How to avoid slipping into hyPOthyroidism from treatment for hyperthyroidism

[Littlefoot1thyroiduk]

4 wks ago diagnosed for hyperthyroidism..tsh low at 0.02pmol/l...t3 and t4 both high. Put on carbimazole..t3 and t4 now in jormal range ..tsh still low at 0.02. Still waiting results for tshr.... test for Graves .Am assuming this means the meds are working ....but not quite right yet at tsh still low ? If things have got this much better so fast.. I am aware of the danger of 'tipping' into hyPOthyroidism....which I want to avoid.

What do I and/ or medics need to do to get the hormone balance just right ? Seems an imperfect science...trial and error?

Thanks

[greygoose]

Certainly is imperfect! Mainly because doctors know very little about it. They should have tested you for Graves' before putting you on carbi. Could be that you don't have Graves', you have Hashi's which starts out with a 'hyper' stage. But, no-one can tell until you've had that antibody test. What were your exact results, with the ranges?

[Littlefoot1thyroiduk in reply to greygoose]

That's what I thought. ...Before meds tsh was 0.02pmol/l....4 wks on still is.

FreeT3 was 10.4 now 5.4pmol/ so think now in jormal range

Free T4 was 27.9 now 23.9pmol/ .so think now in normal range ?

[greygoose in reply to Littlefoot1thyroiduk]

Do you have the ranges? Because we cannot interpret results without them. They vary from lab to lab. But, even so, your previous results do not look high enough to be Graves'.

Doctors tend to only look at the TSH - they don't know much about the actual thyroid hormones. And, if it's low, they have a knee-jerk reaction and start freaking out instead of doing the correct testing.

So, not only do you need the Graves' antibodies tested, you also need the Hashi's antibodies: TPOab and TgAB.

[Littlefoot1thyroiduk in reply to greygoose]

Ah....I do have ranges....Will get back to you....u have just said what I have been thinking.....I will have to get the tpoab tab done privately . Asap. Thank you

[greygoose in reply to Littlefoot1thyroiduk]

You're welcome.

But your GP is perfectly capable of testing the TPOab, if nothing else.

[helvella Administrator Thyroid UK]

Some people who have had low, very low, or zero TSH find it takes a long time for TSH to rise. Quite possibly many months, even years, or never.

It is completely wrong to base treatment on TSH in these circumstances. (Many would argue it is never right, but sometimes it at least stands a chance of making sense.)

[Littlefoot1thyroiduk in reply to helvella]

Exactly......looks like my sceptism is right. I don't get why the simple full set of tests aren't done.....I think it would save money for the nhs in thd end and stop patients having so much worry and uncertainty. Thank you.

[helvella Administrator Thyroid UK in reply to Littlefoot1thyroiduk]

I think you'll find that a widespread view among members.

[PurpleNails Administrator]

it’s usual to start on a higher dose of carbimazole then reduce down when level are in range.

If you hyper is continuous, it a case of adjusting to get the right or level. It turns out to be transient it will inevitably lower no matter how lose a dose,

Dosing must be by FT4 & FT3. My TSH never rose & ive taken carbimazole for over 4 years.

[Bearsnanny]

Hi there , I'm hyperthyroi d with Graves disease, a goitre ( which is the swelling at the front of the through and a few nodukes on my thyroid as well . I have had a long journey to be were in at today but I can not find fault in any of my hospital care , in\out patient, I take 20 mg Carbimazole a day now and I'm on the list fo urgent surgery now , I have put on a lot of weight and I've been told that I will put more on after surgery as I'll then go from Hyper to Hypo and start a new drug regime . I'll try and find some of my old write ups to give you some of my numbers . Trust me when I say you are not alone ,there are so many people in the position of similar . Sending you hugs 🐹