Antibodies, paternalism, and feeling good again

Call me a control freak (you wouldn't be far off), but I want to know my damn labs! They were taken a week ago and I have heard nothing. Nothing. Last time, it took 2 weeks and a dictated letter from the endocrinologist. That's nice that he wants to put his spin on things, but I know how to interpret my own labs, thank you. I will have to ask to be copied next time.

And yes, I called my clinic after hours and tried to wheedle the values out of the RN on call, but she would not do it.

On the other hand, after months of poopiness, I have felt like a million bucks for the past two days. Amazing! I can concentrate on a task for more than a few seconds again! And yet another reason why I want to know my labs—I don't want to plunge into hypothyroidism—for one thing, it can make the eyes worse. The last semester of nursing classes start next week, too, and I need to be on my game for that.

I see the endo in a few weeks and will ask him to humor me and just have the raw labs made available to me.

Then there are antibodies. Just browsing this weekend I was reminded that people who lack TPO (the peroxidase antibodies) but have high levels of TSH stimulating antibodies (me, that is) have a higher than usual instance of eye problems. I need to find ways to lower the antibodies a.s.a.p. Diet and stress reduction seem a good place to start.

Almost done with the prednisone. It does not seem to help lid puffiness, nor does it decrease the diplopia, but it does curb the aching eyes.

The big light-up

Well I had a little feeling to have a big night
And I woke up feeling small and not so brave and not quite right
—Johnny Cash, "The Big Light"



I love Johnny Cash. So much so that I "had a little feeling" to go catch his old band, the Tennessee Three, at a casino north of here. I planned on it for weeks.

Well. That casino was like the worst smoking aversion booth ever created: flashing lights, dinging bells and hundreds of lab rats hunched over slot machines—each one with a heater hanging off his lips. I almost left right there, but made my way to the stage where the band was to play.

Except the band had cancelled. And the casino hadn't bothered to update its web site. Lac Court Oreilles Casino. It's a smoke bomb with surly help, a cobweb site and cancelled acts, as far as I can tell, and should be avoided, unless you like throwing away time and money.

Anyhow, the point of my story is, that my eyes swelled up the following Thursday. Could 20 minutes of thick, blue air trigger Graves' ophthalmopathy? My endocrinologist told me to stay the heck away from secondhand smoke . . .

For the record, I am a former smoker who kicked the habit nine years ago.

By the way, Cash is really wasted on this video, singing about how much he hates hangovers, isn't he?

Labs, late 2007

In November my TSH came back as <0.05, which is below the normal lower limit of 0.35. Free T4 was 1.6, just one tenth of a point higher than the normal upper limit for that lab. Even so, I felt horrible: shaky, weak, bruised-feeling thighs, nervous as a bug. I had the attention span of an Irish setter.

In December I got to see an endocrinologist who ordered a thyroid cascade. The TSH came back as <0.05 again, and the free T4 was the same, too, although just within bounds of the lab's normal range. Free T3 was 5.2, just outside a normal range of 2.1–4.1. So . . . not so bad!

I tested positive for only TSH receptor antibody. I don't know the number, just that the titer was "high."

The endocrinologist also looked at my palms and declared them thickened. He wondered if I didn't have too much growth hormone on board, "Although you don't look like you have acromegaly" to which I added a silent "Amen!" Acromegaly is the result of too much growth hormone after the growth plates of the bones have tossed in the towel, and results in a coarsening of features. Think "Lurch" or Andre the Giant. It most commonly strikes middle-aged people, too.

So, he ordered IGF1, or insulin-like growth factor, a test that indirectly reveals the amount of growth hormone pumped out of the pituitary. I told him why bother—I actually have the more delicate hands of the women in my family. Surprisingly, though, my IGF1 levels came back low. Sweet. So I'm becoming prematurely wizened from the inside out? We will recheck IGF1 when I'm euthyroid and go from there.

All in the family

The lady at left is my paternal grandmother, sometime in the late 1920s. If you look closely, you can see an asymmetry in her eyes and a goiter, although I think she's darn cute, and my grandfather certainly thought she was a dish!

When she was 17 and working as a hired girl, a guest at her employer's house, a physician, noticed a tremor as she served supper and did dishes, and then told her that she had a goiter. Untreated, she told me, her problem got worse after each baby, until she could hardly speak or function. She finally had a thyroidectomy sometime in the late 1940s. I remember the fine white necklace of a scar describing an arc above her collarbone.

Did she have Graves' disease? I'm not sure. But she just died, age 100, so it hardly held her back!

Thyroid trouble tends to run in families, and it makes no difference what form it takes. In their seventies, my mother and her sister have become hypothyroid. In another branch of the family, several members in all generations suffered from thyroid problems. Thyroid problems seem to have converged on me, genetically speaking.