# Newly Diagnosed with Hyperthyroidism/Graves



## HopeHeal (Mar 27, 2012)

Hello, my name is Karl and i'm 29 yr old Male. I was newly diagnosed with hyperthyroidism from Graves. i was looking around for information on Hyperthyroidism and Graves and i came across this blog. When i started reading few posts here those scared me since i'm in a very early stages. But, i can understand what people are going through with the Graves and i want to see if someone can advice me in a right direction

My Hyperthyroidism symptoms
1. Sweats a lot when working out. Moderate sweat when arguing on anything. 
2. Slightly intolerance to heat
3. Abnormal heart beat ( not in a very high variations, but i can feel the heart rate is high sometimes)
4. Anxiety when dealing few things
5. (I do not have any other symptoms like weight loss, Hair loss, weak muscle or any other symptoms. All the above symptoms i have for years and are pretty manageable)

My Graves Eye symptoms (The eye symptoms i'm noticing only from past 3 - 4 months. I had a bad phase in past 5 months due to breakup with my girlfriend and after a month or so i'm noticing these eye symptoms. I did cry a lot during initial weeks of breakup :-( )
1. Eye looks tired and i feel slightly dry (especially when i wake up in the morning. I'm using eye moisturizer during nights )
2. Slightly red and intolerance to bright light 
3. Upper right eyelid is slightly swollen have slight pain sometimes during the day

i first went to my physician reg. my excess sweating, becoz this was the only thing bothering me. And then after blood work she said my thyroid is super active and referred me to Endocrinologist and she did further blood work and when see saw my right eye slightly swollen she said i have Graves. Endo prescribed Methimazole 10 mg a day and blood work every month and in person consultation every 3 months. I have got my Ultrasound done and everything is normal (No swelling or any tumor causing signs). After a week or so when i was reading a lot on GED i was scared and sent an email to the Endo. She said continuing to take Methimazole will reduce eye symptoms. Its been close to a month that i have been taking Methimazole 10 mg one dialy.

So, here're my questions
1. Would continuing to use Methimazole improve my eye symptoms? 
2. Endo said; if the eye syptoms doesn't reduce, she said she will prescribe prednisone. Should i ask for this if my eye symptoms doesn't improve?
3. I will try to attach picture of my eyes. The swelling in very early stage (i assume). Will everyone have severe eye symptoms like eye bulging, swelling around eyes e.t.c, or this happens to only few or most? (i consulted Ophthalmologist last week and he only noticed the eyelid swelling and all other is normal for now. He just asked me to continue eye drops and see him in 3-4 months again)

sorry for such a long post. I thought i will provide all the information so its clear for someone who is reading and have suggestions/advices. Any advises or suggestions will be much helpful.

Thanks
K
P.s. I have Blood report from 03/01 and i'm going for the second one tomorrow. I will grab the first report and try to post it here


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## HopeHeal (Mar 27, 2012)

here's the link showing my eyes


http://imgur.com/Wz8aH


you can hardly see there is a swelling on my right eye, but there is slightly. My eyelids are slightly puffy generally, so not many recognize the swelling until they are looking it from very short distance


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## Andros (Aug 26, 2009)

HopeHeal said:


> here's the link showing my eyes
> 
> 
> http://imgur.com/Wz8aH
> ...


Oh, yeah!!! You do have so far a mild case of GED. However, that is only from outward appearances. I am so glad you are under the ophthalmologist's care.

If the person has a small frontal orbital cavity, the swelling will drive the globes backwards rather than frontward. So you can see how important having a good ophthalmolgist is. There is a lot going on behind the scene such as the optic nerve being stretched and otherwise compromised.

There are no promises with anti-thyroid med. Everyone reacts differently.

Here is anatomy of the skull so you can see for yourself about the orbital cavity. We come in all different sizes.

http://face-and-emotion.com/dataface/anatomy/skullviews.jsp

Will be looking forward to seeing your lab results with the ranges.

Did your doctor do a RAIU (radioactive uptake scan?)

Sleep w/head elevated a bit and don't hesitate to use ice packs to lessen the peri-orbtal swelling Make sure you put a clean cloth first so as to not harm your eyes, use moisturizing drops by day like 
Refresh Drops (make sure no antihistamine as that makes eyes worse), use Lacrilube ointment at night and get wrap around sun glasses from the drug store for the photophobia.


