Sorry, I have clearly have brain fog. I have no idea where the rest of this message went. I'll try again.
Labs: 8/26/13 (GP) Started on atenolol 25mg daily.

TSH

I give up. I can't find how to edit a post, nor how to get my whole message to show up. Not sure what I'm doing wrong. It only posts the first few lines.

Don't use "less than" or "greater than" signs and your message will go through...

As Courage says. This forum is quirky.

{{{hugs}}}

OK I'll try this once more. (There was a less than sign.)

Labs: 8/26/13 (GP) Started on atenolol 25mg daily.
TSH less than 0.03 (0.20-4.5)
Thyroxine, Free 3.3 (0.8-1.8)

Labs 8/29/13 (Endo) Diagnosis of Graves Started on methimazole 20mg/day.
Thyroxine, Free 3.2 (0.8-1.8)
Triiodothyronine, Free 13.2 (2.3-4.2)
TSH Receptor Antibody 3.01 (less than or equal to 1.75)

Labs: 10/16/13 Decreased to 15 mg/day, continue with atenolol 25mg/day
FT4 0.8 (0.8-1.8)
FT3 2.8 (2.3-4.2)
Not surprisingly, I don't feel very well, not that the office asked how I was feeling. Since you all have some experience with this stuff, does this seem like enough of a decrease in MMI? They told me to give it 2 weeks and see if my brain fog lifts. (I'm having to play dumb blonde to cover the fog at work...not good.) Anyway, does this sound right? I sort of got the feeling that they were concerned any lower would send me right back to hyper. And, no one at the office has answered this--were my starting labs really high, or just a little high? If they were really high, maybe that's why my dose stayed high (well, it seems high to me from what I've read.) If they're not that high, I would think maybe a little less MMI would be in order given how I feel. Thanks for all of your wisdom! This is a journey, to be sure...

Your last labs show you as quite hypo. Did your doc lower your meth as a result of these labs rather than these labs being the results of your decrease?

Regardless...our goal is to lower our ATD to maintain our FT4 at the upper half of our ranges...for you...that would be around 1.6 For our FT3...we need it to be just above mid range to feel well...for you that would be around 3.5

We ignore the TSH for now because the antibodies can give skewed readings. From what I can see...you need a reduction so your FT4 can come up and tapper off the Atenolol so your FT3 can come back up.

Yes you were hyper in the beginning and your meds have worked very well for you...thats awesome. Now its time to lower your meds and find that maintenance amount. Just be careful your doc is not medicating you to manipulate your TSH...if he is...find a new doc...we have all run into docs that do this...they will keep you hypo forever...Big Hugs...Kathy

The lowered dose was in response to the labs. The nurse stated they were dosing for FT4, as TSH would be suppressed for a while, so I don't think they ate dosing for TSH. She also said they won't reduce the atenolol until I'm more stable, maybe at the next visit in December. Would it make sense for the MMI to be a smidge lower, like maybe 10mg? From what I've read, and where my labs are, not to mention symptoms, that makes sense in my head, but I'm new at this stuff. Next labs in 6 weeks. And the nurse and the pharmacist both said once a day dosing now would be all right, but that's not what I've been seeing here, but what I've been doing. should I continue that? And should I push, tactfully, for a lower dose, or does this reduction make sense? In my current state not much does...

We don't suggest once a day dosing because of how quickly so many of us can yo yo hypER and hypO through out the day (not fun!).

I suggest to take the MMI (Methimazole) in divided doses of two or three times a day such as in every 12 hours or every 8 hours to keep evenly keel and not yo yo all over the place daily.

Get a good pill cutter that has a thin razor blade.

{{{hugs}}}

Looking at your labs of Oct 16th, I can see why you aren't feeling very well.

Where you have dropped into the normal range and almost off the bottom now with the FT4, I would definitely ask to have the dose lowered some more. Without permission, I would (and often did) take matters into my own hands.

Remember that whatever you do, you are ultimately responsible for yourself. Naturally, you don't want to do anything that would be harmful, and the doctors don't want to tell you to do anything like that either. "First do no harm." But to me, overtreatment with MMI was the most harmful.

Still, for me, I didn't have hyper symptoms when I was only taking my dose at night. I suffered most from the brain fog and could tolerate the hypo symptoms most at night so that's when I took the full dose. Everyone is different, I suppose.

I also liked it when my Endo #2 started out low, with 5 mg per day. I didn't like it when he raised my dose, though. The best times were when I could lower it even though the Endo was just reluctantly giving his permission. The final result was that I stayed within the normal range, so he never asked me to increase the dose again.

One more thing... My new PCP told me that brain fog is often a symptom of insufficient water consumption, and I should take my weight in pounds, divide by 2, and drink that many fluid oz. of water per day.

Thanks for the suggestions. I do drink a lot of water, more than in the calculation, actually. After I quit Diet Coke, I started drinking more water. Which led to a few more healthy choices with my diet. :) So, it sounds as if asking for a lower dose might be the right thing to do? Or, how long with the current lower dose before I might expect to see an improvement in hypo symtoms? Really 2 weeks? Ugh! I want to get better faster, but I don't think I know enough yet to dose myself. (Chicken.) Are there specific dosing guidelines anywhere, like "if FT4=x, then MMI =y"? All I"ve found is "the lowest dose to get the FT4 into the upper range." That could be somewhat subjective--as far as the endo is concerned my new dose is the lowest dose she thinks (or is comfortable with) will get my FT4 where it needs to be. Maybe I could just ask her to help me understand why she chose the dose she did? Is that tactful? Maybe she has a good reason. I really am trying to figure this out not just be a pain to her. Thanks again!

The only dosing guidelines I am aware of when one first starts out should be something like 20 mg for the Methimazole or Tapazole. Any higher is too much.

But to find out how to dose into the wee amounts of ATD (antithyroid drug) is dependent on where lab levels fall within the normal ranges of the FT3 and the FT4. This could be any where from 7.5 mg to 0.625 mg.

{{{hugs}}}

When I first started out on MMI my brain fog was so heavy I literally forgot to take my morning pills every other day, once I realized how much better I felt when I forgot them, I began doing it deliberately. Then I tried being more compliant after I got scolded (and I had forgotten I was supposed to go in for labs before my appointment,) and the endo said he wouldn't let me get labs unless I had been compliant for 2 months. I think I was on 20 mg daily at the time.

Later, when I was more carefully, but more deliberately non-compliant, I found relief the next day after skipping my dose. (I would take the full dose in the evening so I could be awake and not freezing during the day.) That was how I started out. Later, I simply reduced my dose and was consistent for the 6 weeks prior to labs, telling the endo at my appointment how much MMI I had taken.

Now I am on supplements, I find that my TSH rises (from borderline low) in response to having more L-T3 supplementation--counter-intuitive as far as the thyroid doctors are concerned.

Brain fog or not, somehow I'm taking a little less MMI than the doctor wants (her 15mg vs my 10mg). I know in my gut this is the right thing to do, and I feel pretty safe with it. But if I went this low in 6 weeks, how long before these levels come up a bit? My eyes keep getting worse (double vision more pronounced), and I've read there may be a correlation between this and the low levels? This gives me more urgency to see those levels come up. (I see an ophtalmologist specializing in TED next Monday.) Anything I should/shouldn't do diet-wise to help inch those levels up? I'm able to exercise more, and the nurse said that would help my metabolism. Anything else? Thanks!