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Author: ipes2

GRAVE'S DISEASE (penyebab hyperthyroidism)

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Post time 18-8-2022 11:22 PM From the mobile phone | Show all posts
ipes2 replied at 3-1-2022 08:54 PM
ada goitre ye
nnt USS dapat pointers la ada MNG ke tak

hi doc,lama tak update sini.sy busy sgt dari april -jun this year ulang alik hospital sbb ada detected illness lain plak ...
sy dah tukar specialist,dari ent ke endocrinologist.may lepas dah buat  TSI test, confirmed ada grave's Disease.TSI level 9.63..tinggi kan doc...specialist pun agk la terkojut..tp under treatment dia tsh level sy dah naik 0.26, jun lepas.good improvement.doctor bgtau kena amik carbimazole smpai jun next year.
sebenarnya nk buat treatment radio iodine tp tsh level sy dah mula naik. jun next year doctor akan stop kejap carbimazole sebulan,lepas sbln klau kena balik hyperthyroid then baru buat radio iodine treatment.
doc,i nk tanya ada possiblity tak kena hypertension disebabkan grave's Disease?sbb   
jun lepas doctor diagnosed i kena hypertension.dah on medication,micardis.kalau hyperthyroid dah ok,boleh hilang ke darah tinggi doc?
doctor ada bgtau maybe sbb parents ada darah tinggi ,jadi maybe sy kena sbb tu.sbbnya bmi normal,x obes.doctor pun mcm x caya sy ada darah tinggi.
dah la masa diagnosed hyperthyroid awal2 dulu t4 level paling tinggi 130.6, doctor pun terkejut.
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Post time 18-8-2022 11:24 PM From the mobile phone | Show all posts
sue_0684 replied at 18-8-2022 11:22 PM
hi doc,lama tak update sini.sy busy sgt dari april -jun this year ulang alik hospital sbb ada dete ...

*radioactive iodine therapy.
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Post time 18-8-2022 11:37 PM From the mobile phone | Show all posts
ipes2 replied at 3-1-2022 08:54 PM
ada goitre ye
nnt USS dapat pointers la ada MNG ke tak

baru lepas thyroid ultrasound jun lepas.kanan dah x ada active nodules.kiri ada lagi 3 active nodules.
may lepas dpt detected i ada kidney stone 1 biji 0.4cm..gallstones 2 biji  0.4cm jgk.. sabtu ni follow up urologist sbb nk tau result CT scan 2 minggu lepas..nnti i comment dlm thread kindney stone doc lepas sabtu ni .mcm2 penyakit la.
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 Author| Post time 20-8-2022 10:11 PM | Show all posts
sue_0684 replied at 18-8-2022 11:22 PM
hi doc,lama tak update sini.sy busy sgt dari april -jun this year ulang alik hospital sbb ada dete ...

Allahu, sorry to hear awak kena ulang-alik hospital; semoga ianya yg tidak serious
yg penting, bila awak kata awak ulang-alik hospital, maknanya awak adalah seorang yang ambilkisah pasal kesihatan dan sedang mendapatkan rawatan

Jika tinggi TSI nya, maka Grave's lah (USA pakai term Thyroid Stimulating Immunoglobulin ni, kami panggil TRAB iaitu TSH- Receptor Antibodies.. sama lah).
Ha baguslah TSH dah naik sikit dah, oklah tu. So biasanya kita bagi high dose Carbimazole mula2 nya, dan slowly kita taper down berdasarkan TSH, T4 dan T3 dan how the patient feels. Katalah mula2 nya CBMZ tu 40mg Once Daily; bila dah ok sy turunkan ke 20mg; few weeks after, jika TFT improved lagi, sy turunkan kepada 10mg, then after  a few more weeks jadi 5mg then kita maintain sambil tgk2 TFT, kita maintain at 5mg sampai keseluruhan treatment itu 12 hingga 18 bulan dan selepas itu, kita beri pesakit itu drug holidays.

hypertension boleh berlaku yes, samada indirect atau hanya kebetulan. Indirectly, memang thyroid disease (hypo atau hyper) dua2nya boleh membawa kepada hypertension melalui beberapa mechanism. Secara kebetulan pon boleh. Tetapi Graves tidak lah membawa directly kepada hypertension namun untreated, ada mechanisms bertai arus yg membawa kpd hypertension. (NB, Grave's Disease boleh membawa kepada Pulmonary Hypertension).

