Hi Elaine,

I just ordered your book and am looking forward to educating myself more about Grave's. I was diagnosed in November 2020 on routine labs with my primary care doctor. She referred me to an endocrinologist in her practice. I have been on Methimazole since then. My endo was hopeful that she could titrate me down and eventually get me off the Methimazole, but unfortunately, that doesn't seem to be the case. Over the past few years, we have tried decreasing the dose, only for my labs to necessitate bringing the dose back up again.

I have been on 2.5 mg Methimazole (M-F) since February 2023, so 12.5 mg weekly.

My last 2 labs are as follows:

4/3/23:
TSH: 1.5052 (0.3500-4.9400)
free T4: 0.91 (0.70-1.48)
total T3: 0.77 (0.35-1.93)

2/8/23:
TSH: 1.1432
free T4: 1.2
total T3: 0.79

7/20/22: (2.5 mg 4X weekly)
TSH: 0.9789
free T4: 1.09
total T3: 0.67

Initial labs at diagnosis:
11/4/20:
TSH: <0.0025
free T4: 1.82
total T3: 1.75
Thyroid AB:
THYROGLOBULIN ANTIBODIES <1
THYROID PEROXIDASE ANTIBODIES: 5 (<9)
TSI: 368 (<140)

I saw my endo yesterday, and she wants me to continue on the current dose of 2.5 mg 5X a week, and follow up in 6 months.

What are your thoughts about my dose? Should I follow her advice and continue 5X weekly? Do you think there is wiggle room to decrease the dose? I am afraid of heading in to hypo direction.

I take Selenium and B12 complex, and have recently thought about adding L-carnitine and D3 to my daily regimen. I also have cut my alcohol intake from daily to just 1-2 glasses of wine 2X per week. I lost about 5 lbs a few months ago, but it is stable.

Any advice and suggestions? I don't have the willpower to switch to a dairy- or gluten-free diet.

Best wishes,
Amanda

Hi Amanda,
On an optimal MMI dose your TSH is lower, rarely higher than 0.8. An FT3 is more accurate for women than T3, which can be falsely elevated by estrogens. So you could be on a lower dose like 1.25mg. It's also much better to be on the same daily dose so that blood levels are stable.
You're likely close to being in remission since you're secreting adequate TSH on a low dose of meds. Ask for a 25OH vitamin D level before starting D3 so you know what dose you should be on.
It does look as though you're headed in the right direction and just need some fine tuning. Thanks for ordering my book.
Best, Elaine