Hi Elaine – I recently stumbled across this forum and wanted to say thank you for all of the knowledge that you are sharing. Your wisdom and kindness are helping so many of us. <3

Background:
I recently had my first baby September 2022. In December 2022 I started to get really bad anxiety and had a lot of hair loss, both I had attributed to post-partum. February 2023, I went to the ER with an elevated heart rate (I thought I might have been having a heart attack) only to learn and to be later diagnosed with Graves Disease.

I drastically changed my diet based on my research after being diagnosed (eliminated gluten and dairy and have also mostly eliminated soy, corn, grains, sugar and legumes—basically the AIP diet). I would say that I frequently eat broccoli and cauliflower in case that is relevant.

Lab results:

6/22/2021 (reference ranges noted in parenthesis) – Pre-pregnancy and pre-diagnosis
TSH: 2.18 mIU/L (0.270 - 4.200 mIU/L)

2/28/2023 (reference ranges noted in parenthesis)—Initial diagnosis of Grave’s disease
TSH: <0.005 L mIU/L (0.270 - 4.200 mIU/L)
Free T4: 3.1 H ng/dL (0.9 - 1.7 ng/dL)
Free T3: 8.1 H pg/mL (2.3 - 4.1 pg/mL)
TSI Qualitative: Positive A
TSI: 3.33 IU/L H (<0.55 IU/L)
TPO ANTIBODY: <3.0 IU/mL (<5.6 IU/mL)
Thyroglobulin Ab: 1.9 IU/mL (<14.4 IU/mL)
WBC: 3.40 k/uL L (3.70 - 11.00 k/uL) – My WBCs have always been slightly low
Creatinine: 0.44 mg/dL L (0.58 - 0.96 mg/dL)

*2/28/2023 started 20 mg of Methimazole/ day

3/30/2023:
TSH: 0.229 L mIU/L (0.270 - 4.200 mIU/L)
Free T4: 0.9 ng/dL (0.9 - 1.7 ng/dL)
Free T3: 1.7 L pg/mL (2.3 - 4.1 pg/mL)

*3/30/2023 reduced to 5 mg of Methimazole / day

5/10/2023:
TSH: 11.200 H mIU/L (0.270 - 4.200 mIU/L)
Free T4: 0.8 L ng/dL (0.9 - 1.7 ng/dL)
Free T3: 2.5 pg/mL (2.3 - 4.1 pg/mL)

* 5/10/2023 see question below on dosing
I’m scheduled to retest at the beginning of June.

Questions:
1. Is it normal that my numbers have moved so quickly with Graves Disease? How do you know if you have/had PPT?
2. After my most recent test, my doctor is having me stop my Methimazole for 10 days and then will have me restart. He initially suggested keeping at 5 mg / day, but I followed up (waiting for him to get back to me) as I think I should lower my dose to 2.5 mg / day. Let me know if you agree.
3. Based on my background and labs is there other information that you can share / would advise? Would you expect my numbers to move more in range after dropping my dose further? I understand I am at risk of TED since I’ve dipped into hypo. Does this risk go down if I continue to lower my dosage / get my FT4 in the upper end of the range?

Hi,
the risk for TED improves as you raise your thyroid hormone levels, getting them nearer to the high ends of the reference ranges,
It used to be that TSI antibodies were thought to only occur in Graves' disease. Now we know they can also occur in postpartum thyroiditis (PPT). Your levels fell quickly and you may just have PPT or a combination of Graves' disease and PPT.
It's not a good idea to stop your dose for 10 days. Sorry to be slow here but just got back online after a very wet snow and power loss. Landline is still down and cell service is spotty.
I'd go for a lower dose, perhaps 2.5 mg or 1.25 mg. The original research done in the 50's shows that a dose as low as 0.5 mg MMI is effective for lowering thyroid hormone levels. The treatment goal is to use the lowest dose needed to keep FT4 near the high end of the reference range even if TSH is low.
Keep copies of labs. It seems you have a good grasp of what's going on so keep monitoring your doses to make sure they stay optimal. With PPT or PPT with Graves' remission is achieved faster, usually within one year. best, elaine