Latest Blood Results advice please .Graves disease

[hattersteapar]

These are the latest results I have. The Endo says I'm slightly over with levothyroxine and suggests I take 125 mg one day and 100mg the nex. Would this be advisable ? Thanks in advance for any advice

[SeasideSusie Remembering]

If that was me I wouldn't agree. I would point out that my FT3 is very low in range in comparison to my FT4 and that indicates poor conversion of T4 to T3. I would be asking for some T3 to be added to a slightly reduced amount of Levo.

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, has recently published an article saying that T3 is likely essential for many hypo patients. I can't link to PDFs but there is a link in SlowDragon's reply to this post, last but one message down healthunlocked.com/thyroidu...

[hattersteapar in reply to SeasideSusie]

Thanks for your reply, I have Graves disease and I'm on 40mg of Carbimazol a day too, would that make any difference to your advice?

[SeasideSusie Remembering in reply to hattersteapar]

Yes as I assumed you were hypo, I know nothing about how Graves is treated so I would edit your title to attract the attention of people who know about Graves.

[Valarian in reply to hattersteapar]

How long have you been on the 40mg of carbi, and when did you start the levo ?

The aim of “block and replace” therapy is to block the thyroid from producing its own hormone, and replace it with levo. I believe the usual aim is to achieve mid-range thyroid levels (I have Graves, but am on a different therapy - hopefully someone with experience of B&R will chip in).

Your thyroid levels are at the lower end of the range, so it seems a bit odd to reduce the levo, but the endo’s over-riding concern will be to help you achieve remission, even if your thyroid levels do sometimes dip a bit low. Your high TSI results indicate that you aren’t there yet, so possibly the changed dose is a reaction to this. If you have a copy of your previous results, it would be worth looking at the trends as well as the point results.

The reduction in levo doesn’t appear to be huge (although hopefully someone with experience of B&R/levo will comment on this), and presumably you have a follow-up appointment scheduled in a few weeks. If you begin to feel your symptoms are edging towards hypo rather than hyper, you can always call and ask for your blood test and/or appointment to be brought forward, so I would probably do as the endo advised.

It can take a while to achieve the optimum dosage. It’s worth asking the endo to talk through the rationale for any treatment changes - although mine haven’t always volunteered huge amounts of information, they’ve been very willing to take the time to explain things whenever I’ve asked questions.

[hattersteapar]

Hi Valerian, I have only just changed to B&R previously I was just on Carbizmol (I can't remember the dosage but it was low). I saw my Endo in November which was when we discussed B&R as he thought it may help me achieve remission earlier. I have another blood test arranged for 6 weeks time. I see my Endo at the beginning of March. At the moment I feel okay so will try the new dosage routine out, if I begin to suffer I will see my GP who has been fantastic with helping me understand what's going on and nagging the hospital when things take too long.

Thanks again

[Valarian in reply to hattersteapar]

This all sounds typical. Quite a few people start out on a low dose of carbi to take the edge off the symptoms while they wait for their endo appointment.

B&R treatment is usually completed within 6-12 months, whereas titration takes 12-18. Outcomes appear to be similar, the main difference is that on B&R, you need to take a high dose of carbi for a longer period.

Good that you're feeling well - and that your GP is being so helpful.

[hattersteapar]

Thanks Valarian that put my mind at ease.