Hi Elaine,

Thank you so much for answering all of my emails. I really appreciate it. In December I was told by my Endo that I was finally in remission (original diagnosis Nov 2012). After weaning down to 1.25mg of Methimazole every 3rd day I stopped taking it in December. I have been told that my latest lab results indicate I am not in remission anymore. Here is a history of my recent labs:

Dec 2016
TSH 1.04 (.40-.4.51)
T4 1.20 (.80-1.80)
T3 98 (76-181)
T3 free 2.80 (2.3-4.2)
Vit D 31 (30-100)
TSI 94 (<140)

January 2017
TSH .62 (.40-4.51)
T4 1.2 (.80-1.80)
T3 93 (76-181)
T3 Free 2.80 (2.3-4.2)
TSI 121 (<140)


March 2017
TSH 1.20 (.40-4.51)
T4 1.20 (.80-1.80)
T3 100 (76-181)
T3free 2.90 (2.3-4.2)
TSI 119 (<122)
VitD 48 (30-100)

May 2017
TSH .53 (.34-5.00)
T4 1.07 (.58-1.64)
T3 free 3.08 (2.00-3.95) regular T3 not taken
TSI 135 (>122)

July 2017 (do not have actual labs back yet to show the lab ranges - just got the numbers from the office- assuming same as last lab ranges)
TSH .01
T4 1.70
T3 157
T3Free (not taken)
TSI 268
Vit D 32 50k units of prescription once a month

In May my regular doctor wanted me to start back on the Methimazole. However, my endo wanted to wait to see how my next labs looked until I started the medicine again. He told me to pay attention to my symptoms and we would do another lab in 2 months unless I started feeling bad then we would do it sooner. However, he did think I was trending towards hyper again. The July labs came back and the endo has told me I am hyperthyroid again and I should start 5mg of methimazole each day. I have noticed some symptoms, such as anxiety, racing heart/palpitations and more stiffness/tenderness mainly my hip, wrist and lower back area. In addition, my heart rate was normally in upper 60s.. over the last 2 months it was in the upper 80s. I also have gained 5 lbs instead of losing like I did when I was first diagnosed -. Here are my questions:

How would you dose based on these labs?
Is there a chance I can go into remission again?
Is it normal to gain weight instead of lose weight?
Should I be taking more vitamin D per month? How long can I take this high of an amount?
Can I eat shrimp with these labs? - going on vacation soon!
Do you have any other suggestions so I can achieve remission again? ( I do not ever have aspartame/splenda or any other artificial sweeteners, and I don't smoke or drink).

Again, thank you so much for all of your help, I really appreciate it!

Hi,
Hi T,
Your July labs with a rise in TSI and thyroid hormone levels and a drop in TSH indicate that you're not in remission.

How would you dose based on these labs? a 5mg MMI dose sounds appropriate
Is there a chance I can go into remission again? Yes, most everyone who achieves remission on anti-thyroid meds can do so again.
Is it normal to gain weight instead of lose weight? Some people gain weight because of an increased appetite when they're hyperthyroid depending on what they're eating. some people also reduce their activity and drink more sugary drinks in the warmer weather, which can contribute to weight gain
Should I be taking more vitamin D per month? How long can I take this high of an amount? You're not taking a high amount although the old recommendation was for 50,000 IU once weekly. Now it's known that for optimal levels (and your level is still low) people need between 5,000-10,000 IU daily according to the Vitamin D Research Council.

Can I eat shrimp with these labs? - going on vacation soon! in moderation, no more than once a week and add some goitrogens to your meal to prevent absorption of excess iodine. goitrogens include raw cabbage, broccoli, cauliflower, peanuts, almonds, squash, etc.
Do you have any other suggestions so I can achieve remission again? ( I do not ever have aspartame/splenda or any other artificial sweeteners, and I don't smoke or drink).
You might consider what triggered your relapse. typical causes are stress, allergic reactions, cigarette smoke, aspartame, etc. Adding more whole foods and fewer processed foods and incorporating stress reduction techniques (yoga, meditation, biofeedback, walking, deep breathing exercises) can all help.
best, elaine