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## HopeHeal (Mar 27, 2012)

> Will be looking forward to seeing your lab results with the ranges.
> 
> Did your doctor do a RAIU (radioactive uptake scan?)


Andros, thanks very much. I see you are an active member helping so many on this blog.

Does the eye condition get worst in all cases, or most, or few cases? Have you come across any with mild case and remind mild?

Here're my lab results from 03/02

THYROGLOBULIN AB	NEGATIVE
TPO AB NEGATIVE
TSH 0.006 (Range 0.320-5.500)
Free T4 2.23 (Range 0.6-1.7)
ALT 69 (Range 0-50)
(ALANINE AMINOTRANSFERASE)

Above were the labs my Endo. recommended. RAIU was not done. Is RAIU test needed for all? Is there any other labs i need to get done?


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## Andros (Aug 26, 2009)

HopeHeal said:


> Andros, thanks very much. I see you are an active member helping so many on this blog.
> 
> Does the eye condition get worst in all cases, or most, or few cases? Have you come across any with mild case and remind mild?
> 
> ...


You clearly present clinically for Graves.

Here is some info on the eyes.
Graves' Eye Disease
http://www.kellogg.umich.edu/patientcare/conditions/graves.disease.html

The criteria for Graves' is clinical. You must exhibit..........goiter, exophthalmos, pretibial myxedema and thyrotoxicosis as per Dr. Robert Graves' of the 1800 era. 3 out of the 4 qualify.

Otherwise you are classified as hyperthyroid either because of Hashi's, the criteria for that being high TPO Ab and a grapelike appearance of the thyroid, both of which are "suggestive" because this is commonly seen in Hashi's with FNA (fine needle aspiration) confirming those suspicions "if" there are Hurthle Cells indigenous to Hashimoto's. Or because of cancer. We don't know which comes first, the hyperthyroid or the cancer. We just know that they are often found together.

So.................since you did not have RAIU, I would strongly recommend at the very least an ultra-sound just to be on the safe side. Cancer does have to be considered and hopefully ruled out.

Here is excellent credible source for Graves'.
http://www.thyroidmanager.org/

There are 3 chapters in the index.

To answer your question, early intervention is essential so your chances may be very good and a lot depends on antibodies, life-style and a whole bunch of stuff.

Which reminds me; you really really should have this test for these antibodies attack the orbits as well as the thyroid.

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

TSI and the eyes
http://www.ncbi.nlm.nih.gov/pubmed/1677484


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## HopeHeal (Mar 27, 2012)

Andros said:


> You clearly present clinically for Graves.
> 
> Here is some info on the eyes.
> Graves' Eye Disease
> ...


Thanks Andros!

i got my Ultrasound done. Doc said all is essentially normal. Here's the TSI count which i missed in the previous post

TSI - 206 Reference range: <140


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## polly (Oct 29, 2010)

HopeHeal - This is a great board and Andros, as others here, are such a great help! I only had slight eye involvement in my right eye, but nothing major, most times it's not even noticeable.

The one thing I want to mention is if you come to the point of making a decision of surgery or RAI in the future is that RAI can make the eyes worse. I had read this early on in my research of Graves. I recently had a TT after being on meds since 2006. My Endo said surgery was the way to go due to my eye involvement. I was also told that it's possible that I can see improvement in my eye since my thyroid is out.

Two of my major symptoms before diagnoses was heat intolerance and muscle weakness. One day while doing yard work I sat down for a minute. When I went to stand up I couldn't due to weak legs. I had to crawl over to the truck to pull myself up.

The main thing is to find an Endo that you really like and feel comfortable with. I wasn't crazy over my first one so went to someone else. Been with this Endo since 2007!

Wishing you all the best!


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## HopeHeal (Mar 27, 2012)

polly said:


> HopeHeal - I only had slight eye involvement in my right eye, but nothing major, most times it's not even noticeable.
> 
> The one thing I want to mention is if you come to the point of making a decision of surgery or RAI in the future is that RAI can make the eyes worse. I had read this early on in my research of Graves. I recently had a TT after being on meds since 2006. My Endo said surgery was the way to go due to my eye involvement. I was also told that it's possible that I can see improvement in my eye since my thyroid is out.
> 
> Wishing you all the best!


