[cmac]

#1059408

my first labs after starting metoprolol and methimazole are coming up. The order is for

T4 free
TSH, highly sensitive
CBC (including indices, PLT, Diff)

Is this comprehensive. Should I ask for additional tests? I am feeling much better since starting the meds.

[snelsen]

#1174543

Looks pretty typical to me. ***Except I would ask if they plan to do a liver function panel. And ask them more about it.
Most issues with elevated liver labs happen at the beginning of taking an ATD.
Shirley

[Kimberly]

#1174544

Hello – In addition to Shirley’s comments on liver function testing, T3 is helpful as well (although there is some controversy over whether Total T3 or Free T3 should be the preferred benchmark).

[cmac]

#1174545

Just had a visit w/ my MD and went over my labs. T4 and CBC were in range. TSH went even lower, dropping from .01 to .005. I am seeing my first Endo in 2 weeks who will take over my case. The funny thing is, since starting the methimazole a month ago, I feel great. If I didn’t know the labs, I wouldn’t think I still had GD. I am exercising again, easily jogging 3 miles, I couldn’t do 1/2 mile in July. I have regained 10 lbs and my excessive thirst has largely abated. Why am I feeling so well if the TSH situation has worsened? Anyone have an idea? Is this some kind of phony remission?

[snelsen]

#1174546

Asa fellow patient, (unless you heart rate is super high) I think it’s weird. too[
Shirley

[adenure]

#1174547

It is weird, but I know that sometimes while our bodies are trying to figure things out, the numbers don’t always make sense. After my thyroidectomy, my Free t4 was in the upper range of normal and my Total T3 was midrange normal, yet my TSH was hypo- it didn’t make sense at all. My Synthroid was upped and 2 weeks later, everything leveled out to normal. I think when our bodies go through a major change- even if it’s just adding a medication to our daily life, it takes some time for adjusting. When my medicine was upped my free T4 actually dropped a little even though the dose was increased- doesn’t make sense exactly, but I guess the body needs time to get adjusted to whatever we do to it. Maybe get another set of labs in a month or 2 and see if things have evened out. I wouldn’t worry too much right now.

[cmac]

#1174548

No Shirley, the rate has always been good. Now with the metoprolol my bp numbers are @120/60, with a rate of 55. Without the beta blocker , I would be 140/80 and 65. I’m half convinced the lab made a mistake. I’m sure the Endo will order new tests so maybe that will clear up the mystery.
Anyway, I’m feeling good and if I have to choose between good clinical results and bad health, or bad clinicals and good health, I know which is better.

[Kimberly]

#1174549

Keep in mind that the Free T4 and T3 are much more important figures than TSH. TSH can remain suppressed for quite some time in Graves’ patients, so it’s not a good benchmark for making treatment decisions early in the process.

If you feel great, your heart rate is good, and your T4 is in range, I would say that’s great progress!

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