Hypothyroid now?? - Question and Answer Forum - Elaine Moore Graves' Disease and Autoimmune Disease Education

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Sunday, April 08, 2012

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Welcome to The Q&A with Elaine Moore. Registered members are invited to ask any question of Elaine Moore on autoimmune diseases, Graves' disease, other thyroid diseases and subconditions, laboratory work, traditional and complementary medicine, triggers and environmental influences, thyroid and immune disorders in pets and animals, and other relevant areas of inquiry.

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Questions are answered solely by Elaine Moore, a medical writer and clinical laboratory scientist, MT, CLS, with more than 30 years of experience in immunology. Moore has also authored and edited over a dozen books in the area of health sciences and is an editor for McFarland Publisher's Health Topics Series.

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2/25/2012 7:39 AM

lilonecita13

Joined: 11/29/2011

Posts: 2

Hypothyroid now??

Elaine,

I wanted to get your advice because I am confused with my latest results. I was diagnosed with Graves’ at the end of November 2011 and I started on 20 mg of Methimazole and 25 mg of atenolol per order of my Endo. My lab results from Dec. 30, 2011 showed improvement and my methimazole was reduced to 10 mg by the Nurse Practitioner at Endo’s office. I started feeling hypo (cold, tired, join aches end of January but didn’t really think I was going hypo). The next labs were 6 weeks from end of December, although I think it should have been sooner, on Feb. 20, 2011. These labs showed I am hypothyroid according to the NP and she said to stop taking my 10 mg meds for 3 days and start on lower dose of 2.5 mg methimazole daily after 3 days. I just received a copy of my labs from Feb. 20^th and I am confused. I have the following questions, and your answers are greatly appreciated. Thank you. Amalia

1. Am I hypothyroid now and should I be taking replacement hormones?

2. Should I be doing labs more often, instead of 6 weeks, request every 4 weeks?

3. Is the dose of 2.5 mg Methimazole daily right? Or do I need to be off this medication?

Labs: Ranges FT4 (0.8-1.8 ng/dL), TSH (0.40-4.50 mIU/L), Total T3 (76-181 ng/dL)

11/22/11

FT4 2.9

TSH <0.01

TotalT3 256

TSI 362 (range <140% baseline)

12/30/11

FT4 1.4

TSH <0.01

Total T3 118

2/20/12

FT4 0.8

TSH 10.34

Total T3 97

2/26/2012 11:31 AM

Elaine

Joined: 8/1/2008

Posts: 3374

Re: Hypothyroid now??

Hi,

Initially in November, your lab results were moderately elevated and you responded well to the 20 mg starting dose. The reduction to 10 mg was appropriate but you responded even better than expected. You don't need replacement hormone but simply a dose reduction. The plan of stopping meds for 3 days and continuing with a 2.5 mg dose is a good one.

If your next labs show FT4 to be lower than the middle of the reference range, your doctor will likely either reduce the mmi dose to 1.25 mg or add replacement hormone then in a block and replace protocol.

Your current borderline hypothyroidism is caused by the mmi dose being too high. After a day without mmi your FT4 will rise and by the 3rd day probably be optimal. Before it rises higher, the 2.5 mg dose will keep it in check. You don't need to be off meds entirely because your high TSI shows that you'd just return back to where you were in November without meds. Best, elaine

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