The Wellness Q&A with Elaine Moore

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TRAb Level: Continue Meds or Not?
Last Post 24 Dec 2021 12:01 AM by Elaine Moore. 1 Replies.
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bejUser is Offline New Member New Member Posts:
17 Dec 2021 10:57 AM
    Hello--I hope the holiday time is pleasant for you.

    I'm at the point of not knowing who to believe or what to do. I've been taking the lead in my methimazole dosage for some time now, querying my endo about why dosage wasn't lowered or lowering it and then soon thereafter consulting with her. I was diagnosed Graves' in late Sept. 2019, with initial dosage 10 mg. I've been moving closer since then to the point of possibly going off meds to check for remission.

    This month 12/21, I had 3 month labs. My fT4 was 0.82 (0.76-1.46 ng/dL) which my endo said was "fine" even though this was a drop from 0.90 in 8/21. I don't understand the drop because in an attempt to move the 0.90 up I changed my meds from 1.25 mg/daily to 1.25 mg every other day (total of 5 mg every seven days). I informed her of this soon afterwards and she went with it.

    TSH this time (12/21) was 0.90 uIu/mL [0.42-5.47], an increase from 0.81 on 8/21. Thus, I don't understand why fT4 dropped significantly. I have never gotten a fT4 above 0.96 since 6/20 at which time TSH was 1.89 .

    T3 did come up this time to 1.2 ng/mL (0.8-2.0). It was 1.0 on 8/21.

    ANTIBODIES: On diagnosis 9/2019, TRAb was 25.77 [<1.75]. The lab goofed and I did not get results in 9/2020 because they ran a TSI instead, which was 2.91 [<0.55]. On 5/2021, however, TRAb was 1.91, but I had recently gotten 2nd Pfizer. This month (12/2021) it was 1.63 and my endo said ("antibodies are now normal, continue what you are doing").

    One of the Facebook groups on Grave's research is managed by someone who vehemently asserts that TRAb should be BELOW 1 and practically 0 before going off meds. She also says anything below 2.5 mg. of methimazole WILL NOT lower antibodies, so she advocates taking both methimazole AND levo simultaneously to "fight" antibodies while avoiding hypothyroidism. Despite my fT4 hovering so low, my endo has never discussed such treatment with me.

    When I got my 0.82 fT4 lab, I stopped my meds (1.25 alternating days) right away (this week). I told myself that if my anbodies came back still elevated, I would go back on it. My endo seems to be saying to stay on that dose UNTIL I tele-visit with her, which is not until January 2022.

    Incidentally, when I moved to 1.25 mg. alternating days, I soon thereafter had TWO wonderful months full of more energy than ever, with no crashes sleeping >10 hours a day plus naps. THEN, the first of December, crashes returned.

    Elaine MooreUser is Offline Veteran Member Veteran Member Posts:3836
    24 Dec 2021 12:01 AM
    The crashes could be from vaccines if you had any or stress, which is common over the holidays. Individuals with Graves' disease rarely have TSH receptor antibody levels less than 2. Typically, we have low levels lifelong. The TSI is the better test for assessing Graves' remission and a dose of MMI as low as 0.5 has physiological effects (discovered in 1955). You may be in remission since you're doing well on a negligible dose. Best to you, Elaine
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