Advice on the treatment

[femme12000]

Last blood test 19/05/2022

TS H < 0,014 (0,4-4,5)

FT4 1,75 (0,85-1,8)

FT3 5,35 (2,5 -4,4)

Folate 6.2 ( > 5,38)

B 12 307 (211-911)

D3/Ferritin - they did not test but

MCH 26.9 (27-33.5)

Antiperoxidase >1300 (60)

Big multinodular goiter with 4 cold nods(result of Gammagraphy 10/05/2021)

Strong headaches -no medicine helps,sore and light sensitive eyes recently..

Tteatment -before-5mg of carbimazol/10ml propranol (if necessary in case of tachycardia).

Now the doctor changed for15 m of carbimazol and insist on RAI .

What whould you recommend?

Thank you.

[SlowDragon Administrator]

Folate 6.2 ( > 5,38)

B 12 307 (211-911)

D3/Ferritin - they did not test but

MCH 26.9 (27-33.5)

Antiperoxidase >1300 (60)

Very High antibodies looks more like autoimmune thyroid disease also called Hashimoto’s

Have you had TSI or Trab antibodies tested for Graves’ disease

Hashimoto’s frequently starts with transient hyperthyroid results and symptoms before becoming increasingly hypothyroid

Request coeliac blood test before trialing strictly gluten free diet

Are you vegetarian or vegan?

Folate and B12 are low

What vitamin supplements are you currently taking

Ferritin and vitamin D need testing

Low MCH suggests anaemia

healthline.com/health/mch

Would a thyroidectomy be more appropriate if you have large goitre?

PurpleNails may comment on nodules

[femme12000 in reply to SlowDragon]

Thank you very much ,SlowDragon ,for prompt reply👍. I was never tested for Grave’s(no TSI or Trab antibodies tests)I am not vegetarian/vegan.

The vitaminas I take- Magnesium 400, Zink 5mg ,Selen100mg.

If I could chose I prefer the treatment but no RAI or a thyroidectomy.

Actually I have not too many symptoms- only sometimes feeling tired,irritated,sleepless but during a couple of months only ,after comes the other cycle-when I feel sleepy and depressed.

But all these are not interfering too much with my life, at least now ,I know all my problems but after the operation or RAi I have no idea how I will feel.

That’s why I have doubts.

And my goiter is growing inside so you understand all consequences and complicity of the operation.

Of course, if the biopsy shows cancer I will follow the necessary procedure .

Thank you again, for your attention.

[PurpleNails Administrator]

So if you have cold nodules (which do not function) where are the excess hormones causing the high levels coming from? Do you mean there were cold areas, but you have hyper functioning (hot) nodules?

You have high TPO antibodies which does suggest autoimmune activity. This can begin with fluctuating thyroid levels as the immune system destroys thyroid & they release hormone stores.

Has your hyper been continuous? Have you had times when your FT4 & FT3 have been too low?

Currently Your FT3 is a little over range but increasing dose by 3x is an over reaction and will cause you to go hypO.

Start by taking 10 / 5 mg every other day and when you’ve done that for 6 weeks see what FT4 & FT3 are like then. Are you frequently monitored?

MCH 26.9 (27-33.5) is low - this has to be interpreted with full blood count. likely nothing of concern to doctor as in range.

Light sensitivity and sore eye can be thyroid eye disease, (TED) ask for a specialist to access you. Endocrinologist should be aware of this occurring, but many think it only occurs with Graves Hyper. You need to see a ophthalmologist & if there are signs of thyroid eye disease this should be managed by thyroid eye specialist. They are treated as separate conditions by different specialists.

RAI can worsen eye issues.

If you are well and stable on carbimazole I would remain on treatment long term.

[femme12000 in reply to PurpleNails]

Hi,PurpleNails!

I have 4 cold and 5 hot nodules according to the classification accepted here in Spain.

As the doctor explained the cold ones are dangerous(possibility to have cancer)-thats why I will have the biopsy for cold nodules.

I never had low FT4 & FT3 ,only normal or over range during last 12 years since I was diagnosed.

I am monitored every 6 months+-

Thank you very much for your detailed answer.

I am not going to follow the doctor advice to increase carbimazol to15 gr(there is no ground for it) and I definitely not going for RAI.

.Only one thing I will do -its biopsy to control the conditions of the nodules.

The doctors do not have a smallest idea what they are prescribing sometimes so easily without thinking.

I try my best to control my condition sensibly because its my body and their knowledge based only on the books( of course, somewhere, the doctors who can really help ,exist 😊)

Thank you again

[pennyannie]

Hello Femme :

There should be 3 options on the table :

Staying on the AT drug, until when and if a time arrives when your breathing and eating become difficult for you.

RAI - which is a toxic substance and slowly burns out the thyroid in situ.

RAI is known to be taken up, to a lesser extent by other glands and organs within your body and you are looking at a period of around 25 years from ingestion for these ' other ' surprises to be identified.

There is an increased risk of leukemia, and cancer in breast and small bowel

Primary hypothyroidism, caused by RAI is also known to be more difficult to treat.

If your eyes are already affected RAI can exacerbate or even cause further symptoms.

A thyroidectomy is a much cleaner, and more precise treatment option.

Obviously it's surgery and that comes with it's risks but I am not aware of any long term consequences.

elaine-moore.com

pubmed.ncbi.nlm.nih.gov/338...

[femme12000 in reply to pennyannie]

Hi,pennyannie! I completely agree with you.