Graves med titration : Is this going ok?

[Jeanjeanjeanx]

I'm currently on carbimazole 5mg one day, 10mg next day. (Alternating) According to my endo I'd be having 7.5mg in my blood that way.

Situation right now is such that I'm not able to reach my endo and had to refer to this new guy. And I got prescribed with 10mg every night for the next 6 weeks.

But according to the drop in fT4 levels I am wondering wether 10mg of carbimazole every night, doesn't that seem like too much? I did pass this by the doc but he didn't seem too eager to respond. He just said my T4 might suddenly spike too high so to stay at 10 for another 6 weeks.

Any insight into this?

Blood test results by date:

-----------------------

+ Date( 2/3/2019)

Ft4 900.9, TSH 0.01

------------

+ Date( 1/4/2019)

Ft4 0.82 , ft3 2.72, TSH < 0.01

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+ Date ( 9/5/2019)

Ft4 0., TSH 3.8

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+ Date (6/6/2019)

FT3 : 2.74 Pg/ml ; range: 2.0-4.4 Pg/ml

F T4: 0.97 Ng/dl ; range: 0.93 - 1.7 Ng/dl

TSH 3rd generation: 0.180 mIU/ml ; range: 0.35-5.50 mIU/ml

________________________

LATEST test results on which the current endo changed from 5+10mg alternative nights to 10mg every night:

Date 3/8/2019

Ft4 9.91 range: 10-28

TSH 1.21 range 0.46- 4.94

Does this make me hypo?

Any response to this much appreciated.

[elderflower2016]

If it were me, I would stick to alternating 5 mg and 10 mg (i.e. 7.5 mg) for the next 6 weeks. I would definitely not increase to 10 mg/day. With your FT4 being at the lower end of its range, there is even room to reduce the dosage, but best to wait for your endo to recommend that.

[Greekchick]

I agree with elderflower2016 - If it were me, I would stay on what you are on until your regular doctor sees you. It would be a shame for you to be pushed to hypo for no reason. For me, all things thyroid are slow - and anti-thyroid medications, T3 and T4 are also slow for increases and decreases- otherwise it’s too big a shock to the system. Feel better soon.

[ling]

Date 3/8/2019

Ft4 9.91 range: 10-28

TSH 1.21 range 0.46- 4.94

Does this make me hypo?

Yes, I would say so since 9.91 is below 10, the low end of the range.

Dose - daily alternate 5 and 10mg.

WAS THIS DOSING STARTED AFTER THE MAY BLOOD TEST?

WHAT SYMPTOMS DO YOU HAVE AT PRESENT?

Just based on the numbers, I would say raising to 10mg daily is not a good idea.

I have copied out your previous results from your profile page and here, for easier reference, but there are some discrepancies with figures, or missing numbers and ranges.

COULD YOU CHECK THROUGH THE PARTS MARKED WITH DOUBLE QUESTION MARKS AS THESE ARE THE UNCLEAR BITS?

COULD YOU ALSO INDICATE YOUR CARBIMAZOLE DOSAGE AT EACH POINT, STARTING FROM WHEN YOU WERE DIAGNOSED?

(6/6/2019)

FreeT3 : 2.74 Pg/ml

range: 2.0-4.4 Pg/ml

Free T4: 0.97 Ng/dl

range: 0.93 - 1.7 Ng/dl

TSH 3rd generation: 0.180 mIU/ml

range: 0.35-5.50 mIU/ml

(9/5/2019)

FreeT3 is 1.97 Pg/ml

range 2.0-4.4??

Free T4 is 0.65

T4 range 0.80-2.0??

TSH is 3.820 miu/ml3

TSH 0.35- 5.50??

Date( 1/4/2019)

Ft4 0.82

range ??

ft3 2.72

range ??

TSH < 0.01

range ??

2/3/2019:

Free T3 32.2pmol/L??

range: 3.1-6.8

Free T4 90.0 pmol/L

range 12.0-22.0

TSH 0.01 miU/L

range 0.3-4.3

TSH receptor antibody 6.69 U/L

Reference:

negative : < 1.5

intermediate: 1.5-1.75

Positive: > 1.75 U/L

-end-

[ling]

Was FT3 tested on 3/8/2019?

[MaisieGray]

According to my endo I'd be having 7.5mg in my blood that way.

Well no, not exactly. Alternating 5 mg and 10 mg means you are ingesting an average of 7.5 mg daily but that isn't the same thing as having 7.5 mg in your blood each day. Carbimazole has a short half life of just under 5.5 hrs, and is rapidly metabolised to the active thiazimole whose peak plasma concentrations occur at 1 to 2 hours and thereafter fall.

However, based on your latest blood test results, your TSH is comfortably within the reference interval and your FT4 below, so I don't understand the logic of increasing your carbimazole. That your FT4 may or may not spike at some point in the future is not a basis for increasing meds now "just in case", especially since your FT4 currently, is below the reference interval.