[Kimberly]

#1066096

Beths49 – Can you call the endo’s office and ask for an appointment with a Nurse or Physician’s Assistant? It sounds like you could benefit from a sit-down discussion with someone who is familiar with your medical history…*and* who is willing to take the time to answer your questions. It might even help to have a friend or family member sit in on the visit to help take notes. Sometimes hyperthyroidism can mess with our ability to concentrate! ” title=”Wink” /> Having a list of questions written out ahead of time would be helpful, but here are a few you might want to start with. Hope this helps!

1. Clarification on the interaction between your methimazole and bp meds. (Note: I’m not familiar with an interaction warning between bp meds and methimazole…although being hyperthyroid can lead to an elevated blood pressure).

2. Confirmation that the dose should be taken all at once. (Most of the patients I know tend to split up the dosing, unless it’s a *very* small dose…but your doctor may have a reason for his instructions.)

3. Clarification on what "fine" means as related to your labs. Does this mean your thyroid levels are back in the "normal" range?

4. Clarification on why your dosage is being increased. Is it because your labs aren’t moving in the right direction? Or perhaps because your doc started you off with a smaller dose than needed, to make sure you didn’t have an allergic reaction?

5. Find out when they are going to re-check your White Blood Cell Count — hopefully, soon to make sure your WBC count doesn’t dip any lower. Also, definitely report signs of infection, such as a sore throat or fever to your doctor ASAP.

[Beths49]

#1018624

I am responding here because I didn’t want to take up the original posters post. I just found out how to start a new topic!

I did see my primary care dr today and he prescribed 25mg of the generic of Topral for my blood pressure. I went to him just to have him treat my bp, not for treatment of the GD, as I know he doesn’t treat this. Anyway, the pharmacist told me to watch my bp as the Methimazole could make the blood pressure medicine not work well. Those 2 somehow have the possibility of interfering with each other. I do need treatment for my bp though as it is very high and the endo didn’t want to give me a med and I did not receive an answer as to why. It was 184/104 yesterday at his office.

I did receive a call from the endo’s nurse this afternoon and he said the dr had read my blood work and it was all "fine" and to increase the Methimazole from 10mg a day to 30mg a day. I expressed my concerns about this with him yesterday but if you recall from my other post in the other thread and forgive me, I can’t remember what it was named, he didn’t want any questions from me. He only wants me to do as he says. I did get my blood work faxed to me tonight and my wbc was 4.0 and it now reads 3.2L but yet he said all is okay and to up the dosage! What do I do? I asked my pcp if he would have sent me to this endo if he had referred me and he said yes, most definitely. He said he is a good dr, very smart but that his bedside manner is lacking. He told me that yes he does expect you to just do as he says. He said I know this is not how you are and am not saying you should be but he is a good dr. He suggested that I ask questions of the drs nurse or his PA. He said that he would also be available to answer any questions that I might have. I am so confused and still so unsure about this. I am used to having a dr I can communicate with. I am very concerned about taking the 30mg at one time a day (in the mornings is when I have been taking the 10mg). The endo dr and the pharmacist assured me it was okay but I see people here who take divided doses, so I don’t know. Can anyone respond to that? I am also still concerned about the side effects (I have had none at 10mg). Trying to keep the faith and appreciate all of your help and comments! It means alot!

[Bobbi]

#1066097

As Ski pointed out, Beth49, it is not at all uncommon for people to take methimazole as a single daily dose. Methimazole has a fairly long biological "life span" in the body. Unlike PTU (where the biological life span is close to 8 hours) which has to be taken evenly spaced throughout the day, the beauty of methimazole is that it you only need take it once every twenty four hours. That is, indeed, one of the reasons doctors like to prescribe it. So, I don’t think you need to fret about the fact that the doctor wants you to take a larger dose than you are on, and still keep it at once a day. As for the size of the dose itself, that is a calculation based on the results of the most recent blood work. Could it be slightly too much? Yes, but it might be just fine. And the only way to know is to take the prescribed dose as directed. There is a bit of a guessing game that goes on with the medications like methimazole and PTU. You and your doctor are looking for the dose that is just right –not too much, not too little. The only way to find that out is to adjust the dose and redo the blood work a handful of weeks later.

As Kimberly pointed out, higher-than-normal blood pressure is often associated with hyper levels of thyroid hormone. If that is what is behind your high blood pressure issues right now, getting your thyroid levels normalized, and controlled, can lower the blood pressure. So, while the pharmacist is correct that the particular blood pressure med you are being put on can be not quite as effective while you are taking methimazole, that may not be a problem if your blood pressure lowers along with your thyroid levels. Being "not quite as effective" is not the same thing as being completely not effective, if you see the distinction here.

If I am hearing you correctly, though, it seems you are fretting about having to take medications period. You said, I think, that you have a history of side effects from meds in the past? I am somewhat the same, so when I was put on PTU, I fretted about having to take it, as well. And I had to take several of the little pills three times a day. It worried me. But you absolutely MUST do something to get your thyroid levels controlled back in the normal zone, Beth. The enemy for you right now is not the meds, it is the disease. And that has to be your focus. You must — and CAN — get your thyroid hormone levels back to controlled "normal." One way is to try the methimazole, and take it as the endo directs. If you cannot do that, if you cannot bring yourself to take the dose the endo has prescribed, then you must talk with him about other options — like RAI or surgery. Again, the WORST possible thing you can do is allow the hyper levels of thyroid hormone to remain in your body. There might be reasons why you HAVE to stay on the meds. Some folks cannot do RAI or surgery, due to individual medical reasons. Some folks must bring their levels down with the meds before they can consider the other options. So, it may help you, a lot, if you can focus on the disease as your enemy, rather than whatever treatment option has been recommended. Typically, no matter WHAT treatment option we are on, it is much, much safer than remaining even a little bit hyperthyroid.

[James]

#1066098

On the subject of splitting Methimazole dosages throughout the day versus taking it all at once.

My experience with my endo was it was better to split the doses of Methimazole throughout the day. While it may be true that the biological life of the drug is such that you can take it all in one dose, we have had people mention stomach upset and nausea from time to time which is one of the minor side effects of this particular ATD, particularly if you are on a moderately high dose initially (30mg/day is considered moderate). Of course if is more important that you take your meds even if it is all at once, rather than missing a dose throughout the day.

If you are able to get down to a lower dose and maintain at 5mg/day or less eventually, it would become almost impractical to split those doses. If this is of concern to you, your Pharmacist may be a good resource to turn to in this matter.

Take care,

James

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