Hyperthyroidism. There are questions.

[aduschin]

Dear endocrinologists!:)

There are some questions on my status.

I the doctor, the neurosurgeon, now work in an experimental science, in Germany. For a long time felt unimportantly, but all thought, that itself will manage, like not old, 35 years. At home, probably, already would descend or go to somebody - at least, it was known, to itself and where to go. In the civilized Europe, while I (it is casual!) has reached the endocrinologist, has passed or has taken place a lot of time.

On reception from the endocrinologist it was found out:

1) 3, 4 are raised or increased up to one and a half times concerning the top border of norm or rate, TTG - 0,03;

2) - the gland is not increased by US, non-uniform density, with gipoehogennymi sites, in the bottom pole of the right share lotsiruetsja single nodal education up to 2 sm in diameter, with sharp borders, non-uniform density, with a cyst and a capsule;

3) at a scintigraphy with tehnetsiem - intensive diffusive or diffuse (that is surprising, the site on a scintigram it is not visible, but the right share saves much more intensively) accumulation of an isotope (here I am not strong in details, but the lady who was carried out research, approved or confirmed, that is saved tehnetsy twice more intensively, than in norm or rate).

How much or As far as I can judge:o, a picture typical enough for giperterioza. But there are questions concerning clinical displays:

1) already for about a year - a light chair (???), from time to time color comes nearer to normal, last time is predilection to diarrheas. At all this of a transaminase and a bilirubin normal. Whether color of a chair korellirovat with a hyperthyroidism can?

2) about couple of months is pains in knee joints, are more exact - in the field of an articulate or a joint cleft or rima and condyles or malleoluses, internal surfaces beder. From time to time - mialgii, and is more often it happens with with mm. semimembranosus at semitendinosus, muscles tazovogo bottoms or funduses. Whether it can be a sign of a hyperthyroidism?

3) arms or hand always hot, but last time even more often I observe other situation - dryness of brushes and stop so it would be desirable an arm or a hand to wet. What is it - vegetatika on a background of a hyperthyroidism?

4) in last analyses the urinary acid (on a background pohudanija is slightly increased? - for three months about 8 kg), TSRP it is increased up to 1,95 mg/dl, at norm or rate 0,0 - 0,3. Could not read through about value or meanings;importance TSRP at a hyperthyroidism Anywhere;

5) is masa other signs, characteristic as I understand, for a hyperthyroidism: delicacy, including muscles beder, brachiums, fatigability, a bad acceptability of heats, pohudanie, an internal shiver, is broken or disturbed mechanics of fine movements (and at me experiments on vessels at a rat - though howl, arms or hand hodunom go). But items or points 1-4 disturb me for the reason, that I anywhere could not find any information on it or this.

The endocrinologist has appointed or nominated carbimazole, under the scheme or plan: 10 mg in the morning and in the evening, were appointed or nominated with repeated survey in a month. I accept tablets the fourth day, since yesterday - a cold fit, temperature 37,4 - 37,8, there is a dry tussis which has begun even before reception of tablets. Has handed over today, just in case, a blood on the developed or unwrapped analysis. What to do or make, if there will be no agranulocytosis, but the temperature will keep? Whether Is the temperature the described reaction to carbimazole? It is necessary to notice, that somehow to morning, about one and a half weeks ago, I too namerjal at itself temperature - nearby 37,2. Whether has sense to descend or go to the gastroenterologist and the rheumatologist?



Thankful in advance for answers. To hurt or be ill;be sick has bothered:mad:

[Melnichenko]

Presence TTG - independent tirotoksikoza does not cause or cause doubts, its or his form -- Grejvsa-Bazedova vs an autonomy - for the endocrinologist, almost all symptomatology is caused tirotoksikozom, tirostatiki-vremenaja a measure, in visu a radioactive iodine vs operation. The reason of a subfebrile condition - for lech. The doctor (an. Bloods it is obligatory).

[aduschin]

Dear Galina Aleksandrovna, I understand, that additional questions now izlishni, but nevertheless the signs described by me, anywhere in a network I have not met.

Separate complaints, type mialgy tazovogo bottoms or funduses (in occasion of what I have been operated with suspicion on a hernia of a disk in 1999) are marked or celebrated at me already for a long time. Whether meet such mialgii at thyrotoxicoses, I do not know. Very much it would be desirable to know your opinion.

