Lab Results 7/18/17

TSH 0.01 (.33-4.70)
FT4 3.79 (0.89-1.76)
T3 free 8.8 (2.3 -4.2)
Reverse T3 86.6 (9.0-27.0)
Thyroglobulin Ab 0.9 (4.0)
Thyroid Peroxidase Ab 0.7 (0.3-9.0)

8/14/17 ER Visit
FT4 2.64 (0.89-1.76)

I haven't seen an endo yet but my PCP phoned her today and endo said to up my methimazole from 15mg per day to 20 mg per day.

I have anxiety, trouble breathing and heart palpitations. Have lost 25 lbs. When I eat stomach feels big and trouble taking a deep breath. Heart speeds up mostly at night. I requested panic attack meds today.

My PCP doesn't look at reverse T3 and wants my T4 to be mid range on the scale. Concerned with lowering T4. No mention of anything else. In two weeks they will test levels. I have been struggling.

Hi,

The goal with meds is to use the lowest dose needed to keep FT4 near the high end of the reference range. Was your level in July from when you were diagnosed before starting meds? Considering your levels, you would have been best on the usual starting dose of 20 mg.
when first starting meds, with the usual starting dose of 20 mg, it takes 6-8 weeks before all the hormone stored in your gland is used up. at this time your FT4 should fall within the reference range and the dose can be lowered. since you started or had been on only a 15 mg dose, it can take longer for your FT4 to fall within range. And FT3 takes longer. There's no need for a reverse T3 test in Graves' disease as this level will be high as your body tries to convert more T3 into an inactive form. All of your symptoms are consistent with those seen in hyperthyroidism and they should subside as your levels fall back into range. I hope you start feeling better soon. best, elaine