[Gabe]

#1059844

So I started this journey in January with a TSH of <0.017 and a T4,Free of 1.11. After no changes in labs in late Feb endo increased Methimazole to 10mg 2x/day and 25 mg beta blocker

Labs last week indicated TSH is 6.060 and T4,Free is 0.73 so endo cuts back meth to Mon-Fri same dose and nothing on Sat/Sun.

This change was all done by voicemail since I missed his call. He says he ‘over corrected’ so he wants to dial back.

Doe this mean I’m now hypo? Is there an inverse relationship between TSH and T4? Should I be requesting different labs? My liver labs have all been consistently within normal ranges. My eyes are still swollen and my irritability/inability to focus is still very prevalent. I don’t ‘feel’ any better and sometimes worse even with meds for 3 months.

I know we can’t diagnose each other, etc. Just thoroughly confused. I read and read and nothing seems to stick with me. I think I know the path this will take and then get slammed with labs results that don’t make sense (to me). I will be calling endo AND keeping my TT surgical consult for 6/5.

Karen

[adenure]

#1178202

Hi!

No, we can’t interpret labs or give advice. But, yes a TSH of 6.060 would indicate that you’ve swung hypo. If your TSH is above the normal range, than it is hypo. If it is below the normal range, than it is hyper. (kind of peculiar!) You didn’t post the normal ranges, but I believe (in general) the upper end of a normal TSH is 5.00. Yes, if the TSH is high (hypo), than the free T4 (and T3) would be lower, showing there isn’t enough thyroid hormone in the body. The TSH (Thyroid stimulating hormone) is high because there needs to be more thyroid hormone production. Where if your thyroid stimulating hormone (TSH) is low, it is low because your T4 (and T3) are high. So, yes it is an inverse relationship so to speak.

You might still feel yucky bc it sounds like you took a pretty big swing from hyper to hypo in a relatively short amount of time. Swinging never feels all that great. The good thing is that he is making an attempt to right things and scale back some- so that is good. Hopefully that will find your ideal spot with your hormones. Maybe you could ask him if your dose could be lowered and spread out over the week instead of taking the same amount 5 days and then 2 days off? Maybe it would help with evening things out- just a thought. Well, the good thing is your liver is fine and the methimazole is working! Working a bit too well… but, you are on the path to getting normal again, and yes, if you’re still considering TT, keep that appointment!

[Gabe]

#1178203

Alexis. Thank You! Your explanations are clear and make sense to me. I do plan to ask him about a lower dose every day vs the all or nothing approach. I originally started on 10mg 1x/day and nothing changed after 6 weeks so he doubled it. Maybe somewhere in the middle is better for me. I’ll see what the dial back does to the hyper vs hypo. The good thing is the surgical consult is 2 months away so hopefully I will know whether I can be stabilized toward remission or get rid of the thyroid for good!

Your response was very helpful!
Thanks!
Karen

[Kimberly]

#1178204

Hello – I don’t know if you were prescribed 10 mg pills, but methimazole comes in 5 mg doses as well. You can also buy an inexpensive pill splitter.

I’ve been on a “two days off” regimen before, and I picked Monday and Friday, just so I wasn’t going back-to-back days with no meds. That’s also worth a discussion with your doctor.

Also, it’s helpful (if insurance permits) to ask your doctor for a lab slip for your *next* set of labs at each appointment. Then you can have bloodwork done in advance of your next appointment. The down side is that this does require separate trips to the lab and to the doctor’s office. (And some insurance companies balk at covering the separate trips). However, this allows you to spend your time with the doc actually looking at the results of your labs and being able to ask questions, rather than having to decipher a phone message after the fact as to how to adjust your dosing!

Take care!

[Gabe]

#1178205

Thanks Kimberly. Great suggestions. I’m blessed with great insurance so I do get my labs before my visits and almost as often as I need/want them. I’m calling tomorrow to ask about splitting pills vs full days off/on.
Much appreciation!
Karen

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