Question About Labs + Mmi Dose Change
Posted 27 April 2021 - 03:52 PM
Hi everybody! It's been a long time since I was diagnosed and logged on here. My Graves' has been pretty much controlled since diagnosis 11/2017. I've been on 2.5mg/day of MMI for about a year or so and doing well. A few months ago my Dr. advised lowering the dose to 2.5mg 5x/week instead of every day. And after my most recent labs, she wants to again lower my dose to 2.5mg 4x/week.
My Dr. was looking for a rise in my TSH to signal a reduction in MMI. And that happened last round of labs. All my numbers look good still, but after dropping my dose from every day to 5x/week, my TSH has dropped. But still within normal range. And Dr. now wants to lower dose even more. But I'm concerned my TSH will drop even more, below the normal range. And then I'll have to raise the MMI dose again. Any thoughts?
Here are my current numbers and lab ref. ranges:
FT4: 13 pmol/L (10 - 18)
FT3: 4.3 pmol/L (2.6 - 5.7)
Albumin, serum/plasma: 4.2 g/dL (3.5 - 5.0)
Creatinine: 1.33 mg/dL (0.73 - 1.24)
eGFR: 68-79 (>59)
Vit. D: 35 ng/mL (20 - 50)
PTH: 61 ng/L (18 - 90)
Calcium, serum: 9.5 mg/dL (8.4 - 10.5)
Phosphorus: 2.7 mg/dL (2.3 - 4.7)
Calcium ionized: 1.24 mmol/L (1.14 - 1.34)
TSH: 1.23 mIU/L (0.45 - 4.12) DOWN FROM 2.0 BEFORE LOWERING MMI DOSE
TSI: <89% of baseline (<140%)
Posted 27 April 2021 - 04:36 PM
Your doctor is doing the right thing to lower the MMI dosage to allow the Free T4 to come up. The goal for many people with Graves' in order to feel their best there at, is to allow the Free T4 to come up to the upper third range.
As for the TSH dropping when the MMI dosage was lowered, please do not worry. As long as there are any positive TSI numbers, the TSH numbers will not be accurate. Instead we must look at the Free Ts to go by how we feel to adjust our meds by and don't even ook at the TSH.
In my case, I have been in remission for about 15 months now with no meds. My TSH levels is low because I still have positive TSI and TRAb antibodies numbers even though these are lowering down gradually. Instead I look to see how my Free Ts are doing and go by how I feel with these numbers.
If your doctor is looking at the TSH and is not aware of how the TSI and TRAb antibodies for Graves' Disease can make the numbers wonky, then she may not be well informed about thyroid disease.
The doctor I see is aware how the TSH can act with the positive thyroid antibodies and isn't concern and he looks at only the Free Ts.
Posted 27 April 2021 - 07:05 PM
Thanks for the info!
My Dr. isn't concerned with or really watching FT4. At least she hasn't mentioned trying to increase that. She is concerned with TSH. And waited for it to start rising before lowering my MMI. And now that it did rise, she lowered my dose, but TSH dropped after doing that. So my worry is that if she continues to lower my MMI, TSH will continue to drop and FT4/FT3 will increase and I'll start to experience symptoms again. My TSI result shows below the threshold for Graves' diagnosis as far as I'm aware?
When I was diagnosed, my TSI was in the 300% range. Now it's below 89% and the reference states normal is below 140%.
Posted 28 April 2021 - 03:56 PM
If it were me I'd find another doctor that looks at the Free Ts and not at the TSH. Any doctor who doesn't realize that for the Graves' Disease patient who will have positive thyroid antibodies which the TSH really can't be used to see how one is doing, doesn't understand the thyroid very well.
There was a point in my life that I managed my own thyroid care for a great number of years (still do). While I was on the MMI, I ordered labs on my own or used my doctor whom I currently see, for labs. I watched the Free Ts to tweak my MMI to keep my FT4 at the upper third range and the FT3 at mid range. When I have ordered labs on my own, I only ordered the FT3 and the FT4 tests. I never bothered with ordering a TSH test.
Getting the TSI to come down even lower such as in the 20s or less would be even better.