After having further blood tests to confirm thyroid issues, I have been doing my own research whilst waiting for an appointment with GP, I suspect I have Graves’ disease??
Blood results are:-
TSH- 0.008 (0.35- 4.94).
T4 - 23.2 (9-19).
T3- 8.2 (2.4-6).
TSH receptor antibody- 11.9 (0- 3.09).
Thyroid Peroxidase Antibody - 67.1. (0-5.59).
I am wondering what the likely( best) treatment for this is and how soon symptoms will improve.
Are there any other things that I can do to improve how I feel as I have felt poorly and have been off work for yearly a year due to also having cardiac issues requiring a Pacemaker.
Any further advice and information would be appreciated ahead of seeing my GP.
Thanks in advance.
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Blossom1573
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Initial treatment would almost always be Carbimazole. With the option of Propylthiouracil if the Carbimazole is not tolerated.
As I try to explain in my blog, Carbimazole has its direct action extremely quickly. But the stored thyroid hormone (e.g. in your blood) can take weeks to fall. Hence symptoms can take weeks to alleviate.
It is quite usual to offer Propranolol as well - this would be expected to help with high heart rate, but also has a small impact on conversion of thyroid hormone T4 to T3.
helvella - Splitting Carbimazole Doses
A short discussion about Carbimazole primarily focussed on splitting doses but containing some other information.
Carbimazole is the 1st choice anti thyroid. It works by lowering new hormone production, so levels will reduce slowly. & symptoms will gradually improve. It will take time for symptoms to fully resolve.
I was also prescribed propranolol along side carbimazole as this helps with symptoms particularly palpitations. Usually it’s intended to be temporary but I’ve remained on dose dose for migraine prevention. Do not stop it abruptly, always reduce propranolol gradually.
Usually carbimazole is started at a higher initial dose, then it’s very important to repeat thyroid function levels around 6 weeks. The dose is often reduced.
Drs tend to treat by TSH but FT4 & FT3 shouldn’t be allowed to go too low to see TSH rise.
You have very high TRab which is accepted evidence of Graves. So I’d start treatment on the probable likelyhood your hyper will be continuous.
Graves can typically reach very high levels but any continuous over range levels require treatment, hopefully it means a lower dose of carbimazole will be sufficient.
I very much doubt you have Graves', not with those numbers. Your TSH is suppressed, yes, but that doesn't mean much. It's suppressed because your FT4/3 are quite high, but not high enough for Graves'.
Your TPO antibodies are saying Hashi's, which can swing between hypo and low 'hyper'. Your TRAB are high, but that often happens with Hashi's.
So, the treatment for the false 'hyper' phase of Hashi's is... nothing. The levels will eventually come down by themselves as the excess hormone is used up/excreted.
What you can do for yourself is get your nutrients tested: vit D, vit B12, folate, ferritin. They are probably low and will be causing symptoms of their own. It's very important to have optimal nutrient levels with thyroid problems.
Thankyou so much for your advise. I will certainly be asking the GP to check nutrient levels.
Do you think that the “False hyper” stage of Hashi’s will take long to resolve as I have been experiencing unpleasant symptoms of hyperthyroid for quite some time and in fact they seem to be getting worse especially fatigue and heat intolerance/ sweating.
Graves is a poorly understood and badly treated Auto Immune disease for which there is no cure and generally only gets diagnosed when your immune system starts attacking your thyroid and or eyes.
The thyroid is a major gland and responsible for the full body's synchronisation of your physical ability and stamina and your mental, emotional, psychological and spiritual well being, your inner central heating system and your metabolism.
So when compromised by an immune system malfunction symptoms can be diverse and confusing - and generally speaking we see the T3 and T4 thyroid hormones rise high over their ranges and it is these high levels especially of T3 that cause the worst of the symptoms being tolerated.
Graves is said to life threatening if not medicated - and the medication is an Anti Thyroid drug - either Carbimazole or Propylthiouracil ( PTU ) - and all this drug does is ' buy you time ' while we wait for your immune system to calm back down again -
and it does this by semi - blocking your new, own daily thyroid hormone production so slowly these over range T3 and T4 readings fall back down into range with hopefully your symptoms relieved.
Everyone's journey with Graves is unique to them but stress and anxiety are known common triggers- there is likely a genetic predisposition with a family member, maybe a generation away from you with a thyroid health issue, and Graves can occur after a sudden shock to the system like a car accident or unexpected death of a loved one - or seem to appear - simply out of the blue.
How are you feeling - your T3 and T4 levels are not too high above the ranges so hopefully your symptoms are not too extreme ?
With Graves you can have either blocking or stimulating antibodies - at any given time - driving your thyroid production up or down - and there are phases where these 2 extremes of symptoms seem to cancel / burn each other out - leaving you feeling relatively normal - but it can be a roller coaster of symptoms without any of the fun with something of a brain / body disconnect.
The NHS generally allocate a treatment window with the AT drug of around 15-18 months with the hope being this is just a ' blip ' and your thyroid resets itself, and remission is found, without the need for any drugs.
Should this not happen it's suggested that you have definitive treatment such as RAI thyroid ablation or a thyroidectomy :
We do have some research you might find of interest :-
The most well rounded of all I researched - though 10 years after I had had RAI thyroid ablation for Graves in 2005 and more unwell than I've ever been - is that of Elaine Moore - books, forum and website elaine-moore.com
Thanks you so much for your detailed and very informative response. After doing a small amount of research on Thyroid issues including Graves to try and make sense of what is happening to me, your explanation has provided a lot of clarity and has helped me enormously to understand this condition.!!
I have had no formal diagnosis as yet as waiting to see GP but have been trying to understand thyroid issues and prepare myself for what to expect in terms of diagnosis, treatment etc.
Unfortunately I have little faith in the NHS following a recent bad experience when I started to feel unwell nearly 12 months ago with cardiac issues and despite tests coming back abnormal. I was told by a Cardiology Consultant that there was nothing wrong and attempted to imply my problems were potentially due to my age and implied I was suffering with anxiety and depression.
To cut a long story short I ended up having a Pacemaker and once I had recovered from this procedure I hoped I would start to feel better and my life would start to return to “normal”. However I was still feeling very fatigued and weak with an unpleasant discomfort in my neck, throat and a feeling of pressure in my head. I have also been very intolerant to heat and experiencing excessive sweating following minimal exertion. I desperately want to return to work but feel that due to my stressful and demanding job, mentally and physically that it would be unsafe to work as I feel so unwell.
Thankyou also for suggesting other sources of information which I intend to read. I believe information is power especially when you lack faith/ confidence in health professionals.
Ironically my Mother in law has suffered with Thyroid disease for years and had states having RAI treatment, the worst thing she ever did. She advised me to join this forum for which I am very grateful and already suspect it will be of hugh benefit to me.
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