Hi Elaine,

I hope you are doing well!

I wonder what you would think about my recent labs. I have had a wild ride for the last year due to extreme stress and life events. Trying to get stable again now.

I will put my lab results below with the most recent at the top. Note that in October 22, I stopped MMI on advice of my primary care provider, that was a mistake, and I am not sure why I didn't suspect it would be given my 12 year history of managing Graves. I guess I was not thinking well.

I have been somewhat stable but I can't seem to get my FT4 to adequate levels. I have been reluctant to reduce my MMI since it does seem to do a good job keeping the auto immune condition controlled.

However, at this point with the low FT4 I have had for 7 months I need to make a change that will get it up. I am exhausted all the time.

I am on 50 mcg of Levo, and it is making my hair fall out again (lost so much last year!) and it is not really helping my FT4.

Would you suggest reducing the MMI and/or the Atenolol? I need to try to keep my FT3 in range but I need more FT4 or I just don't function well. I have typically needed my FT4 at the top end of the range to feel good.

My heart rate when just moving around my day has been around 62 and blood pressure normal for 6 months now, so I don't know if the Atenolol is contributing to my exhaustion or not. In the first 5 years of my Graves journey I only took 25 mg of Atenolol. I think it helps to keep my FT3 lower? But then my FT4 is low.



----Testing Ranges----
TSH 0.45-5.33
T3, Free 2.3-4.2 pg/mL
Free T4 0.7-2.0 ng/dL
T4, Total 6.1-12.2 ug/dL

LABS

7/31/2023-----

TSH 0.27
FT3 3.7
FT4 0.8

5 mg MMI
50 mcg Levo
50 mg Atenolol


6/30/2023-----

TSH 1.44
FT3 3.4
FT4 0.7

5 mg MMI
37.5 mcg Levo
50 mg Atenolol


5/30/2023-----

TSH 6.14
FT3 3.2
FT4 0.5

5 mg MMI
25 mcg Levo
50 mg Atenolol


12/29/2022-----

TSH 0.49
FT3 2.8
FT4 0.3

5 mg MMI
Add 12.5 mcg Levo
50 mg Atenolol


11/8/2022-----

TSH 0.01
FT3 16.9
FT4 4.9

No MMI (Primary thought I could stop)
Hair falling out like crazy
50 mg Atenolol
Resume MMI after these results

10/14/2022-----

TSH 4.58
FT3 2.9
FT4 0.3

5 mg MMI
25 mcg Levo
50 mg Atenolol
Stop MMI after these results per primary


9/16/2022-----

TSH not ordered
FT3 2.6
FT4 <0.2

5 mg MMI
No Levo
50 mg Atenolol

6/23/2022-----

TSH not ordered
FT3 2.6
FT4 0.6

5 mg MMI
No Levo
50 mg Atenolol


5/17/2022-----

TSH <0.01
FT3 7
FT4 2.8
T4 Total 18.2

5 mg MMI
25 mcg Levo
50 mg Atenolol


Thanks so much for all your help!
Christine W

Hi TC,
You're right that you likely don't need atenolol. It's usually used for the first 6-8 weeks and lowered and stopped. You might ask about lowering the dose and then stopping. It doesn't lower FT3 appreciably the way propranolol does.
Since you probably want to stay with the same dose of MMI to keep FT3 in range, you would do well increasing levo. Ask your doctor about increasing it to 37.5 mcg. Best, Elaine