Here are the labs again, I see it was hard to read when I posted originally.
3/13/13 1.0 2.8 0.490 Dose reduced 7.5 to 5.0mg
4/17/13 1.0 3.0 0.524 dose reduced to 2.5
5/21/13 1.3 4.7 0.022 keep 2.5, with 5.0 sat/sun
8/12/13 1.4 4.7 0.015 arthritis worse went 2.5, 5.0 Sun
9/25/13 1.1 3.6 0.027 2.5 every day
11/20/13 1.2 4.0 0.018 2.5 every day
1/27/14 1.1 3.5 0.044 what shall I do??

You could try a 1.25 mg dosing for the MMI. Then recheck labs in six weeks to see if your FT4 has come up some.

Are you dividing your doses to twice a day?

{{{hugs}}}

Thank you, mmz!
Yes I am dividing the dose to two times a day.
I was thinking I should try a smaller dose as well. It appears the TSH may be creeping up now. Is that what we look for to try remission? That the TSH gets to normal range?

Unless you can get a doctor to prescribe some thyroid hormone replacement to prevent hypothyroidism, you might need to go off MMI if you can't stay out of being hypo.

Yes, TSH around .3 indicates remission. However, staying hypo to try to achieve a desired TSH will just increase antibody production.

Our bodies sometimes start to produce blocking antibodies that actually block the production of thyroid hormone and suppress TSH just like the stimulating antibodies.

I had to go off 1.25mg MMI because that dose kept me hypo (with almost the same FT4 level you've been having) and I couldn't find a doctor to prescribe thyroid hormone replacement.

I wound up joining the 20% of Graves' patients who go hypo after remission about 5 months later.

That was 4 years ago and I've been taking replacement ever since then.

Forgot to mention, my TSH was suppressed when I went off MMI which indicated the presence of blocking antibodies.

My TSH remains suppressed on replacement (which is really what it should be if a person is properly treated)

Cd- are you saying that you think I am hypo? 1.1 is midrange. It's a little lower than I would like but this is why I think maybe I should lower my dose from 2.5 to 1.25. Then I am hoping the TSH will come up.

I guess what you are saying is that yours did not come up so you went off mmz. Now you take thyroid replacement. That stinks, I am so sorry to hear of that. I appreciate the information. I do hope to get off meds and be done with this thyroid stuff forever.

According to thyroid textbooks, healthy people have FreeT4 levels in the upper quarter of the range so, yes, I think you're hypo.

I know I'd be on my knees with easily 30+ symptoms of hypothyroidism if I had your levels. How *are* you feeling?

I don't mind the fact that I have to take thyroid hormone replacement since I feel the best I ever have.

I made a lot of dietary and lifestyle changes because of thyroid disease and I'm sure they play a significant part in just how great I feel.

Thankfully, I found a Graves'-savvy doctor before I needed to go on replacement so I am getting adequate doses of T4 & T3.

I definitely agree with your thoughts about going down to 1.25mg/day now.

If your FT4 level after 4 wks. on that dose is still lower than mid-range, I'd consider it appropriate to go off meds.

I thought the dosing was more reliant on the FT 3. And that is above range. I have been looking at the wrong one for the past year?
What kind of life changes have you done CD? I have no discipline. I tried for a few days to do gluten free and fell off it.
I feel ok except for weight gain. But I really don't exercise or eat right.
I had a hysterectomy last year and broke my leg a few weeks after that. All of that I'm sure contributed to my weight gain. Other symptoms are arthritis and dry eyes. Those 3 are the most bothersome.
I started on 1.25 yesterday. Now to convince my endo again...

I meant to say my FT3 is above MID range.

The hyperthyroidism treatment guidelines indicate that the patient is to take the lowest possible dose that will maintain the **FT4** level near the high end of the range, regardless of TSH.

Re dietary and lifestyle changes....

It's been a slow process that began in June 2007 when I was first diagnosed with Graves'.....and some of the changes were made after I started taking replacement (March 2010)

The first thing I did was to look for hidden sources of iodine in my diet. I never really ate seafood so didn't have to worry about that.

