The Wellness Q&A with Elaine Moore

Welcome to the Wellness Q&A where members can ask Elaine Moore any health-related question. Moore is a medical writer and retired clinical laboratory scientist with over 30 years experience in immunology. Get started by selecting Member Questions. This is a question-and-answer forum, and each thread represents a member question or set of questions. The question will only appear once it's answered. Thank you for joining.


Methimazole Dosage
Last Post 04 May 2022 02:14 PM by Elaine Moore. 1 Replies.
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mlm1013User is Offline New Member New Member Posts:
18 Apr 2022 03:20 PM
    Hello Elaine,

    It's nice to read that you've been doing well and are in remission and I will continue to keep you in my prayers. Thank you for answering our questions.

    I was diagnosed with Graves over a year ago and my original TSH was .01 and FT4 was 2.2 (.6 - 1.12). Right before I started meds, my TSH was .01 and FT4 came down to 1.4 (.6 - 1.12) on it's own without meds. I was put on 10 mg and my FT4 came into range rather quickly, then dropped below range, but my doctor wanted to keep me on 10 mg until I reached a TSH of 3. I submitted questions to you about this and based on your suggestions cut dosage in half until I got to 2.5 mg Methimazole per day and my TSH was 1.1 with FT4 1.1 (.78-1.48) after several weeks. I felt good and was kept on 2.5 mg of methimazole daily. Late November 2021, my TSH was 1.79 and FT4 was 1.05 (.78-1.48) and I questioned the doctor about my TSH. She said to keep on 2.5 mg. It was a stressful time (ageing parents, holidays, travel) and I didn't want to change doses in the middle of it all. On 1/14/22, I ended up testing again with TSH 2.25 and FT4 1.14 (.78-1.48) so I cut down to 1.25 mg of methimazole every day and follow up labs on 3/9/22 showed TSH at 2.2 and FT4 at .9 (.6 - 1.12). My TSI ranges have been high from the beginning on 1/21 at 6.1, 11/21 at 4.8 and 4/22 at 3.8 all ( <=1.3). My TSI level is slowly falling and my current doctor (different then the first one) seems to think that I should stay on 2.5 mg of Methimazole 3 times per week (Monday. Wednesday and Friday) to continue to bring TSI down. She says that a dose of 1.25 daily is infective and I should be at 2.5 three days a week. When I questioned my TSH, she said that it would be fine even if it went to the low 3's so my TSI level could continue to fall. She seems to think that my TSI level is due to stress but I can't help but think that if stress was really affecting my levels, the TSI would continue to be high and my thyroid levels would be harder to control. I have a lack of energy and motivation to do much of anything, including exercise, which is the one of the ways I control my stress. I told her this and she said it had nothing to do with the TSH level.

    Advice from here on out? My doctor said she would consider having me go down to 2.5 mg twice per week or I could stop the Methimazole for a month and then go back on it. All the advice from here reads that if you're secreting TSH on a small dose of Methimazole, to stop the meds but I still have a high TSI so I'm a little leery. My recent eye exam showed no signs of TED but my eyes are dry at times and sensitive to sunlight. I've read that a high TSI correlates more with TED than hyper symptoms. Diet and vitamin levels are good, I just don't know where to go from here. Thank you for any advice you can give me.
    Elaine MooreUser is Offline Veteran Member Veteran Member Posts:3822
    04 May 2022 02:14 PM
    A dose as low as 0.5 mg has effects and you're better taking a lower dose daily for stable levels. Once you're down to 1.25 mg then you can take the dose every other day. Your TSI is still high but it's coming down nicely. Once these antibodies are in your circulation, it takes 2-3 months before they break down and are excreted. Your TSI is falling as expected. With sophisticated tests, most everyone with Graves' disease does have some TED, usually mild so your symptoms are likely related.
    Lifestyle and diet are important and just cutting back on grains can help move things along. If you're secreting TSH normally on a negligible dose of MMI like 1.25 mg then remission is suspected. But with TSI being still elevated a good option would be block and replace where you'd stay on 2.5 mg MMI and add 25 mcg of levothyroxine. This works well although not all doctors are familiar with its use. Best, Elaine
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