I was diagnosed with Graves last year (3/2022) when a thyroid storm brought me into the ER. I was put on PTU and beta blockers. PTU began at 50mg 2x/day and has been steadily increased. I’m now taking 500mg daily and understand that this amount can cause liver damage. Despite the high dosage. I’m still experiencing severe symptoms (rapid heartbeat, inflamed throat, snoring, exhaustion, temp) and I had a 3rd thyroid storm recently (2/2023). I eat whole foods, no gluten, no alcohol or soda, and I don’t smoke cigarettes. I’ve exercised regularly throughout my entire life, and I meditate daily. I’m working with a naturopath too who is testing my adrenals and working on getting the inflammation down. I guess I’m just searching for any additional insights. My most recent labs:

T3, total 436 neg/dl (71-180 ng/dl)
T4-Free Thyrox 1.62 ng/dl (0.82-1.77 ng/dl)
TSH <0.005 uIU/mL (.450-4.500)
Thyrotropin Rec AB, Serum 38.40 IU/L (0.00-1.75 IU/L)
Thyroid Stimulating Immun 25.00 IU/L (0.00-0.55 IU/L)

My T4 has gone down over the last year, my T3 stays high but fluctuates in a high state, my TSH remains low, and both TR ab and TSI fluctuate in a high state.

I’m being pressured by my endo to get surgery but I don’t want to navigate a hypo state for life and don’t feel I’ve exhausted all other options. Wondering if I should try Methimazole? Or is there anything else I should consider?

Thank you.

Hi,
I would switch to methimazole because it's safer and better tolerated. A 500 mg dose of PTU is equivalent to 40-50 mg of MMI. And with a high dose, you'd want to take it in 2 divided doses to reduce any side effects.
Many people are seeing high T3/FT3 levels after having Covid or receiving Covid vaccines. Could that have precipitated your last thyroid storm?
Another option although not many conventional doctors are skilled in its use is Lugol's Iodine solution. Naturopaths are more likely to know how to use it. I describe its use in my book, Graves' Disease, A Practical Guide.
Another option would be bugleweed (Lycopus virginius or L. officianalis). Bugleweed is a natural herbal anti-thyroid drug and it's often found in combination with herbs like lemon balm that help reduce symptoms. You can find it in Thyrosoothe or similar products on Amazon.
Many patients use it along with PTU or MMI.
Dietary and lifestyle changes are also important. Some people never achieve remission until they start avoiding grains and known or suspected allergens.
Stress reduction techniques like meditation or yoga can also help.
Lastly, ask for a 25OH vitamin D level as low levels are associated with thyroid antibody production.
Best, Elaine