effect. But my face looks so very pale. Is this normal?

[Lmclem]

Hyper propranolol pale

[PurpleNails Administrator]

Thyroid affects so much and can cause a huge array of symptoms. The text book say Graves sufferers have warm velvety skin & hypothyroid have pale dry.

Being pale might have another cause, such as being iron deficient. The symptoms are easily complicated by your hyperthyroid symptoms.

GPs do not always do a full thyroid function. Do you have / or can get a copy of your results, you can request a print out. You need your results with ranges.

TSH, FT4 and FT3. Also important to test vitamin D, folate, ferritin (this will show if you need an iron panel) and B12. These need to be optimal for thyroid health.

You also must have your thyroid antibodies checked (although this is usually only done by specialist). Presumably your antibodies have been tested at least once to confirm your Graves?

[Lmclem in reply to PurpleNails]

Hi

Thanks for your response. I've had full thyroid function and antibody tests, but not vitamin D, folate, ferritin and B12, so I guess that's the nest step

[PurpleNails Administrator in reply to Lmclem]

Have you been prescribed an anti thyroid such as carbimazole or PTU? this will reduce production of excess thyroid, whereas propranolol which is usually only prescribed temporarily will be relieving symptoms.

What dose are you taking? are you taking any other medication or supplements?

[Lmclem in reply to PurpleNails]

I am on Carbimazole 20mg once a day, no other meds or supplements

[PurpleNails Administrator in reply to Lmclem]

How long have you been taking carbimazole?

You must have a repeat thyroid function test around 6 weeks after new dose, as often requires adjustment.

[Lmclem in reply to PurpleNails]

Just started 4th week of treatment

[PurpleNails Administrator in reply to Lmclem]

Ok good, a repeat test in 2 weeks or so is in order. Make sure you FT4&3 is reviewed and dose adjusted by this and not just TSH.

When I was diagnosed I began on 20mg carbimazole and 3x40mg propranolol. Was tested after 2 months and my levels which were FT4 borderline high & FT3 well over range were both nearly below range.

Be aware propranolol is known to have a mild anti thyroid affect and can lower FT3. By reprioritising the conversion of T4 to RT3 over T3, so it helpful for hyperthyroid. Do not stop propranolol abruptly. I was advised to half my carbimazole to 10mg and stop propranolol & it triggered migraines. I have been back on it at a lower dose ever since. On the month I stopped taking it my FT3 rose quite high & disproportionately to my FT4.

[Marz]

How was your Graves diagnosed ?

[Lmclem in reply to Marz]

Antibody test, (I have not see the results) and letter from Endo Consultant

[jib70]

Are you saying this paleness has happened since you started propanolol ? If so might be the effect of this drug.

[Lmclem in reply to jib70]

Yes, only noticed since the hotness and sweating have gone. I just look pale really

[jib70 in reply to Lmclem]

Apart from your pallor how do you feel? Do you feel very cold, especially hands/feet? If you have poor circulation, breathing problems these can be seriously affected by propanolol as I believe it lowers your blood pressure.

I only offer this as a suggestion, and if you feel well apart from looking pale sorry I'm not much help.

best wishes.

[Lmclem in reply to jib70]

Thanks for your reply. I generally feel ok, tired though. Am only on 4th week of treatment, so early days for me

[pennyannie]

Hello Lmclem and welcome to the forum :

Graves is an auto immune disease and there is probably some genetic predisposition, possible a generation away from you, and can be triggered by a sudden shock to the system like a car accident or sudden death of a loved one.

Your thyroid is a major gland responsible for full body synchronisation, including your mental, physical, emotional, psychological and spiritual wellbeing, your inner central heating system and your metabolism.

Your thyroid is not the cause of your illness - it is the victim of an attack by your own immune system, and since the thyroid is such a major gland, when it comes under attack the symptoms expressed can be diverse, strange, with some symptoms considered life threatening.

Some people find they become nervous and anxious, others have insomnia, , most are exhausted, but mentally unable to turn off, others are eating everything in site and loosing weight, and this can all be just one persons' experience within 24 hours - as your metabolism is running very fast - your exhausted physically but can't slow down.

The anti thyroid medication works by blocking your own thyroid production and the NHS tend to give about a 15 month window of treatment with the thought your symptoms will lessen and you will be able to ride out this period and hope the antibodies stop attacking your thyroid and your thyroid production goes back down into range. Throughout this period you should be monitored regularly and as your blood test results reduce back down into range your dose of the AT drug should be adjusted accordingly.

The NHS do not know how to reduce, stop or control the antibodies that are attacking your thyroid but you can start to learn what you can do to help yourself and suggest you dip into the Elaine Moore Graves Disease website - as this is the most all encompassing site for all things Graves Disease, as Elaine has the disease and decided to do the research as she found little information in the mainstream when she became ill.

Your metabolism has been running very fast and now with the AT drugs it may have slowed it down too much, and when your metabolism isn't " spot on " there is a risk you will not have been able to absorb the nutrients and goodness from your food, so irrespective of eating well, it's essential to maintain your core strength strong and would suggest you get your ferritin, folate B12 and vitamin D tested as these need to be maintained at optimal levels.

It will be in your best interests to keep copies of all your blood test results and make notes on how you feel at each dose change so you can give this feedback to the endocrinologist as to your wellness at any given time, and so he gets some understanding of you as person, rather than just a mathematic equation and a blood test result on a computer.

I too have Graves and was put on Carbimazole, though I wasn't on any beta blockers so can't help with this question.

If in any doubts revisit the doctor, that is what s/he is there for, reassurance - but you will also find help on this amazing site as well, so just keep a foot in each doorway.

It is important that you do receive a positive antibody blood test report, and the medical evidence of Graves Disease are either a TSI ( stimulating ) or a TR ab ( basically blocking ) antibody above the range.