Block and replace graves and feel awful - Thyroid UK

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Block and replace graves and feel awful

cgauthie
cgauthie

My dr started me on block and replace 5 days ago. I was on 1.24 mg tapazole and though all my blood were normal my t3 was 2.9 (normal 3). T4 13 amd tsh 1.6 )

I still have graves antibodies so he asked me to start 100mg synthroid and up my tapazole to 2.5 mg per day.

I feel awful. Can’t sleep past 230am and feel nauseous 5 days in.

Anyone have any insights on block and replace and this problem?

10 Replies
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SlowDragon
SlowDragonAdministrator

As your thyroid levels have been low, vitamin levels may have dropped too

Important to retest vitamin D, folate, B12 and ferritin

cgauthie
cgauthie in reply to SlowDragon

i Had full blood work up including vitamin d. All normal. I requested b12 and will get that done today. Thanks and I’ll see how that is today!

Since your T3 was low and your TSH was well over 1 why didn't your doctor just lower your dose of tapazole instead of giving you additional hormones? (I can't tell if your T4 was low or not because you haven't given a range.) Was your level of Graves' antibodies very high?

Do you think the doctor knows what he is doing?

You should read this recent post by helvella - it fits your circumstances perfectly :

healthunlocked.com/thyroidu...

The thing about having Graves' antibodies is that they never go away. But they don't always cause problems in the long-term. What symptoms did you have before treatment began? And how long have you been on tapazole?

cgauthie
cgauthie in reply to humanbean

Hi my t4 amd tsh are normal and in the ideal spot. I still have graves antibodies this the block and replace. I don’t have hashimoto

humanbean
humanbean in reply to cgauthie

So, what is your T4 and TSH with their reference ranges?

Edit : And what is your T3 along with its reference range?

cgauthie
cgauthie in reply to humanbean

Tsh 1.62 (.32-4)

T4 13(9-19)

T3 2.9(3.1-6.2)

I have TSI antibodies at 3.2(should be 0)

humanbean
humanbean in reply to cgauthie

Your T4 is 40% of the way through the range. You would probably feel better with it being in the upper part of the range, possibly 70%or more of the way through the range - most of us do, but people are all individuals.

Your T3 is below the range and obviously you would need that to be a lot higher too. In the upper half of the range is best for this too. People on this forum have discovered that Free T3 levels are the best indicator of how well someone is from a thyroid point of view. You need to get that up to the upper half of the range, and as with T4, most of us like it to be around 70% or more of the way through the range.

Your TSH is important to your doctor, but really is of much less importance than your T3.

One thing I'm not sure of is if your T4 and T3 test results are for Free T4 and Free T3 or whether they are for Total T4 and Total T3. The Free tests are far better and more informative than the Total tests.

Before you were put on Tapazole I'm assuming that your TSH was very low and your Free t4 and Free T3 were very high.

The tapazole has reduced your Free T4 and your Free T3 and raised your TSH, which is what it was intended to do. Your dose may have been fine to begin with, but has now dropped your Free T4 and Free T3 too low. The solution to this is to reduce your dose of Tapazole, allowing your Free T4 and Free T3 to rise slightly.

If you decide that you want to stay on Block and Replace then you need to raise your Levo dose so that you get more T4 and your body has the chance to convert this extra T4 to T3. And as I said above, it is T3 that makes people feel well when it is at the right level.

(I have assumed that your doctor will not prescribe T3. And anyway, I've never heard of T3 being used in Block and Replace treatment for overactive thyroid.)

cgauthie
cgauthie in reply to humanbean

I am just feeling so bad now. I sent note to dr.

humanbean
humanbean in reply to cgauthie

That will be caused by the under-the-range T3. You have to find a way of getting that level up and well into the range.

cgauthie
cgauthie in reply to humanbean

Thanks for all

You help. I see deficiencies in zinc selenium

And b12 b6 can help. I’ll get b12 done today!

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