And more... Through pair hours I shall know the developed or unwrapped analysis of a blood. Now T - 37,8, without the catarral phenomena. If the formula, nevertheless, will be normal, whether to stop to me reception of carbimazole see you tomorrow, that is before consultation of the attending physician?

Yours faithfully,

Alexey.

[Melnichenko]

If the formula normalna-is not present.

Mialgii can have and other nature, but whether you here eliminate or erase;remove it or her.. And tirotoksikoz, fortunately, we shall eliminate or erase;remove.

PS - a wedge. The intern of 1 year, the future rheumatologist shaken or amazed by effect of Mercazolilum at 80-years babuli with a functional autonomy with all prelestjami tirotoksikoza-*quot; As vse-taki it is good to you. To endocrinologists.. As effects of treatment are obvious... *quot;

PPS - tirotoksikoz as those is eliminated or erased;removed tirostatikami on 4 6 week. Arthralgias, however, can tirostatikami be aggravated. But in tselom-will understand, all will be decently.

[aduschin]

Once again thanks for the answer and support.

Has noticed, that last time somehow strange itself conducts the left eye - constant dryness, it would be desirable to press on it or him, that he *quot; has risen on ?N?O*quot;. If it orbitopatijka, what to do or make? Whether there Are ways that is called, *quot; to strangle in O?N*quot;?:)

[Melnichenko]

At a functional autonomy orbitopatii cannot be. Iskljuchenie-a rare or an infrequent variant which suddenly began to name with- Marina - Lenharta (I shall be grateful written clause or article on history of a question) - combination FA and Grejvsa - Bazedova.

Retort in storonu-in 70 this or thus proud imenenm named multinodal toxic a struma, u-yes to Marina and Lenhart have brought the invaluable contribution to struggle with iodnym edfitsitom.. But here during what this moment eponim began to belong to a combination of two tiropaty (the wind blows from Germany) - I have missed..

[aduschin]

That is my description declines you to an idea on a functional autonomy?

[Melnichenko]

As a whole it is a problem or task of the attending physician - I do not see you. It is possible to tell or say naoborot-orbitopatija (bude she is) = illness or disease Bazedova. Prophylaxis progressirovanija-for the doctor, from you depends a basis onoj-refusal of smoking (to her I do not say lies..)

SHkurnyj vopros-and as though to learn or find out more in detail, that for experimental jobs from the neurosurgeon (at us very much even quite good group of neurosurgery vykristalizovyvaetsja)... Can, we shall find the general or common points?

[aduschin]

Oh, and I also did not smoke never: (

PS. Most likely, results of the analysis of a blood I today shall not wait. And at me 37,8 and in an hour carbimazole to drink it is necessary. Or it is not necessary, without the analysis? Excuse for persistence in this question - experience, understand, any... Pavors one:)

[Melnichenko]

Without analiza-to not accept tirostatiki

[aduschin]

All the same the analysis - it's OK has come. Has eaten tablets:)



Now about neurosurgery. I am now borrowed or occupied not by neurosurgery - experimental patofiziologija, modeling ishchemicheskogo prekonditsionirovanija, in particular - on a myocardium. Here on koronarah also it is necessary to operate. At rats. Chineses are engaged in it or this in our lab on mice, but on that they and Chineses:). Basically, a technique some material is universal, saved up or universal, collected. So if you have ideas to which I could promote, I with pleasure shall help or assist. Write to me on a mail.

Thanks for support.

Last question: if on a background of a normal picture of a blood the temperature will not be gone still, say, couple of days, what then to do or make?

[Melnichenko]

Basically, the subfebrile condition is quite possible or probable at not compensated tirotoksikoze, but it is better to look for it or him prichinu-then and will be clear. What to do or make.

PS - thanks for the offer.

[aduschin]

Galina Aleksandrovna, is some questions.

I drink the third week carbimazole; the temperature in occasion of which I worried in the first letters, was on a background of a virus infection. In couple of weeks of reception of carbimazole it became little bit better. In analyses of three-week prescription all was anything, except for a urinary acid (hardly it has been raised or increased), the AlAT was in norm or rate (within previous three months the AlAT has been raised or increased, is maximal - up to 95, two times looked antibodies to viruses of all hepatitises, have found nothing).

