[Shelly77]

#1060497

I was diagnosed with Graves’ disease in June 2013. I recently quit going to my endocrinologist and have an appt scheduled with my pcp to discuss further plan of care.
6/9 tsh <0.01, free t4 3.0, t3 455, tga <20, tpo 800. She drew tpo because she thought I was hypo, but I had all the signs of graves except the skin condition. I was started on methamazole 10 mg 2x day
9/3 tsh 19.600, free t4 0.6, tbll 71.2, tsi 135 methamazole decreased to 5 mg 2x days
11/1 tsh 0.044, free t4 1.4, t3 200 methamazole increased to 15 mg day
1/4 tsh < 0.005, free t4 1.5, t3 221 methamazole increased to 10 mg twice a day
3/28 tsh 73.600, free t4 < 0.3, t3 91 methamazole stopped
4/17 tsh 0.056, free t4 2.2, t3 465, tga <20, tpo 445, tsi 555 methamazole 5 mg 2x day
8/19 < 0.005, free t4 1.4, t3 181. Not sure what my pcp will recommend. I'm going Monday. I feel so lost. I don't understand the labs but feel I'm going in circles and it will never be regulated.
From what I read t3 and t4 levels, once normal the tsh will eventually rise? How long does it take? I’m so confused

[Kimberly]

#1182964

Hello and welcome! We’re fellow patients here, not doctors, so we’re not allowed to interpret lab results. In general, though, I’m not sure if the results you posted were delivered via phone or if you have a hard copy of the labs. I would really encourage you to get a hard copy of your labs, so you can see where your levels are compared to the lab’s “normal” reference ranges – and keep track of them over time. Different labs can use different “normal” ranges, so the actual numbers are only useful in the context of your specific lab’s range. Are your levels right in the middle? At the upper end? The lower end? And where are you compared to your last set of labs? This is the kind of information that can be useful over time. In general, for a patient who is hyperthyroid, you want to see T3 and T4 decreasing towards the normal range (but *not* dipping below normal) and TSH increasing towards the normal range. As you noted, the TSH can take longer to respond than the T3/T4, so the TSH level is *not* a good benchmark for making dosing decisions. Much of the medical literature says that TSH will respond within a few weeks – but it’s not uncommon to hear from patients who took several months for TSH to come back up.

Also, I don’t know how your appointments are structured, but if you are able to get labs *before* your appointment with the endo, then you can spend the visit discussing the results. This requires the hassle of two stops (one for labs and one for the appointment), and some insurance companies won’t pay for this, but it’s really the best way to understand your results and the doctor’s dosing recommendations. Hope this is helpful!

Take care!

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