12 replies to this topic

[Katy_QN]

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Hi,

I was diagnosed with Graves on June 13 2014 and these are my lab results: 

 

June 13 2014 

T3, total     311  (76 - 181 ng/dL)

Free T4     5.5   (0.8 - 1.8 ng/dL)

TSH          <0.01 (0.40-4.50)

THYROID PEROXIDASE AB  81 (<35 IU/mL)

Thyroglobulin Ab <20 (<20 IU/mL)

Thyroglobulin  12.7 (2.0 - 35.0 ng/mL)

TSI  447 % baseline

I was put on 30mg of Methimazole  (once a day)

 

 

July 31 2014

T3, total     30  (76 - 181 ng/dL)

Free T4     0.7   (0.8 - 1.8 ng/dL)

TSH          0.23 (0.40-4.50)

Reduced Methimazole dosage to 10mg (once a day)

 

September 3 2014

 

T3, total     30  (76 - 181 ng/dL)

Free T4     0.7   (0.8 - 1.8 ng/dL)

TSH          10.82 (0.40-4.50)

 

 

My endo wants me to reduced Methimazole dosage to 5mg,  but my general doctor recommended getting off Methimazole completely and have another blood test in 4 weeks. 

I am so lost I don’t know which I advice I should take. Is this stage of going hypo was from taking too high dose of MM? or it was because I have Hashitoxicosis? ( both if my TSI and THYROID PEROXIDASE AB are high)

 

Thank you so much for you help!

Katy

[Shelby]

You're still finding your maintenance dose, so you're going hypo because you're simply on too much medicine. We don't recommend going off of Tapazole until you've reached remission which is gauged by how many autoantibodies you have. You have a HIGH number of TSI so if you went off of Tapazole you would likely relapse into another episode of hyperthyroidism. In order to avoid a rollercoaster yo-yo of thyroid hormones, stay on a small dose of Tapazole for as long as you can. 

I would reduce your dose to 2.5mgs. Some folks on here are on doses so small they have to cut their 5mg tablet into fours ... but we have a high rate of remission and stable levels on this board because we follow the research that's been done on how Tapazole affects auto-antibodies.

[mmztcass]

I would reduce to 5 mg taken in divided doses of twice a day, every 12 hours.  You still have positive high TSI antibodies which means Graves' Disease.  The TPOab means how inflamed your thyroid is and it seen for both GD and Hashi's.  I feel your Graves' Disease is the dominating one right now.

 

{{{hugs}}}

[Hedgehog25]

I would reduce to 5 mg taken in divided doses of twice a day, every 12 hours.  You still have positive high TSI antibodies which means Graves' Disease.  The TPOab means how inflamed your thyroid is and it seen for both GD and Hashi's.  I feel your Graves' Disease is the dominating one right now.

 

{{{hugs}}}

 

Just out of curiosity, can someone's Tapazole dosage be EXTREMELY low (e.g., .625 mg/day or less) and still be keeping their Graves antibodies under control? Or is more likely the case that, if they are on such a low dose, they are likely to be in remission?

[Shelby]

There are studies that show low doses of Tapazole (5mgs) are just as effective at lowering autoantibodies as high doses. That being said, being euthyroid on a very very low dose of Tapazole doesn't equal remission. Often Graves' patients begin going hypothyroid (or on the low side of normal) after years because they begin to have more blocking autoantibodies than stimulating. The true test of remission is an auto-antibody test.

[Hedgehog25]

There are studies that show low doses of Tapazole (5mgs) are just as effective at lowering autoantibodies as high doses. That being said, being euthyroid on a very very low dose of Tapazole doesn't equal remission. Often Graves' patients begin going hypothyroid (or on the low side of normal) after years because they begin to have more blocking autoantibodies than stimulating. The true test of remission is an auto-antibody test.

 

Interesting, thanks for the info. But what if someone initially (when first diagnosed with thyroid issues) tested positive for TSI antibodies, but not Hashimoto's antibodies? Is it common for them to randomly start producing blocking (I'm assuming these are the same as Hashimoto's) antibodies after spending about a year on Tapazole?

[Shelby]

 It's seen in many Graves' patients. Sometimes it takes many years but for some people it never happens. I don't believe Hashimoto's autoantibodies are the same as our blocking autoantibodies. In Hashi's, their thyroid is literally being destroying and they are permanently losing thyroid function. In Graves, the blocking autoantibodies are simply not allowing the thyroid to be stimulated into making hormone. We do have a little bit of destruction going on but not on the same levels as a Hashimotos patient.

[Katy_QN]

Thank you guys for the great advice. My other question is can my number go back to normal range if I take MM even at a lower dose ( 2.5-5mg)? Should I add my doctor to add in levothyroxine at this point? 

[mmztcass]

You can even try 3.75 mg cut with a thin razor blade pill cutter and take it as 2.5 mg and 1.25 mg every 12 hours or the other way around if you are a bit more hypER in the evenings.  Your Free Ts should normalize however you still have a high TSI from back in June, remission would not likely happen right away.

 

I would want to lab in four to six weeks from the dose reduction to see if on track.

 

It might be easier to work with dose reductions just for a little bit more time before adding any replacement meds with the MMI.  Not every doctor (or Endo) are interested in having their patients try the Block and Replace.  Let's hope yours will.

 

Please refer to the Thyroid 101 here to help you understand the thyroid, diet, exercise, and triggers to avoid to help you be proactive with your thyroid disease.

 

{{{hugs}}} 

[Katy_QN]

Thank you I will definitely talk to my GD tomorrow about reducing the dose like you advice. My next blood test is in 4 weeks. I will post the result as soon as have it. Thank you guys again for your help. 

[Shelby]

I concur with mmztcass . Btw, what does your screenname mean mmztcass? 

[mmztcass]

mmztcass = the first four letters of my 4 children followed by the last four letters as part of my last name.

 

{{{hugs}}}

[MyGraves1980]

I would REDUCE/DIVIDE THE DOSING >> If you stopped taking the Methimazole abruptly, you could cause your thyroid to go HYPER AGAIN!   It can take a while for the Dr.s to get the dosing right as we all respond to the meds differently. Also the Primary Dr doesn't have as much knoledge on the Graves Disease.. So I would go by what the Endocrinologist is advising... Take care & Good Luck

Ps Hopefully you will be feeling better soon!