Yesterday suddenly zaplohelo: tremendous delicacy (it is more in femurs), mialgii. Today it is hardly better. Has handed over analyses: TTG both was 0,03, and has remained; hardly it is raised or increased fT3, 4 in norm or rate. There was above a urinary acid (at norm or rate 5,7 has risen up to 6,6) and, that has disturbed me especially, the AlAT - 113, at norm or rate till 35-50 (three weeks ago was 30).

I here something already nachitalsja, including that the AlAT in general at a hyperthyroidism can raise or increase, and on a background of carbimazole - and for a long time (though to me it was thought, that GGT should raise or increase on a background of carbimazole first of all). Esteemed something on a myopathy and gipokaliemicheskim to affairs at a hyperthyroidism. But I not the endocrinologist, and these facts am not enough me about what speak. Here are already necessary not knowledge, and experience. Therefore there are some questions:

1) whether it is typical, really, for a hyperthyroidism, moreover in such (according to my today's analyses) not a high degree of the expression, the isolated rising the AlAT?

2) whether it is possible to adhere somehow to a hyperthyroidism rising of a level of a urinary acid, considering, what on a background of thyreostatic therapy I for about a week have ceased to lose weight?

3) whether attacks of delicacy experienced by me and coming between them *quot are typical for a hyperthyroidism; light O?N?OO?*quot;?

4) if this all is valid signs of a hyperthyroidism, what, according to your experience, dynamics or changes regressirovanija the described symptomatology, first of all displays of a myopathy? From time to time I feel absolutely not bad, and then - a new wave of delicacy such, that legs or foots I am afraid to bend - that look will break. How long your patients with a thyrotoxicosis come to norm or rate?



Well also what you to me now would advise to make? The doubt - whether Involuntarily creeps in instead of hepatic affairs my status (and podnemenie brushes and stop, and pains in kolenjah, both delicacy, and unstable, from time to time lightish, a chair speaks. Can not from that extremity or end we here we dig?

Yours faithfully,

Alexey.

[Melnichenko]

Tirotoksichesky a hepatitis - quite possible or probable thing, but at itself tirostaticheskaja therapy improves parameters, toxic reaction on karbimazol-too is quite real, the combination zabolevanij-is quite real. Zadachka for the attending physician.

The version of primarily hepatic disease imitating DTZ is unreal. And if on sovesti-a radioactive iodine and a point.

[DimkaSh]

*gt; *gt; *gt; *gt; *gt; podnemenie brushes and stop, and pains in kolenjah, both delicacy, and unstable, from time to time lightish, a chair.



Forgive or Excuse, that I interfere. Precisely same signs were at me during the highest 4 and 3. The pain in kolenjah reached or achieved such force, that few times I could not resist on legs or foots and fell. At indemnification of a thyrotoxicosis the situation with all it or this was normalized, also as well as temperature (was constantly 37-37.2). More than two years already anything similar it is not observed (fie-fie-fie)

[aduschin]

Thanks for answers.

Galina Aleksandrovna, and here the fellow sufferer writes, that the similar symptomatology was at it or him on peak or pique of parameters. At me all as though on the contrary - the level of hormones falls, and I am am covered with a wave from the inferior my times. It that - at parting that did not forget?:) me as to the doctor, this phenomenon is interesting even from the practical point of view. I observed in the neurosurgical practice as children wavy leave any unpleasant statuses, and it seemed to me quite explainable: postoperative and posttraumatic edemas, vessels today so, and tomorrow - on another, a neurology *quot; ?aoaNO*quot;...

But, to tell the truth, I fondly believed, that improvement of my status will occur or happen proportionally to falling of a level of hormones as my German endocrinologist and has told or said: *quot; In a week you will be as ?oU*quot;. About relapses, moreover and on a background of falling of a level of hormones, words it has not been told or said.: (

And more in occasion of an iodine. It is much already told or said in this occasion. But the prospect to sit on a thyroxine not that that would frighten all life, but also amuses. Was thought to sit some time on tireostatikah - can and would manage? I so understand, that you is simple so speak nothing. At least, there was such opinion. Why at once an iodine?

