Graves' Disease Support Group
Graves-Basedow disease is a medical disorder that may manifest several different conditions including hyperthyroidism (over activity of thyroid hormone production), infiltrative exophthalmos (protruberance of one or both eyes and associated problems) and infiltrative dermopathy (a skin condition usually of the lower extremities). This disorder is the most common cause of...
I have not been here in a long while, tho do lurk every so often, everything was going well with my spoiled brat of a thyroid, it was behaving until just recently. I was classified as subclinical graves with symptoms so put on a mild dose.
I have been on 1.25 mg of methimazole once a day, tests in Dec 2012 were TSH 2.31 ( .27 - 4.3)
FT4 1.03 (.90 - 1.6)
T3 111 (75 - 170)
of course then they felt, I was doing fine, no need for more tests, see ya in a year !!!!
So I finally convinced my family doctor to add in the thyroid tests with regular blood work in June of this year
TSH 1.76 ( 358 - 3.74)
FT4 .8 ( .76 -1.46)
no T3, had to tell her to do the Ft4 since she wasn't.
Emailed the endo and he says: Well I don't worry about you going low until the TSH gets over 3 !....it's going down not up and the FT4 is off compared to the last. Then he says well if you want you can lower the methimazole.
So I assume I am going hypo?
shall I just stop the drug all together and wait until next blood work?, I did have them to make me an appointment but in November. hopefully they will schedule blood work also. I have heard that the methimazole can affect the liver and I have yet to have blood work for that.
I have been on 1.25 mg of methimazole once a day, tests in Dec 2012 were TSH 2.31 ( .27 - 4.3)
FT4 1.03 (.90 - 1.6)
T3 111 (75 - 170)
of course then they felt, I was doing fine, no need for more tests, see ya in a year !!!!
So I finally convinced my family doctor to add in the thyroid tests with regular blood work in June of this year
TSH 1.76 ( 358 - 3.74)
FT4 .8 ( .76 -1.46)
no T3, had to tell her to do the Ft4 since she wasn't.
Emailed the endo and he says: Well I don't worry about you going low until the TSH gets over 3 !....it's going down not up and the FT4 is off compared to the last. Then he says well if you want you can lower the methimazole.
So I assume I am going hypo?
shall I just stop the drug all together and wait until next blood work?, I did have them to make me an appointment but in November. hopefully they will schedule blood work also. I have heard that the methimazole can affect the liver and I have yet to have blood work for that.
Ideally, per the treatment guidelines linked below, you would have been taking the lowest possible dose that would have maintained your FreeT4 level near the high end of the range, regardless of TSH
http://www.fpnotebook.com/endo/pharm/AnthyrdDrg.htm
https://www.aace.com/files/hyper-guidelines-2011.pdf
If anything, your endo should have told you to switch to 1.25mg every other day or every third day back in December.
Now, 8 months later, it's clear you are very hypo (sorry).
Please know that, per thyroid textbooks, healthy people have FreeT4 levels near the high end of the range (surprise, surprise) and TSH around 1....and definitely not as high as yours.
I think it would be a good idea for you to stop methimazole and see if your remission is "sticking" in November.
It's almost medical malpractice that you didn't get baseline liver tests before starting methimazole and during treatment.
Both hyper and hypothyroidism can cause elevated liver enzymes so, until your thyroid levels become more appropriate, I wouldn't be surprised if your liver enzymes are off (sorry).
Still, congratulations on what appears to be remission!!!
(BTW - if your FT4 level stays low for many months off methimazole, there's a chance you'll be one of the 20% of Graves' patients who go hypo after remission. I am one of them. If this is the case, it's reasonable to ask the doctor for a small dose of thyroid hormone replacement. The hypothyroidism can be temporary but, just like hyperthyroidism, it needs to be treated)