Jika parents ada hypertension, maka awak akan dapat 1 copy of genes dar dua2 pihak mom and dad maka sy akan jangka awak akan ada hypertension ie Essential Hypertension.. ini keturunan. Kurangkan garam, keep well hydrated, keep fatty food down, exercise dan ambik lah amlodipine ke apa dulu.

T4 130+ semasa diagnosed? koh koh.. tentu macam maniac awak masa itu. Nasib baik tak kena thyroid storm ye

Ye, jika dah relapse Grave's nya, eloklah buat RAI. Di USA, tahu je ada Grave's, Endocrinologist akan terus offer RAI. Sy disini beri options jugak.
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 Author| Post time 20-8-2022 10:12 PM | Show all posts
sue_0684 replied at 18-8-2022 11:24 PM
*radioactive iodine therapy.

RAI, yes.
Jgn missed your CBMZ tu, nanti susah kita nak manage drug holidays nyer
Tahukan apa side effects CBMZ?
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 Author| Post time 20-8-2022 10:18 PM | Show all posts
sue_0684 replied at 18-8-2022 11:37 PM
baru lepas thyroid ultrasound jun lepas.kanan dah x ada active nodules.kiri ada lagi 3 active nodu ...

kidney stones (renolithiasis) common di negara panas .. keep well-hydrated; sebenarnya kita tidak perasan kita ni dehydrated. esp jika dah biasa dgn panas eg Malaysians.
gallstones common la dikalangan wanita. Jika tak buat hal pada kita, ignorenya dan elakkan makan fatty food

pasal active nodules tu, kita tidak akan tahu nodules itu active atau tidak selagi kita tidak buat Radioiodine Uptake Scan. Uptake scan akan tunjuk mana yg active.
USS hanya detect nodules dan beri characters of the nodules itu pada kita. Dalam kes Sue, sebab ada beberapa biji nodules tu, sy akan kata awak ada MNG (ie Multinodular Goitre). Jadi, ada kemungkinan awak ada compuran Graves dan MNG.



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Post time 20-8-2022 10:27 PM From the mobile phone | Show all posts
ipes2 replied at 20-8-2022 10:12 PM
RAI, yes.
Jgn missed your CBMZ tu, nanti susah kita nak manage drug holidays nyer
Tahukan apa side ...

sepanjang sy mkn cbmz ni,susah la nk turun berat badan doc..dari 52 naik 56-57kg..puasa hari tu dpt turun 55.8kg..even sekarang ni pun mmg strict diet,kurang oily food, kurang garam kalau masak pun mmg agk tawar rasa .
gula putih mmg sikit sgt amik,kalau kat kedai rasa air tu manis ,sy x boleh nk minum. .padahal member rasa x manis pun.
lunch biasa amik sup dgn nasi putih..atau kalau ada kuah lemak amik 2 sudu je dgn ikan/ayam bakar..tp sabtu or ahad ada jgk cheat day.
tadi measure cholesterol level  di farmasi dah turun dari 7 ke 6.09..
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 Author| Post time 20-8-2022 10:37 PM | Show all posts
sue_0684 replied at 20-8-2022 10:27 PM
sepanjang sy mkn cbmz ni,susah la nk turun berat badan doc..dari 52 naik 56-57kg..puasa hari tu dp ...

bagus la ada cheat days
sy fikir, garam sgt important untuk taste
buat lah cheat days utk garam juga

berat awak akan mula improve bila TFT awak makin normal
so hari2 dimana awak boleh makan apa saja dan still kurus, are over sebab awak semakain pulih dari hyperthyroid awak
pulih dari hyperthyroid adalah lebih penting bagi awak buat masa ini dari berat awak

BP saya minggu lepas ranging from 102/76 to 128/78 (paling tinggi)
Random blood glucose sy 5.3
berat sy 66; awak 52kg aritu? koh koh hubby awak boleh lambung2

pasal cholesterol, ia akan terus turun bila thyroid normalizes.
Ini kerana, thyroid dysfunction, samada hyper atau hypo, akan rosakkan metabolism semua benda

Cholesterol Profile org yg ada thyroid dysfunction membawa kepada profile yg favour towards heart disease; sebab itu kami treat thyroid disease walaupun ianya subclinical. Bila dapat blood results Cholesterol Profile nanti, perhatikan:

Total Cholesterol
Triglycerides
LDL
HDL
Non-HDL Cholesterol
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Post time 20-8-2022 10:42 PM From the mobile phone | Show all posts
ipes2 replied at 20-8-2022 10:18 PM
kidney stones (renolithiasis) common di negara panas .. keep well-hydrated; sebenarnya kita tidak  ...

btol doc,pasal kidney stone tu tadi dpt result CT scan and consult specialist , size stone tu 3mm je. .so doctor bgtau kena minum bnyk air,nnti akan keluar naturally . kidney stone tu x da effect apa2 lagi.ada buat urine test yg kena kumpl urine 24 hours(yg selama 3 hari tu) tu doc may lepas.. result semua normal.
masa awal kena goiter tu doctor detect MNG then lepas tu baru buat TSI test.
p/s: sy mmg concerned kalau rasa mcm x kena dgn badan sbb parents ada 3 serangkai(high bp, diabetes,jantung) n dlm ramai2 adik bradik sy ,mmg sy paling x suka consume supplement kecuali kalau perlu je.mcm sekarang sy consume fish oil je sbb nk turunkan kolestrol.
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 Author| Post time 20-8-2022 10:51 PM | Show all posts
sue_0684 replied at 20-8-2022 10:42 PM
btol doc,pasal kidney stone tu tadi dpt result CT scan and consult specialist , size stone tu 3mm  ...

ye, urine test tu biasanya kami kumpul 1 hari je ie 24-hour Urinary Calcium.

eleh 3 mm je, you will pee it out nanti. ya minum air byk2 dan elakkan dari dehydrated.
jika parents dan siblings ada DM, BP dan chol, maka Sue kena hati2 lah.
sy pon ambil fish oil daily for overall health sebab ikan mahal kat sini.. dan tak dari jenis yg saya suka..
... hmmm tetiba terlintas nak makan sushi kat japanese cafe kat depan ni..
mmg sedap sushi dia

pasal nak kurangkan chol tu, tgk2 apa yg kita makan adalah lebih berkesan:
elakkan full-fat milk, butter, full-fat yogurt (ie apa2 yg best ha ha)
processed meat (eg burgers, spam, sausages)
fried food eg nasik goreng, ayam goreng, mee goreng (ambil ini dalam cheat days sahaja)
shellfish (cheat days sahaja)
kuih2 melayu yg bergoreng tu

PS: sila jgn create 3 4 hari cheat days seminggu.. bagi awak: 1 day a week sahaja, max 2 days a week
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 Author| Post time 20-8-2022 11:01 PM | Show all posts
sue_0684 replied at 20-8-2022 10:42 PM
btol doc,pasal kidney stone tu tadi dpt result CT scan and consult specialist , size stone tu 3mm  ...

berkenaan cheat days itu, buat lah same day eg weekend
jgn tukar2 hari itu
supaya awak akan really tertunggu2
dan bila tiba hari nya eg saturday, ha masa tu enjoy betul2
semua kuih akan rasa super sedap, semua night out dan cakes akan rasa superbest
baru ada makna cheat days itu
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Post time 20-8-2022 11:03 PM From the mobile phone | Show all posts
ipes2 replied at 20-8-2022 10:37 PM
bagus la ada cheat days
sy fikir, garam sgt important untuk taste
buat lah cheat days utk garam ju ...

tq doc byk info.jgn charge sy.. .kdg sy ni bnyk tanya bila ada x kena.so sbb tu sy tukar another specialist. not getting promising explaination bout my tsh level with previous specialist...sy ada informed kat komen lepas sy ada tnya previous specialist knp tsh level sy x naik2 even 5 bln dah amik carbimazole..puncanya dos carbimazole tu tinggi sgt 12 biji masa tu..60mg..dgn current specialist baru dia reduced dos.baru tsh level sy mula naik.

owh,tadi di pharmacy sy measured total kolestrol je..
last measured cholesterol may lepas doc,masa consult dgn specialist.so dpt result kat bawah:
Total Cholesterol   7
Triglycerides  1.3
LDL  4.4
HDL  2.01
Non-HDL Cholesterol 5
sbb tu sekarang control mkn sikit ,sbb tgok kan LDL tu high.

