Chapter 4: Trina's Story

Twenty-seven-year-old Trina is married and works as a special education teacher. In 1998, she began to experience symptoms that are all too familiar in her family.

I was lethargic, short of breath, and had headaches for a month straight. I also had scant menstrual periods and a decreased sexual drive. My heart palpitated a lot. I'm 5'4" and usually weigh 120 pounds, but I lost down to 102 pounds. My mom noticed that my skin color changed; it got darker. I was working at the time and in school. I noticed when I walked from the car to class, I would get short of breath.

I knew that thyroid disease ran in my family. My grandmother, an aunt, mom, and sister all have hyperthyroidism. I went to an endocrinologist right away. He drew my blood. It came back a week later, and he told me I had Graves' disease. He put me on antithyroid medication because he said I was too young for surgery. I can't remember why we didn't do radioactive iodine.

I took the [antithyroid medication] for about four to five months. One day my mom took me to breakfast and noticed my neck was still kind of large. All of the other symptoms were better. She referred me to her endocrinologist.

Her mother's endocrinologist reviewed the pretreatment test results, which included an elevated free T4 level and a low TSH level. Her initial radioactive iodine uptakes were high at 25% after four hours and 47% after twenty-four hours. These test results confirmed a diagnosis of hyperthyroidism.

Physical examination by her new endocrinologist revealed the presence of a thyroid nodule. A fine needle aspiration biopsy was done and was negative for cancer. Trina had become hypothyroid; therefore, the antithyroid medication was discontinued. Her TSI were positive, confirming the diagnosis of Graves' disease. Seven months later, her thyroid function test results were normal, but Trina developed new symptoms.

I had problems with frequent urination, so I wanted to check my bladder. I went to a urologist, and he ordered an IVP. They injected me with [iodinated] dye. The results came back normal.

Trina returned for a follow-up visit with her endocrinologist three months after her IVP. He discovered that her TSH was below normal, and her 6-hour radioactive iodine uptake was now low at 0.8%.

When I went for the thyroid scan at [my endocrinologist's] office, it came out black. They thought the machine was broken, and so they had it serviced. They called me back, and the scan still came out somewhat black. So they figured it was me. It was black because of the [iodinated] dye.

I put it on a medical form at the urologist's office that I had Graves' disease, but he didn't ask me any questions about it. I didn't know that the dye they used could have an effect on my thyroid.

My blood work showed that I was hyperthyroid, but [my endocrinologist] didn't put me on any medication. He said to wait a couple of months until the dye got out of my system. Now I'm not on thyroid medication of any kind.

Iodine, especially the large amounts in iodinated x-ray dyes, can interfere with thyroid function and thyroid function test results for a long time. Six months after her IVP, Trina's thyroid function test results returned to normal and her 6-hour radioactive iodine uptake was normal at 15.6%. Five months later, her thyroid function test results were still normal.