Yours faithfully,

Alexey.

[Melnichenko]

The analysis the patient of the sensations, especially at so specific disease, as tirotoksikoz (I know...), it is hardly constructive (it I to you, the colleague, I speak as the regional specialist) .artralgii can be both consequence or investigation tirotoksikoza, and consequence or investigation of reception tirostatikov (the same - in occasion of a liver).

tiroidnye hormones operate or work INTRACELLULARLY, on mitohondrialnyj and the genetic apparatus of a cell (t.e that. That floats now in a blood there is no that. That already works in a cell). *quot; you will be as the newcomer through 2 ?NnN??*quot;-superoptimism, at the real attitude or relation to zhizni-becomes better in 2 weeks...

To be treated god-means to be treated year, will arise problems much.

To be all life on a thyroxine.... K.Ljuis on run works as the champion n a thyroxine. And Dzh. Bush - starshij-Georges Bush.

[aduschin]

Dear Galina Afanasevna!

There are current questions after two months of carbimazole. Now hormones within the limits of norm or rate (for about a month as), except for zero TTG.

From sensations:

1) there was a force in arms or hand and legs or foots;

2) hardly it became better with a chair;

3) the periods dryness (a numbness vanishes?) stop and brushes of arms or hand;

4) there is no tachycardia, prosypanija at night with rabietic palpitation;

5) has almost returned the lost eight kgs.



Now about that disturbs:

1) pains in kolenjah became less, but from time to time appear, though and not such intensive;

2) unpleasant, burning, pulling sensations in femurs, especially on an internal surface and in a zone of knee joints;

3) it is especially disturbing! - the hypersalivation, oshchutimo oslablo several days ago has suddenly tumbled down a soft palate, so pronouncing of sounds *quot; i*quot; and *quot; i*quot; became problematic. As a matter of fact, an easy or a light;a mild bulbar syndrome. First has thought, that business in a neck as unpleasant sensations were localized precisely at the left, and several months ago I had a history with intensive giddinesses with the same, link sided localization. On MRT have found nothing. Then it was suddenly thought, whether it is connected with a hyperthyroidism (which at me, like, already is not present, and above described bulbar (?) Signs it was not observed even at the height of disease. Or leaving or care from a hyperthyroidism in a relative hypothyrosis could play such joke? I do not know, as to think. Now, like, hardly it became easier, but all the same a soft palate hardly podvisshee. Well and ideas - podstat situations: whether miastenijka it as the frequent combination of a myasthenia to disturbances of function of a thyroid gland is described?

What speaks your experience in occasion of a swallowing-phonation-articulation- at patients in a stage of medicamental indemnification of a hyperthyroidism? Whether it is not necessary to exclude a myasthenia? I with a myasthenia, unfortunately, in the practice did not see patients, therefore your opinion for me more than important.

Thankful in advance for the answer and advice or councils.

Yours faithfully,

Alexey.

[Melnichenko]

Alexey, all ideas in occasion of transitions in relative gipotiroz and the greased sounds we shall reject, over 4 and a potassium we shall look or see, if over 4 on the bottom border normy-we shall begin the scheme or plan *quot; block and ?a?NUa*quot;, on miastenii-I met only women with Grejvsom and a myasthenia, but all dostaochno has been distinctly outlined. Clearly, what is it subjects for discussion with lech. The doctor. With it or him - a bilirubin, thrombocytes and leucocytes.

As a whole is nebodlshie commas in your history, but they would be useful for discussion with ordinatorami-more likely shall tell or say, I would discuss gipokaliemicheskie problems at DTZ and a Gee's disease in advanced age at autoimmune tiropatijah, would force them to look for markers, would find nothing and have calmed down, and there, look, and the symptomatology would pass or take place...

Success to you also do not expostulate for nekonstuktivno detailed tone - with the patient I would be lakonichnej, at internal consultation it would be easier..

[aduschin]

Galina Afanasevna, I thought of a hypopotassemia, therefore always the potassium asked to define or determine. Never there were depressions below norm or rate, though at borders 3,5 - 5,5 he at me always *quot; i?OaNO?n*quot; within the limits of 3,8 - 4,0. Or all occurs or happens sharply on a background of critical short-term depression of a level of a potassium? Guilty business has bought or purchased to itself a potassium in capsules:o about couple of weeks as.

