[scarlettx]

#1059580

Hi All,

I apologize in advance for the long post, but I am new to this board and have a lot to say. My 28yo partner was diagnosed hyperthyroid a month ago at a health clinic, after symptoms of unexplained weight loss, pounding heartbeat, heat intolerance, goiter, tremor, and frequent bowel movements. There is also some lid retraction and slight proptosis in one eye. Some symptoms had been occuring since the beginning of the year, but we explained most of them away thinking they were caused by other issues. Also, having no insurance makes you not visit the doctor very often. When the pounding hearbeat got worse, she went to the clinic.

Very nice Dr. diagnosed her hyperthyroid and ordered TSH, FT4, and T3 and started her 11/15/2012 on Methimazole 10mg twice a day, and Atenolol 25mg once a day. He wanted her to get an ultrasound, but it was going to be $200, since she is getting insurance (Kaiser) in January, we felt that could wait until then. We don’t have a diagnosis of Graves’ disease yet, but I hope it’s okay that I still post questions on here.

Initial Labs 11/15/2012
TSH <0.01 (0.35-5.50)
FT4 8.74 (0.70-1.53)
T3 >651 (71-180)

Follow up Labs 12/11/2012
TSH <0.01 (0.35-5.50)
FT4 2.92 (0.70-1.53)
T3 375 (71-180)
FT3 13.3 (2.0-4.4)

My partner is not the researching kind, so I have been reading past posts on this board, other boards, reading literature, and trying to educate myself as best as possible to be her advocate. I have seen a common thread in almost all the posts, the medication dose is too high for too long and most patients end up hypothyroid.

Today we saw the Dr. to discuss the follow up labs. He said that even though her levels are improving, they are still high, and he wanted to keep her at the 20mg/day. I voiced concern that if she continued on that dosage for another 4 weeks, she would be hypothyroid by then. I can tell that he probably doesn’t have too much experience with methimazole dosage, etc. because for the most part he pulls up information about the condition on some sort of management program that gives background, treatments, dosage, etc. I am by no means complaining, because he is a wonderful clinic Dr. with a great bedside manner. He listened to everything I had to say about it, read some more, etc. He was hesitant, but finally agreed that it would probably be okay to drop the methimazole down to 10mg/day. But he kind of scared my partner with talk of her levels going back up and hyper symptoms returning, etc. He said he felt it was less dangerous go slighly hypo and then adjust the meds if necessary.

What do you think? I am right to being concerned? Should we wait until her FT4 comes into normal range before cutting the dose in half? My partner is feeling really good right now, most of her symptoms have improved or gone away, and I don’t want to do anything to mess that up.

Thank You,
Scarlett

[Kimberly]

#1175934

Welcome – and thanks for being such a great advocate for your partner!

This board is a little different from other online forums, as we are operated by a 501(c)(3) charitable organization with an active Board of Directors. We will not try to interpret labs, make dosing recommendations, or give or give medical advice. We recognize that because we are fellow patients, not docs, we could actually do more harm than good by going down this path. Your partner’s doctor is in the best position to provide advice, especially since he is aware of her full medical history. Here are a couple of general comments, though…

1. Has your partner been given a definitive diagnosis of Graves’? Graves’ is the most common cause of hyperthyroidism, but there are other potential causes as well (thyroiditis, overactive nodules, etc.). You can read more about the different causes of hyperthyroidism and their treatment options in the “Treatment Options” thread in the announcements section at the beginning of the forum.

2. Dosing with anti-thyroid drugs is part art, part science — and our body doesn’t always respond in a pre-determined 4-week or 8-week interval! Regardless of what your partner and her doctor decide regarding dosing, if there is a major shift in symptoms in between appointments, it’s always a good idea to call the office, explain what is going on, and ask for a new set of labs. Common symptoms of hypO include fatigue, joint pain, weight gain, constipation, dry skin, cold intolerance, and slow pulse.

Take care – wishing you and your partner all the best!

[scarlettx]

#1175935

Hi Kimberly,

Thank you for the advice, and I certainly understand the damage that can be done by trying to interpret lab results, etc.

She hasn’t been diagnosed with Graves’ yet, she will be starting with Kaiser in San Diego, CA in January, so hopefully we will be able to find her a good doctor and endocrinologist that can fully explore the cause of her hyperthyroidism. The clinic Dr. suspects that it is Graves’ Disease based on her symptoms, especially the goiter and eye involvement.

The Dr. did explain all the treatment options, he spent about 30 minutes just explaining everything on our first visit. We decided to go the ATD route, and see how that goes. So far, she is doing really well on the medication, so we will see.

We have a follow up appointment in 4 weeks, so we will see the results of the dosage change at that point.

Thank You,
Scarlett

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