Elaine's reference for TSH suppression

[Guest guest]

Hi all -

I'm still put out about my chat with the doctor and since I had some time

before I had to pick up my daughter at preschool, I stopped by the library

(yes, I live there!) and within 10 minutes found the article which Elaine

references in her Suite 101 article on TSH levels and how they can remained

suppressed for long periods of time. Man, I am so tempted to mail it to my

doc! It very clearly states exactly why the TSH level is an inadequate test

for patients with GD and why.

Here's just the abstract for anyone who cares:

From Journal of Clinical Endocrinology and Metabolism, Oct 2001, pg 86(10)

" Antithyroid treatment for Graves' hyperthyroidism restores euthyroidism

clinically within 1-2 months, but it is well known " (I love how it says WELL

KNOWN here...obviously not well known to MY doc) " that TSH levels can remain

suppressed for many months despite normal free T(4) and T(3) levels. This

has been attributed to a delayed recovery of the pituitary-thyroid axis.

However, we recently showed that the pituitary contains a TSH receptor

through which the TSH secretion may be down-regulated via a paracrine

feedback loop. In Graves' disease, TSH receptor autoantibodies may also bind

this pituitary receptor, thus causing continued TSH suppression. This

hypothesis was tested in a rat model. " (Description of testing on rats

deleted for length here) " We conclude that TSH receptor autoantibodies can

directly suppress TSH levels independently of circulating thyroid hormone

levels, suggesting a functioning pituitary TSH receptor. "

Now I am full of righteous indignation that I was correct and my doctor was

just un-knowledgeable! Sigh, not that it does me any good. He'll still

probably want me to do RAI. I feel a little scared that I may actually know

more than my doctor about this particular disease. I don't think that's

necessarily a good thing, either.

Anyway, it was an interesting article as well. Thought it may also come in

handy for the Top 20 list references. Thanks for the cite, Elaine!

Now it's a top 20

Top 17 Reasons Why I¹ll Never Have RAI

1. It¹s permanent; if you don¹t like the results, too bad

2. Since the science is inexact, it may have to be repeated

3. Graves disease is an auto-immune disease, not a disease of the thyroid,

so killing the thyroid doesn¹t stop the disease

4. Who ever said hypothyroidism is easy to treat, lied

5. Being hypothyroid is neither less debilitating nor less dangerous than

hyperthyroid

6. Increased antibody titers after RAI skew lab test results, adding to

treatment difficulties

7. RAI is absorbed by other organs and can cause cell death or DNA mutations

8. For up to 4 weeks after dosage, we¹re exposing those around us to

radioiodine

9. Studies show an increase in cancers, especially of the thyroid gland and

small bowel, after RAI.

10. Possibility of damaging the parathyroid, causing hypoparathyroidism.

11. RAI can cause difficulty with future attempts to become pregnant and

carry pregnancies to term

12. Chance of thyroid eye disease developing increases dramatically

13. Chance of significant, unhealthy weight gain is increased

14. Replacement hormone products currently on the market, both synthetic and

pig, are not comparable to our own hormone, leading to

15. Reduced quality of life. For ever.

16. Ongoing problems as the gland gradually dies, necessitating close

medical surveillance and replacement hormone dosage adjustments

17. Increased risk of developing fibromyalgia

18. For most GD patients, medication with ATD¹s creates a euthyroid state

similar to " normal life "

19. As modern science explores the human genome, a cure for GD could be

found, but after RAI kills the thyroid, it wouldn¹t work

20. I131 is so dangerous it¹s transported in a lead container and kept at

the hospital only for the briefest time before being dispensed by a doctor

shielded in lead from head to toe.