The Wellness Q&A with Elaine Moore

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New here - Advice on results and dosing?
Last Post 07 Aug 2023 11:13 PM by Elaine Moore. 1 Replies.
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HalieUser is Offline New Member New Member Posts:
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01 Aug 2023 09:00 PM
    Hi Elaine,

    I'm a 36yr old female from the UK and I was diagnosed with Graves' Disease in February (with thyroid receptor antibodies greatly elevated at over 100!)

    These are my blood test results:
    16 Feb: TSH <0.01 mU/L (0.27 - 4.2) Free T4 78.1 pmol/L (10.0 - 21.0) Free T3 >30.8 pmol/L (3.5 - 6.5) TRAb >100 iU/L (<1.75)
    14 Mar: TSH 0.02 mU/L (0.27 - 4.2) Free T4 4.5 pmol/L (10.0 - 21.0) Free T3 4.5 pmol/L (3.5 - 6.5)
    02 May: TSH 0.03 mU/L (0.27 - 4.2) Free T4 10.6 pmol/L (10.0 - 21.0) Free T3 6.4 pmol/ (3.5 - 6.5)
    05 Jun: TSH 0.02 mU/L (0.27 - 4.2) Free T4 12.2 pmol/L (10.0 - 21.0) Free T3 5.9 pmol/L (3.5 - 6.5)
    18 July: TSH 3.59 mU/L (0.27 - 4.2) Free T4 8.6 pmol/L(10.0 - 21.0) Free T3 4.6 pmol/L (3.5 - 6.5) TRAb 16.56 iU/L(<1.75)

    I have been taking:
    40mg carbimazole daily since 17 Feb (along with a beta blocker for the first six weeks)
    75mcg levothyroxine daily from 05 April to 03 June, followed by 50mcg levothyroxine since 04 June
    (I switched to 50mcg because I experienced palpitations and shakes on 75mcg. Feel much better on 50 but have just been advised to return to 75 as my FT4 is too low).

    My questions are:
    1. What do I make of the sudden big increase in TSH to 3.59? And of my FT3 remaining normal despite FT4 being low?
    2. Do you think lowering carbimazole could work well as an alternative to increasing levothyroxine? I would like to be on meds long-term to allow a better chance of remission and would prefer a lower carbimazole dose to reduce the risk of side effects. In recent weeks I've wondered about asking my Dr if I can switch to carbimazole only, but with my TRAb being high perhaps it would be safer to stick with Block and Replace? (I only have the two TRAb figures as I can't seem to get a TSI test unfortunately)

    Many thanks
    (And thanks so much for this site - I'm finding it a really useful resource!)
    Elaine MooreUser is Offline Veteran Member Veteran Member Posts:4084
    --
    07 Aug 2023 11:13 PM
    Hi,
    TSH begins to rise before thyroid hormone levels fall below range. On July 18, TSH rose because FT4 fell below range.Whenever you increase your dose of thyroid hormone, you'll have transient symptoms for a week or two as your
    body adapts to the change. If the dose isn'y high hypo symptoms improve at first and then return after a few weeks.
    I see your point in lowering carb but it does a good job of lowering FT4. However, it's a high dose so you'll eventually need to lower it.
    I also like the protocol where Carb or MMI are lowered over time and levothyroxine increased with the final protocol using levothyroxine alone for a year or longer.

    Thanks for your kind words. Best, Elaine
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