[adenure]

#1058931

Hello,

I had a question about getting labs done. I had posted once before; I was diagnosed with Graves 2 weeks ago and have been on methimazole (5 mg. daily). It seems to be working. I’m supposed to get labs done every 8 weeks for 1 year. The labs my endo ordered are TSH and T4 free. Initially, I had TSH, T4 free, T3, Thyroperoxidase Antibody, and the Immunoglobulin test as well. Are the TSH & T4 free tests for checking how the methimazole is working sufficient? Should I also ask my endo about having the T3 again or does that not matter? Thanks for any advice.

Alexis

[trudy]

#1171020

I’m a newbie to Graves (diagnosed about six weeks ago), so I can only tell you what my doc is doing. She measures free T3, free T4, and TSH every 2-3 weeks until we know I’m stabilized of the correct dose of Methimazole. Then the testing interval will be moved out. She also did a one time test of the TSI antibody.

Perhaps the frequency of testing depends on how off the scale one is originally, I dunno.

She is using T3 and T4 to tune the Methimazole.

[snelsen]

#1171021

Adenur, Do you know if you are also having a CBC and liver function labs at the same time as your other thyroid labs? I am more familiar with the way Trudy is having her labs, and this makes a lot of sense, because you can change how you feel pretty rapidly when beginning the ATD’s. I believe it is also a standard of care to do the two labs I mentioned above, because the WBC (white count) and liver studies need to be watched when beginning ATD’s. I am patient, not a doc. But I think these are very good questions for you to ask your doc. Tell her you’ve been doing some reading, or simply ask the questions This is pretty common knowledge.
The antibody tests are not done frequently, and sometimes, never again.
Get it discussed pretty soon, so don’t worry about it.
Shirley

[Kimberly]

#1171022

Hello – The latest guidance from the American Thyroid Association and American Association of Clinical Endocrinologists is as follows:

“An assessment of serum free T4 should be obtained about 4 weeks after initiation of therapy, and the dose of medication adjusted accordingly. Serum T3 also may be monitored, since the estimated serum free T4 levels may normalize with persistent elevation of serum T3. Appropriate monitoring intervals are every 4–8 weeks until euthyroid levels are achieved with the
minimal dose of medication.”

So according to this guidance, Free T4 testing is definitely recommended, and T3 testing is optional.

Antibodies have a fairly long “shelf life”, and the testing is fairly expensive, so these aren’t usually done routinely. My own doctor checks these about once a year. It’s also recommended to check antibody levels prior to withdrawing anti-thyroid drugs, as patients with elevated antibody levels are very likely to end up hypER again. (Antibody testing is also recommended in pregnant women who have a history of Graves’).

My doctor also runs the CBC and CMP tests that Shirley mentioned, although there is some controversy over whether these tests are effective in catching negative side effects early in the process.

Take care!

[adenure]

#1171023

Thank you! I had asked about testing sooner, but my endo. said that I wouldn’t see any changes in labs so early on, so my first labs after starting the methimazole are 8 weeks after the first dose. Not sure why so long, but I guess it’s okay. It’s been 2 weeks so far. I’m feeling better than I was although not 100% yet. I did ask for the liver and CBC tests to be added to the TSH and T4free. He didn’t order the T3- said it wasn’t necessary. The antibodies test makes sense (not doing it for awhile). Well, I’ll just wait it out until mid- May and then find out how the methimazole is working I guess. I think it’s working as, apart from sporadic sleeping, I’m doing pretty well. Still somewhat shaky, heat bugs me at times, can’t do a whole lot of physical activity, but my heart rate is down, I’m eating, and not losing anymore weight- so those are positives. Can’t wait to get normal sleep again though.

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