As to last analyses of hormones:



TSH *lt; 0-01

fT4 - 16,4 (N = 10 - 25 pm/l)

TT4 - 92 (N = 58 nm/l)

TT3 - 2,98 (N = 1,23 - 3,08 nmol/l)



Norms or Rates I write only because I do not know, in what all this is measured in Russia; on everyone chluchaj it would be desirable to relieve you of translation or transfer:).

So about replacement, probably, still to speak rather early.



Now on autoimunnym tiropatijam and Grejvsu. Antibodies have been twice measured all (TSH-Rezeptor-Ab, TPO-Ab, TG-Ab), in both cases the badge *lt appears; *lt; the bottom border of norm or rate. Or here other antibodies and criteria?



As to your tone I simply am surprised how you find time to respond to our groans:confused: and to remain correct and precautionary? Anything to me, for example have not told or said in occasion of that I you on a regular basis named in the first letters Galina Aleksandrovnoj:).

[Melnichenko]

Both the same antibodies, and norms or rates at us the same, and sets, likely (except for AT r TTG) the same.

Though it is usual at immunogennom tirotoksikoze (Grejvsa-Bazedova), unlike disseminirovannoj a functional autonomy (it is form TTG - independent tirotoksikoza is well familiar to Germans so it is a subject for conversation with the doctor) those or other antibodies are defined or determined in the increased quantity or amount, it not 100 % a situation (epitopes, sets, imperfection.. A word, here can be methodical problems) .i teoreticheskie-is or not disseminirovannaja avtonomija-a question of principle.

With a transitional hypopotassemia I would not be got or started, the scheme or plan block and replace - business of taste (evidens as we have started to be expressed at a forum, it is rather weak), here business more likely of a habit of the doctor.

- Grejvs or FA I would pay attention to a situation lech. vracha-he you sees (orbits).

And in tselom-disease quite decent, and comprehension admitted or allowed before a typing error in a patronymic is included into criteria of indemnification. Write, to hurt or be ill;be sick always tjazhelo-you suddenly it appear on that party or side of a barricade, and like as the doctor. Should know all - and area not yours.. In a word, we sympathize and we wish good luck.

[aduschin]

Hello, Galina Afanasevna!

Well, if you not against I shall abuse your attention once again, do not collect or claim:).



As they say, without delay.



Has received on arms or hand yesterday's analyses:



1) the urinary acid hardly is raised or increased - 6,1 (at norm or rate up to 5,7);

2) the AlAT - 80 (norm or rate up to 50).



This all and earlier was. And now that was not:



1) a creatine kinase - 190 (norm or rate - up to 174);

2) triglycerides - 256 (norm or rate - up to 200), at low value or meanings;importance LPVP (55 - the bottom border of norm or rate).



Both the creatine kinase, and triglycerides were repeatedly investigated or researched since November of the last year: the creatine kinase was a maximum 104, and triglycerides - 101. In occasion of triglycerides I sin, that has handed over a blood after dense meal with a cake. A glucose, by the way, in norm or rate.

TSRP - 0, a myoglobin in norm or rate.



On a background of all mine above the described problems with an articulation which have a little faded into the background, that is I have some poluchshelo, to me somehow these or it kreatinkinaznye business or affairs only add all of a headache and conduct an idea on a way: a myodystrophy (or nevertheless a myopathy - but here only what: on a background of a hyperthyroidism (like it or him also is not present) or low for me concentration of hormones on a background tireostatikov?) - *gt; rising the AlAT and creatine kinases.



And for last three weeks hormones on a background tireostikov continued to fall:

TT3: 2,98 - *gt; 1,72 (1,23 - 3,8)

TT4: 92 - *gt; 78 (58 - 154)

fT4: 16,4 - *gt; 13,0 (10 - 25),



And this all is already much closer to the bottom border, than to the middle of an interval. Can to me simply became a little, and potekli other processes?



