29 yo F – Graves, thyroidectomy, fatigue

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Welcome! Forums 29 yo F – Graves, thyroidectomy, fatigue

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    • #852

      Hi, looking for any additional insight on this case anyone can share. I’ve read through previous posts that relate to those who have undergone thyroidectomy but just want to see if there might be anything else to add.
      F, 29. Scored 5 on IFM MSQ.

      Difficult childhood, family history substance abuse and schizophrenia, had to leave school early teens to support family. Lived in Bulgaria (next to plastic factory) until mid 20s, then moved to US for 1 year, then to UK. Does not speak to family any more, but has a very supportive husband and created life in the UK.

      Food intake in childhood poor, very high sugar i.e soda and literally sugar cubes. Frequent ear infections and high antibiotic use.

      From aged 19/20 started with Sx inc swollen eyes, fatigue, goitre, photophobia, increased heart rate.
      Aged 21 Dx Thyrotoxicosis from diffuse toxic goitre + Graves Disease
      Aged 22 Thyroidectomy (very very small piece left) – since medicated with Levothyroxine (current 50mcg QD) Also suspected glaucoma, on-going increased eye pressure, persisted. Eye drops (Latanoprost, Hylo-Forte & Optive) which ease eye problems.
      Most recent bloods see image – also had an OAT & DUTCH test.
      Currently main concerns:
      Dry skin / rash occasional acne.
      Swollen eyes, dark circles.
      Fatigue, weakness, lethargy.
      Anxiety / depression – as a result of surgery, still not well.
      Feels she is ‘inflamed’.

      Never been well since surgery. Diet is pretty clean for last 3 months, regular meals, plant and fish only, little meat, no red meat. No alcohol, 1x coffee per day, does smoke cigarettes 6-7xday. Sleeps 8.30-3/3.30am, as starts work at 4am.
      Would welcome any insight or input, if more info is required please let me know.

      Posted by Helen Fletcher 20.03.18

    • #854
      Christine Bailey

      Dear Helen,

      Many thanks for your question regarding your client with Grave’s disease who after a thyroidectomy is still experiencing a range of symptoms. The test results highlight much could be done to address the imbalance in vitamin D and Omega 3 fats. In addition, I note that TIBC is high. A total iron binding capacity (TIBC) test is a type of blood test that gauges whether there’s too much or too little iron in your bloodstream. High levels can indicate the following:

      haemolytic anaemia

      iron or lead poisoning

      frequent blood transfusions

      liver damage

      In rare cases, high iron levels may be caused by an overdose of vitamins or iron supplements.

      The symptoms of high iron levels include:

      feeling tired and weak

      painful joints

      a change in skin color to bronze or gray

      abdominal pain

      sudden weight loss

      a low sex drive

      hair loss

      an irregular heart rhythm


      Many of these are similar to Grave’s. You may wish to ask her to speak with her GP who may need to do additional tests.

      While I appreciate that she is on medication for T4, there is no measurement so it would be good to check this level is appropriate for her. Some of her symptoms may be due to imbalances in the thyroid. As Grave’s is an autoimmune condition I would also look at triggers which could be viral, bacterial, stress, food related. Tackling these may help to reduce symptoms and possibly the antibody levels. I presume she is not on gluten at all? You may wish to consider a Cyrex food immune reactivity test to check for any other food triggers.

      As with all auto-immunity, this is an inflammatory condition so do consider adding anti-inflammatory nutrients including fish oil and GLA which would also help the skin.

      About 30 percent of people with Grave’s disease show some signs and symptoms of a condition known as Grave’s ophthalmopathy. In Grave’s ophthalmopathy, inflammation and other immune system events affect muscles and other tissues around your eyes. The resulting signs and symptoms may include:

      Bulging eyes (exophthalmos)

      Gritty sensation in the eyes

      Pressure or pain in the eyes

      Puffy or retracted eyelids

      Reddened or inflamed eyes

      Light sensitivity

      Double vision

      Vision loss


      If health of her eyes is a concern which appears to be the case I would consider a supplement with lutein and other carotenoids to support overall eye health.  One of the most prominent features of hyperthyroid states is a weakness of skeletal muscles that can be debilitating to the sufferer and leads to fatigue overall.  Carnitine is an essential nutrient for transporting fuel (mostly fatty acids) into the cellular “furnaces” known as mitochondria. As muscle cells burn fatty acids in a wasteful response to increased thyroid activity, carnitine turnover is dramatically increased using up cellular stores of carnitine while potentially contributing to the increased urinary losses at the same time. Increased thyroid activity increases the need for carnitine in cells and increases carnitine loss in urine, some evidence suggests that thyroid hormones could actually suppress natural production of carnitine, further reducing the availability of this vital nutrient just when it’s needed the most. If muscle cells lose the carnitine supply that helps them import fatty acids – their best source of fuel – then muscle function could be weakened.

      In clinical studies, L-carnitine supplementation helped prevent or reverse muscle weakness and other symptoms in individuals suffering from hyperthyroidism.

      In a case report, L-carnitine showed promise in helping prevent the possible lethal outcome of thyroid storm.

      L-carnitine may help protect muscle health and strength in a variety of conditions, including hyperthyroidism.  Clinical trials investigating L-carnitine in thyroid conditions have utilized doses ranging from 2,000 to 4,000 mg daily. While these studies have focused on L-carnitine, advanced carnitine formulations such as acetyl-L-carnitine, acetyl-L-carnitine arginate, and propionyl-L-carnitine may also offer promise for individuals who suffer from thyroid conditions.

      Benvenga S, Amato A, Calvani M, Trimarchi F. Effects of carnitine on thyroid hormone action. Ann NY Acad Sci. 2004 Nov;1033:158-67. https://tinyurl.com/ybsqle8b

      Suzuki M, Tokuyama K, Yamane A. Carnitine metabolism in thyroid hormone treated rats and mice. J Nutr Sci Vitaminol (Tokyo). 1983 Aug;29(4):413-28. https://tinyurl.com/ycmaz7nr

      Caturegli P, Kimura H, Rocchi R, Rose NR. Autoimmune thyroid diseases. Curr Opin Rheumatol. 2007 Jan;19(1):44-8. https://tinyurl.com/h2g233s


      You may also wish to consider NT factor phospholipids to support overall energy as well.



      The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

      Energy support

      NT Factor Chewables (ARG) – chew 1 twice daily

      Acetyl-L-Carnitine (ARG) – take 2 twice daily on an empty stomach – https://tinyurl.com/yd72aqjq

      Anti-inflammatory support

      EFA-Sirt Supreme (BRC) – take 2 three times daily – https://tinyurl.com/yal7tyxj

      KappArest (BRC) – take 2 three times daily – https://tinyurl.com/jms9v3n

      Vitamin D3 Complete (ARG) – take 1 daily – https://tinyurl.com/jqx3ttt

      Pro Greens (ARG) – take 1 scoop daily – https://tinyurl.com/gtqgbyo

      Multi with eye supporting nutrients

      OcuDyne II (ARG) – take 2 twice daily – http://tinyurl.com/z4ndrzx


      I hope this helps with your client


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