The Wellness Q&A with Elaine Moore

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From Hyper to Hypo under methimazole
Last Post 30 Jan 2022 01:19 PM by Elaine Moore. 1 Replies.
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risayesaUser is Offline New Member New Member Posts:
10 Jan 2022 12:12 PM
    Hi Elaine Moore,

    Happy New Year! It is my first time to ask a question here and I am glad I can find this place!

    My question is I have Grave disease when I was young but my results was good for the past 10 years and I was not on Med.

    In Jul 2021, I feel my heart beat is rising, so I got the lab work showing the TSH is decreasing. (I got the Covid vaccination in May 21, unsure that related). So I started Med in Aug for 20Mg.

    I am currently under methimazole 10MG and below is my lab results. Based on the 1/7/2022 TSH results, it seems I am from Hyper to Hypo right now. My doctor ask me to stop the medication right away, I am wondering should I slowly decrease the amount, such as reduce to 5mg or 2.5mg? I don't know which way is better, sharp stop or gradually stop?

    Also, I was considering change the methimazole to PTU recently to plan for a baby. My doctor said I am good to change the medication anytime now. But based on the current issues, should I wait longer for the lab results to be stabilize more? If I am going to start on PTU, what amount is a good starting point? Really appreciated a lot for your answer!!

    1/7/2022 10MG methimazole
    TSH 6.67 (0.4-4.5)
    FT4 1 (0.8-1.8)

    11/16/2021 10MG methimazole
    TSH 1.84 (0.4-4.5)
    FT4 1 (0.8-1.8)
    TSI 402 (>140)

    10/20/2021 10MG methimazole
    TSH 0.08 (0.4-4.5)
    FT4 1.1 (0.8-1.8)

    9/29/2021 10MG methimazole
    TSH <0.01 (0.4-4.5)
    FT4 1.3 (0.8-1.8)
    FT3 4 (2.3-4.2)

    9/10/2021 10MG methimazole
    TSH <0.01 (0.4-4.5)
    FT4 1.9 (0.8-1.8)
    FT3 5.7 (2.3-4.2)

    8/9/2021 20MG methimazole
    TSH <0.01 (0.4-4.5)
    FT4 3.5 (0.8-1.8)
    FT3 11.9 (2.3-4.2)
    TSI 297 (>140)

    7/8/2021 20MG methimazole
    TSH 0.23 (0.4-4.5)
    FT4 1.4 (0.8-1.8)
    FT3 3.4 (2.3-4.2)

    TSH 1.1 (0.4-4.5)
    Elaine MooreUser is Offline Veteran Member Veteran Member Posts:3836
    30 Jan 2022 01:19 PM
    First, I'm sorry for the delay. Cancer treatment is taking its toll.
    Your dose was far too high and ideally your FT4 would be near the high end of the reference range. A low FT4 affects fertility. Many doctors wait to switch patients to PTU after they become pregnant. A 5mg dose of methimazole is equivalent to about 50 mg PTU. Finding the optimal methimazole dose might be easier and you are right to reduce the dose slowly.
    Have your doctor check your vitamin D level also with a test for 25OH Vitamin D. Many of us have low levels, and low levels are associated with high TSI levels. It would be good if TSI fell and it could also be associated with the Covid vaccine, in which case it will begin to fall after 2-3 months. Best to you, Elaine
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