Hi Polly, thanks much for the post. good to know you had mild eye symptoms. I will keep in my mind that the RAI will worsen the eye. May i ask, how old were you when you were diagnosed with Graves?

K


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## polly (Oct 29, 2010)

Hey K,
Asking a woman her age?  I was 48.

Your eyes don't look bad at all. When I first started researching GED it seemed like the worst case pictures were all that popped up. So don't let that get to you. Maybe it won't get any worse and there is so many things that can be done for the eyes.

From my research I found a little test to do for the eyes to see if there was involvement. Look straight ahead with your eyes, then look up, down, and side to side without moving your head. If there was tightness in the movements then that was an indicator of eye involvement. I felt it in my right eye as well as a gritty feeling. So I was totally expecting my Graves diagnosis.


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## HopeHeal (Mar 27, 2012)

polly said:


> Hey K,
> Asking a woman her age?  I was 48.
> 
> Your eyes don't look bad at all. When I first started researching GED it seemed like the worst case pictures were all that popped up. So don't let that get to you. Maybe it won't get any worse and there is so many things that can be done for the eyes.
> ...


haha...Polly, age is to just see when these things happen to people  But grave seem to attack even in early 20's (read a 23yr guy's story on this blog)

i can freely move my both eyes in all directions fine. Ophthalmologist checked this, and my vision is fine too. My eye are sensitive to bright light, and my eye hurt when step out in sun without sunglasses or look at the bulb. As i said; my eye feel dry when i wake up in the morning. Sometimes i feel slight pain and feels like something is happening in top area of my right eye  if i can get the swelling lil in control i can pretty much manage all my symptoms.


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## Andros (Aug 26, 2009)

HopeHeal said:


> Thanks Andros!
> 
> i got my Ultrasound done. Doc said all is essentially normal. Here's the TSI count which i missed in the previous post
> 
> TSI - 206 Reference range: <140


Yowza! TSI is high. Definitely hyper and definitely not good for the eyes.

Wonder what "essentially normal" implies?


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## HopeHeal (Mar 27, 2012)

Andros said:


> Yowza! TSI is high. Definitely hyper and definitely not good for the eyes.
> 
> Wonder what "essentially normal" implies?


thanks Andros!!

here'z what Doc. said when i requested the ultrasound results

"Your thyroid ultrasound was essentially normal. No tumors was seen.
Completed by: DANIELLA E HINES MD, March 23, 2012, 12:05 PM"

Is there a natural way to bring down TSI, like some vegetables, fruits . e.t.c? I just don't want to relay on medication.


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## Andros (Aug 26, 2009)

HopeHeal said:


> thanks Andros!!
> 
> here'z what Doc. said when i requested the ultrasound results
> 
> ...


You might want to research this further and always include your doctor in the game plan.

http://www.elaine-moore.com/Articles/GravesDisease/LcarnitineforGravesDisease/tabid/177/Default.aspx


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## HopeHeal (Mar 27, 2012)

Andros said:


> Yowza! TSI is high. Definitely hyper and definitely not good for the eyes.
> 
> Wonder what "essentially normal" implies?


Hi Andros, just want to share my recent second monthly blood test results here with you

TSH - <0.005 (range 0.3 - 5.5). Previous result was 0.005 --- No change 
F T4 - 2.07 (range 0.6 - 1.7). Previous result was 2.23 
ALT - 48 (range 0 - 50). Previous result was 64

TSI was not tested and the Doc says TSI will remain high and no reason to repeat TSI test. Is this the case? There is no way to lower my TSI numbers?

thanks
K


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## Andros (Aug 26, 2009)

HopeHeal said:


> Hi Andros, just want to share my recent second monthly blood test results here with you
> 
> TSH - <0.005 (range 0.3 - 5.5). Previous result was 0.005 --- No change
> F T4 - 2.07 (range 0.6 - 1.7). Previous result was 2.23
> ...


This could be the case. I certainly cannot find any proof to show otherwise. I will say though that removing the thyroid and treatment to the eyes apparently stops the attack. The 2 have to be treated independently of one another.

Thank you for the ultra-sound info and no, there does not appear to be much change in the labs. The FT4 will fluctuate on an hourly basis.............


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