Hello Elaine,

I wrote to you not so long ago with my lab results. After being diagnosed with Graves 3 years ago I got rather frustrated that no doctor explained to me why I need to take the treatment and how Graves actually works. Reading the articles on the website and many other member posts has helped immensely, so now I come back to you hoping you might be able to help yet again.

You accurately predicted that I might be going into hypo and I have as the latest lab results show:

- FT4: 7.9 (10.6 - 22.7), previously 11.3 a month ago
- Anti-thyroglobulin: 1630 (<=115), increasing from June when it was 1343

I'm now on 10mg Thiamazole, after being on 15mg in the last 2 weeks.

What does the increase in anti-thyroglobulin mean? Why do I need to keep taking Thyrozole if my Anti-thyroglobulin is increasing instead of decreasing? My doctor insists treatment should be at least 12-18 months, followed by total thyroidectomy. I have decided against surgery but I don't understand why such a long course of treatment is needed? I have no nodules, just strong vascularization. I feel tired all the time, gained some weight, find it hard to concentrate as I used to, all signs of hypo.

Thank you very much for everything you do.

Hi,
Anti-thyroglobulin are thyroglobulin antibodies. These are seen in high levels in Hashimoto's thyroiditis and in moderate levels in Graves' disease. Your level is high because your FT4 is too low. When you move into hypothyroidism your gland tries to fix things by speeding up its activity. this includes increased thyroid antibody production. You're supposed to be on the lowest dose of Thyrozole needed to keep your FT4 around 22. Your 10 mg dose may still be too high if your FT4 isn't at least 20 with your next labs.
You'd expect to have signs and symptoms of hypothyroidism considering your labs. Keep an eye on your FT4 and if it's not optimal, ask to lower your dose further.

Most experts recommend not doing aggressive treatment (RAI or surgery) without at least trying meds for 12-18 months. This doesn't mean that you have to be on meds that long. some people achieve remission sooner although on average the best rates of permanent remission are seen in people who stay on meds for several years. we're all different though. that said, when your dose is too high and you become hypothyroid that prevents remission. the idea is to lower the dose as needed always going along with the recommended guidelines (lowest dose needed to keep FT4 near the high end of the range). best, elaine