Just curious, about block and replace

[ABCD210506]

Hi! I have Graves disease.

I see people mentioning about block and replace, do you guys mean having carbimazol or others and levothyroxine prescribed together ? If so, what are you experience on that and what leads to being prescribed both ?

[PurpleNails Administrator]

Block and replace is usually used if levels fluctuate unexpectedly and controls seems difficult.

Or if either FT4 or FT3 is dominant. Usually FT3. ie FT3 is still above range when FT4 is under range.

Most manage with titration. Higher starting dose and dose adjustments to keep levels in range.

[ABCD210506 in reply to PurpleNails]

Hi purplenails,

thank you for your reply.

[asiatic]

I have Graves. TRAb was high so unlikely to go into remission. On Carbimazole even a low dose made me hypo worsening my TED. For me Block and Replace has worked well for about 5 years now only requiring minimal dose adjustments. I take 7.5mg. Carbimazole and 75 mcg. Levo. and feel well on it.

[ABCD210506 in reply to asiatic]

How high was your TRAb?

I used to be prescribed Carb and Levo since I swing from being hyper to hypo in very short period of time. The doctor wasn't expecting so he prescribed me both and it seems to be working well as my levels managed to stabilise and allowed me to be wean off.

But now I am on relapse, with a different doctor, they only prescribed me with Carb. I have been wondering if block and replace going to help me,

Thanks btw

[asiatic]

TRAb was 16. Endo said I would likely relapse if over 5. He monitored me to achieve my wish of being on the lowest effective dose of B and R. I hope eventually to go into remission but am not sure while on BR how you would know . Did you just stop the meds ? I thought I might titrate down Carbimazole first as I suspect I have blocking TRAb dominating and might still need some Levo to keep fT3 at 75% through range which is my sweet spot.

[ABCD210506 in reply to asiatic]

they lower down the dose gradually and after quite sometime I was stable. I managed to have more than a year of remission. You found your sweet spot! that's great.

Now actually my TSH and FT4 were in range but I feel really bad.

[asiatic in reply to ABCD210506]

After many blood tests and keeping a detailed record of levels/ symptoms/dose it came as a surprise how narrow a band within the range my fT3 needs to be for me to feel well..... anything under half way I feel awful. I will happily stay on BR for a few more years to hopefully give me the best chance of remission.Hope you find your sweet spot too.