While I was never one to add salt to my food, I started reading nutrition facts more carefully and opt to eat foods that contain 15% sodium or less. Things have evolved towards me eating very few processed foods since I feel much better "inside" when I don't eat processed foods.....same deal with sugar.

I've slowly added supplements over the years in addition to the multi-vitamin and fish oil that I'd always taken. I now take Triphala (an Ayervedic herbal that promotes colon health), selenium (ever since I went hypo), flaxseed oil (eye health), Vit B (cell mitochondria function), SAM-e (liver, joint and mood health), magnesium, Vit D (since my level went less-than-optimal over the years) rhodiola rosea and also reishi mushoom(adaptogens).

Back in 2011, I switched to having smoothies for lunch in an effort to increase my protein intake when I started the P90X extreme fitness program. I found I feel so-o-o-o much better "inside" as a result. (I think they have reduced inflammation). The smoothie ingredients started out with 1% milk, Greek yogurt, organic blueberries (most oxident-rich food there is), organic strawberries/raspberries/blackberries, organic banana and chia seeds (nutritional powerhouse). After reading about the benefits of coconut oil, I now have that in my daily smoothie and use it (or safflower oil) for cooking. Quite recently, I've swapped the 1% milk out for organic kefir and wow, can I feel a difference! I feel even better "inside" since kefir came into my life.

I eat organic foods whenever possible to avoid the toxins associated with pesticides.....and especially avoid the "dirty dozen" unless I can get them in organic form.

I also try to avoid corn and corn products since corn is often GMO. I never ate/eat soy.

I eat nuts daily so I can benefit from the omega 3's in them. And, in the past year, I've taken to eating an organic apple every day.

While I've never used aspartame (didn't feel well using it), I used to use Splenda - no more. I now use stevia.

I've learned to say "no" and do not push myself. I make sure to get adequate sleep and have continued with my lifelong daily exercise.

There could very well be more things I've done for my thyroid health but, what I've shared is what's coming to mind now :)

As I mentioned, the changes were part of a slow process....well-researched and manageable.....all of which I'm *very* glad I made.

Thank you CD! This is going to be so helpful. I am going to print this off and do some research. I know I really need to get a move on and get healthy. I have used my surgeries and Graves' disease as an excuse for too long!
Maybe I need to add poor memory to my list of symptoms as I thought the Free T3 was what I look at.....
Thanks again. I so appreciate your quick, detailed response.
Have a blessed day
Mary

Happy to help!

Sorry my post turned out to be a mini novel. lol

I forgot to mention that my New Year's resolution was to have a cup of organic green tea daily.

Small changes can have a big impact.

Best of luck to you!!

CD:

You're doing great with your diet. As I have mentioned to you before, when I eat GMO-free and organic whenever I can, I feel so much better too.

At the beginning of the year, I've been alternating cans of organic half and half coffee with the regular half and half coffee. If organic coffee wasn't so expensive, I would drink 100% of the time. I did this because organic has higher vits/minerals besides being chem/toxins free. My holistic doctor said, "Yay!"

{{{hugs}}} :-)

Thank you both! I'm going to try to do better at my eating habits.
What are the dirty dozen? You mean they have pesticides?
What vitamin do you take? I couldn't find a multi one without iodine or soy.

Here's some info on the "dirty dozen" (foods with the highest pesticide load):

http://www.ewg.org/foodnews/summary.php

According to the link, the sweet corn and zucchini found in supermarkets are not necessarily GMO (it's more that GMO corn or soy is used in processed foods) Still, I'd be looking for the organic varieties of corn and zucchini.

Yes, organic food is more expensive. However, I think it's cheaper when looking at the bigger picture of overall health.

I've always taken Centrum vitamins that contain the RDA for iodine. I've also been a big dairy consumer (definitely 3 glasses of milk/day or the equivalent via yogurt or kefir).

In discussing my iodine intake with Elaine Moore on her Q&A Forum, she felt my intake wasn't problematic for me since I didn't have any reactions to it and, most especially, that my intake of iodized salt (usually found in processed foods) was limited.