BP sy pernah naik 170/90 sbb tu on medication sekarang.
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Post time 20-8-2022 11:12 PM From the mobile phone | Show all posts
ipes2 replied at 20-8-2022 10:51 PM
ye, urine test tu biasanya kami kumpul 1 hari je ie 24-hour Urinary Calcium.

eleh 3 mm je, you wi ...

haha..sedap2 semua mknn yg mentioned tu.
kalau powdered milk mcm full cream milk tu x boleh ehh doc?sy ada jgk minum susu fernleaf je full cream.
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 Author| Post time 20-8-2022 11:14 PM | Show all posts
sue_0684 replied at 20-8-2022 11:03 PM
tq doc byk info.jgn charge sy.. .kdg sy ni bnyk tanya bila ada x kena.so sbb tu sy tukar another ...

eh ingat free ke RM350 tau koh koh (gelak style manak)

TC akan improve bila thyroid improve
TG very good, ie awak mmg jaga makan
LDL ini tinggi, kena aim <2.6 utk elak cardiovascular probs.. tapi bila thy improve, ia akan improve
HDL sgt bagus.. in women, kita nak >1.3.. HDL penting utk protect heart from chol-related cardiovascular
Non-HDL nanti akan turun insyaAllah

BP meds nya apa dan sila PM sy age awak
metabolism kita changes with age

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 Author| Post time 20-8-2022 11:16 PM | Show all posts
sue_0684 replied at 20-8-2022 11:12 PM
haha..sedap2 semua mknn yg mentioned tu.
kalau powdered milk mcm full cream milk tu x boleh e ...

powdered milk memang tidak elok
full cream milk, susu pekat dari tin eg dutch lady semua tu tak elok sgt
jika ingat guna susu, guna yg semik-skimmed real cow's milk ie bukan powedered
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Post time 20-8-2022 11:25 PM From the mobile phone | Show all posts
ipes2 replied at 20-8-2022 11:16 PM
powdered milk memang tidak elok
full cream milk, susu pekat dari tin eg dutch lady semua tu tak el ...

owh.. jadi skimmed milk tu boleh la kan doc?..
pernah minum ensure gold . minum pagi masa breakfast tp salah cara doc.. naik plakk berat badan.
patut dah minum susu ni pagi,breakfast mmg kena kurang portion makan..
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 Author| Post time 20-8-2022 11:36 PM | Show all posts
sue_0684 replied at 20-8-2022 11:25 PM
owh.. jadi skimmed milk tu boleh la kan doc?..
pernah minum ensure gold . minum pagi masa breakfas ...

skimmed milk boleh, mostly, industry turunkan fat dalam tu hanya kepada 4% sahaja
non-fat milk biasanya agak mahal sikit dan kurang rasa dan tak byk di UK ni
di sini, skimmed-milk yg 4% ini laku.. cuma sy yg biasa dgn full fat milk ini memang tahu perbezaan rasa
lama2 sy boleh terima 4% milk ini

haha portion size je yg selalu buat kita berat
bila makan gulai kari tu, buat la angkat berat 10minit dgn heavy books ke apa
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Post time 20-8-2022 11:38 PM From the mobile phone | Show all posts
ipes2 replied at 20-8-2022 11:36 PM
skimmed milk boleh, mostly, industry turunkan fat dalam tu hanya kepada 4% sahaja
non-fat milk bia ...

pernah consumed skimmed milk tp x sedap la...adehh . sampai x habis .buang gitu je
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 Author| Post time 20-8-2022 11:42 PM | Show all posts
sue_0684 replied at 20-8-2022 11:38 PM
pernah consumed skimmed milk tp x sedap la...adehh . sampai x habis .buang gitu je

jika biasa dgn full-fat milk, memang akan rasa beza nya
after a while, few weeks gitu, you will get used to it
full-fat full-cream milk tu tidak diperlukan pada kita ni
sbb kita byk sources of fat yg lain
di africa sana, mereka memang perlu minum susu2 dari lembu mereka sebab depa really kurang benda2 berfat (sgt byk energy dalam fat berbanding carb)
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Post time 20-8-2022 11:46 PM From the mobile phone | Show all posts
ipes2 replied at 20-8-2022 11:14 PM
eh ingat free ke RM350 tau koh koh (gelak style manak)

TC akan improve bila thyroid improve

BP meds telmisartan 80 mg ,once daily.
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