To Lower or Stay at Current MMI Dosage? - Question and Answer Forum - Elaine Moore Graves' Disease and Autoimmune Disease Education

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Saturday, April 21, 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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To Lower or Stay at Current MMI Dosage?

3/16/2012 3:16 PM

Naomi

Joined: 2/22/2012

Posts: 4

To Lower or Stay at Current MMI Dosage?

Hi Elaine,

I need some advice regarding my recent labs.

A quick summary of my situation:

I was diagnosed with GD in August 2011, Dr. overmedicated me with MMI and I became hypO. My MMI dosage was finally lowered in January 2012, and my new Dr. has been gradually lowering the dosage. I've been at 2.5mg a day for a little over 3 weeks now, but I still feel hypO.

Current symptoms:

fatigue

anxiety

hair loss

sensitivity to cold

***jittery/racing/fluttering heart

***swollen upper arms, legs (from thighs to ankles), face

***loose stools

The symptoms with the ***s are new; these started in the past 3 weeks, since I've been on the new 2.5 mg dosage.

My questions:

1. When I was initially diagnosed with GD, the MMI brought down my hyperthyroid symptoms fairly quickly (within weeks). Is it normal for it to take significantly longer for anti-thyroid-medication-induced hypothyroidism symptoms to be controlled?

2. From your experience, would you say I should stay at the 2.5 mg a day for now and see if my levels keep improving? Or should my dosage be lowered to 1.25 mg a day?

Here are my labs:

7/15/2011

Free T4 3.63 (Range 0.81-1.54)

TSH less than 0.01 (Range 0.35-4.0)

*** Prior to starting methimazole.

8/5/2011

Free T4 3.39 (Range 0.81-1.54)

TSH less than 0.01 (Range 0.35-4.0)

T3 379 (Range 58-158)

TPOAB less than 3.0 (Range: less than 5.6)

ESR Westergren 8 (Range 0-20)

*** Prior to starting methimazole.

10/3/2011

Free T4 1.1 (Range 0.81-1.54)

TSH less than 0.01 (Range 0.35-4.0)

*** 10mg/day of methimazole. Most hyper symptoms gone or decreased.

10/27/2011

Free T4 0.9 (Range 0.81-1.54)

TSH 0.01 (Range 0.35-4.0)

*** 10mg/day of methimazole. HypO symptoms began and increased.

1/9/2012

Free T4 0.74 (Range 0.81-1.54)

TSH 9.24 (Range 0.35-4.0)

*** 10mg/day of methimazole. Severe hypO symptoms.

2/20/2012

Free T4 1.03 (Range 0.81-1.54)

TSH 5.24 (Range 0.35-4.0)

*** 5mg/day of methimazole. Severe hypO symptoms are mostly gone, but definitely still feel hypO.

3/15/2012

Free T4 1.18 (Range 0.81-1.54)

TSH 3.69 (Range 0.35-4.0)

T3 94 (Range 58-159)

*** 2.5mg/day of methimazole. Still have hypO symptoms; listed at the top of this post.

Thank you so much for your help. You rock, Elaine!

3/18/2012 2:33 PM

Elaine

Joined: 8/1/2008

Posts: 3424

Re: To Lower or Stay at Current MMI Dosage?

Hi,

Your labs aren't bad. Although TSH is still elevated, it takes at least 6 weeks for it to fall and reflect your new thyroid hormone levels. You could move to a lower dose and your labs would be even better, but your new symptoms are sort of worrisome. Loose stools and heart flutter, had they occurred right after the dose change, could have been transient symptoms resulting from the dose change. That they're occurring later suggests that they're not related to hypothyroidism and could be related to hyperthyroidism. The swelling of upper arms and face could be related to hypothyroidism but you'd have expected these symptoms to have shown up when your hypothyroidism was severe in January. So my concern in lowering the dose would be the return of some hyper symptoms. I'd probably stay on the 2.5 mg dose for now and see what your next labs look like. However, if your hypo symptoms seem troublesome, you could call your doctor's office, report these symptoms and ask about lowering the dose (they may be confused by the TSH and give you the go ahead or they may order you to have labs sooner). Best, Elaine

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To Lower or Stay at Current MMI Dosage?

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