Now the main question - a creatine kinase. Whether something Is what is it? marked or celebrated similar on a background of therapy (as consequence or investigation of a hyperthyroidism, I think, it to apprehend difficultly for the hyperthyroidism is compensated already almost as for about a month, and earlier, even on its or his background, the creatine kinase remained normal)? Or there is a sense to borrow or occupy diff. Diagnostics with myodystrophies?



Yours faithfully,

Alexey.

[aduschin]

Galina Afanasevna, hello!

Itself I understand, that in last report has bent, and you the silence have a little taught me.

But now it would be desirable to return to your early retort: *quot; I would discuss... For a Gee's disease in advanced age at autoimmune tiropatijah, would force them to look ?aONOU*quot;...

Situation in the following: independently to not puzzle over fruitless suspicions, I have gone to gastroenterologists and have told about the transitional isolated rising the AlAT and problems with a chair. The doctor has spent the test with elastase and has found, in addition, the moderate exocrine failure of a pancreas (171 mkg/u instead of a minimum 200/). In November 2004 at a gastroscopy (on a histology) at me have found any strannenkoe an intersticial or interstitial inflammation as a toxic lesion mucous. Esteemed something on a Gee's disease - and attributes of a hepatitis, and vneshnesekretornoj failures of a pancreas, and a problem with a thyroid gland, and arthropathies are the most frequent displays of a Gee's disease and, accordingly, indications to tests for a Gee's disease.

Here it would be desirable to tell or say separately - I can approve or confirm nothing and I do not wish to put in advance to myself any diagnoses. But for me the tactical question is important - that I should speak on reception at university gastroenterologists on June, 15th? Here, in Germany, a situation very strange - you will not ask to carry out any research - will not spend. The situation, when at me here then private patient, transuretralno cleaned or removed a hypothetical stone of a ureter, not slelav before it or this even the general or common analysis of urine is still memorable. So I now go to local doctors only having prepared to visit.

Question: when you spoke about autoimunnyh tiropatijah that you meant? Whether at me any antibodies standardly defined or determined at a hyperthyroidism, absence misses this your assumption? That is, in other words, if at me an antibody to receptors and TG within the limits of norm or rate, whether it means, what any autoimunnyh tiropaty at me is not present? Or here other antibodies, type of two-dimensional reactions with antigliadinovymi are actual? That you in general mean, speaking about *quot; autoimunnyh tiropatijah? *quot; whether there Is in this concept something the general or common with autoimunnymi the hepatitises also marked or celebrated on a background of a Gee's disease?

I wish to approach or suit to an occurring with gastroenterologists in vseoruzhii.



Thankful in advance for the answer.

Yours faithfully,

Alexey.

[Melnichenko]

To autoimmune tiropatijam would carry Grejvsa - Bazedova, autoimmune tiroidit in its or his classical (t-O Hashimoto) and neklassiicheskom (atrophic autoimmune) tiroidit and puerperal tiroidit (it or him, fortunately, to exclude in our case it is not necessary).

In ours iododefitsitnyj krainah (we and Germany. Though last has passed the law and iodiruet salt owing to what liquidated deficiency of an iodine in last two - three years), that not menee-in our countries are neimmunnogennyj TTG-independent tirotoksikoz- nodal and diffusive or diffuse. Here with last with diagnostics worst of all.

In view of all your problems I would ask to exclude adrenal nedostatochneost (days urine on over a hydrocortisone) and a Gee's disease (antibodies to endomiziumu) + to discuss a question about FA diffusive or diffuse.

[aduschin]

Galina Afanasevna, that you have advised to make, make quickly in German conditions is practically impossible. Improbably, but the fact. Next week at me visit to the treating endocrinologist, with which I and obsuzhu (is planned at its or his favourable participation if those will take place) your references.

In passing I wish to ask your advice or council here on what question. At me in the anamnesis a cryptorchism, operation on bringing down did or made, when to me was years eight, that is it is a little after recommended term. How you consider or count, whether it is necessary to discuss necessity of exception of a choriocarcinoma, that is definition of chorionic Gonadotropinum at which high concentration too there is a hyperthyroidism with the endocrinologist? External signs (an edema,) at me are not present morbidity, but also experience in this question too is not present. To pass or miss such penku it would not be desirable. Or again I am engaged in nonsense: (?

Yours faithfully,

Alexey.