recent labs hypo?

[Woodsman4]

37yo male currently stateside.

August 17th at diagnosis of graves

Free T3 was greater then 13 pg/ml normal range 2.3-4.2

Free T4 was 5.61 ng/dl normal range .89-1.76

TSH was less than 0.01 normal range: 0.33 - 4.70 uIU/mL

Trab was 25.6 IU/L normal range 0.00 - 1.75 IU/L

November 3rd labs

Free T3 was 3.5 pg/ml normal range 2.3-4.2

Free T4 was .7 ng/dl normal range .89-1.76

TSH was less than 0.01 normal range: 0.33 - 4.70 uIU/mL

December 6th labs

Free T3 was 2.7 pg/ml normal range 2.3-4.2

Free T4 was .45 ng/dl normal range .89-1.76

TSH was .55 normal range: 0.33 - 4.70 uIU/mL

December 28th labs

Free T3 was 3.2 pg/ml normal range 2.3-4.2

Free T4 was .66 ng/dl normal range .89-1.76

TSH was 11.98 normal range: 0.33 - 4.70 uIU/mL

I was on 30mg daily of methimazole from the time of diagnosis until after the November 3rd labs when it was reduced to 25mg daily then reduced once again to 20mg daily after the December 6th labs. As I've been told on here before, symptoms typically go ahead of what labs show. I started feeling hypo symptoms in early November and they have just gotten worse. Much worse in the second half of December. I could hardly even get out of bed and was so fatigued, sore, achy and have daily headaches. Let alone depression.

After December 28 labs on new years I eliminated methimazole for 3 days then resumed 5mg daily for 4 days then went to 10mg daily at the advice of my doctor. I felt pretty good for about 2 weeks until this week. I am now feeling achy and extra tired again. I'm very sore and my body is slow to recover. I'm feeling much more like I did at the end of the year when I was full hypo

my most recent labs were on January 24

Free T3 was 4.2 pg/ml normal range 2.3-4.2

Free T4 was 1.31 ng/dl normal range .89-1.76

TSH was .02 normal range: 0.33 - 4.70 uIU/mL

I'm trying to find the right maintenance dose to keep T4 in the upper end of the range. Am I correct to assume I should reduce my 10mg daily dose to 5mg daily?

thank you!

[Charlie-Farley]

Hi Woodsman

Graves is not my specialty, but it sounds like you have a good handle on your body’s response to the medication. A 10 mg would be too much long term unless there was an upward fluctuation- 5mg would sound a sensible move but I will tag in PurpleNails and GlowCoach to see what they think - I believe they are a good deal more knowledgeable than little old me 😊👍

[PurpleNails Administrator]

Diagnosed

Free T3 was greater then 13 pg/ml normal range 2.3-4.2

FT3: 13(Range 2.3 - 4.2) 563.16%

Free T4 was 5.61 ng/dl normal range .89-1.76

FT4: 5.61 (Range 0.89 - 1.76) 542.53%

November 3rd labs

Free T3 was 3.5 pg/ml normal range 2.3-4.2

FT3: 3.5 (Range 2.3 - 4.2) 63.16%

Free T4 was .7 ng/dl normal range .89-1.76

FT4: 0.7 (Range 0.89 - 1.76) -21.84%

December 6th labs

Free T3 was 2.7 pg/ml normal range 2.3-4.2

FT3: 2.7 (Range 2.3 - 4.2) 21.05%

Free T4 was .45 ng/dl normal range .89-1.76

FT4: 0.45 (Range 0.89 - 1.76) -50.57%

December 28th labs

Free T3 was 3.2 pg/ml normal range 2.3-4.2

FT3: 3.2 (Range 2.3 - 4.2) 47.37%

Free T4 was .66 ng/dl normal range .89-1.76

FT4: 0.66 (Range 0.89 - 1.76) -26.44%

Looking at the percentages of your FT4 & FT3 levels shows your levels when diagnosed were 5x the normal range, (very high). very high TRab also confirms Graves’ disease.

Your FT3 is disproportionately high. Considerably so. The FT4:FT3 balance is affected. FT3 dominance or “FT3 driven” is seen in about 10% of cases.

By time FT3 is in normal range your FT4 is dropping very low.

Ask you doctor if block & replace as an option. You take a higher blocking dose or antithyroid to completely block your own natural function. Then take replacement levothyoxine which is synthetic T4 (LT4). This restores the levels to right level & body converts what is needed to FT3.

This stabilises the levels as you effectively have almost complete control. The drawback is you are taking a higher dose and you cant see what levels are naturally doing. So your levels could naturally normalise with titration of methimazole & you would not know. Ending treatment is also trickier as halting all treatments can be a shock the system & hyper can return quickly or reducing either or both can be confusing. (Doctors don’t know how to approach it)

[Woodsman4 in reply to PurpleNails]

my most recent lab looks somewhat normal. I feel I was mismanaged being on such a high dose of MMI for 5 months. Essentially a block with no replace. Now that I've drastically cut the MMI doesn't my most recent lab work suggest I'm on the right track?

[PurpleNails Administrator in reply to Woodsman4]

Within range technically, but do you feel well with a FT3 at very top of range & FT4 in lower half of range?

Most feel well with FT4 in top 3rd eg 75% & FT3 over mid point eg 60%. Most have 10-15% lower % of FT3 compared to FT4.

It might naturally balance given some more time, but if it consistently remains disproportionately out of balance & you experience lingering symptoms you might need to look at block & replace to combat it.

[Woodsman4 in reply to PurpleNails]

Just curious what the lingering symptoms would be.

I should also specify I'm currently on 20mg of propranolol daily. Does that play any role in those numbers?

[PurpleNails Administrator in reply to Woodsman4]

In theory you could have a mix of hypothyroid symptoms from low FT4 AND hyper symptoms from high FT3. Some seem unaffected by low FT4 provided FT3 at right level for them.

So levels & symptoms are an individual thing. I had lots of typical hypo symptoms in the years of having high FT3.

[Woodsman4 in reply to PurpleNails]

As for the propranolol? Is this necessary or helpful at this point. I have been on it since august doing 80mg and was reduced to 40mg in December and then 20mg at the beginning of the year. The only reason I haven't come off of it was because I started having headaches and panic attacks when it was attempted to come off of it entirely in December.

[PurpleNails Administrator in reply to Woodsman4]

Sorry I meant to add something regarding propranolol.

Propranolol does have a mild antithyroid affect & helps lower FT3. So it’s helpful for hyperthyroid (not for hypothyroid).

I was given high dose propranolol when first diagnosed hyperthyroid with fast heart rate. Is was then stopped abruptly (which should not be done) & I had terrible migraines. GP resumed it & I very gradually reduced it to a lower dose but remain on it for migraines prevention.

I think the propranolol is necessary for you right now. As you have high FT3 and causing headaches when lowering.

Propranolol can lower magnesium levels long term & this can worsen migraine & headaches.

I do well with powdered citrate as I take it in a drink before sleep.

You might find glycinate a good form which I took initially, however the brand I had were 3 large pills a day & I find the powdered more convenient.

Magnesium is a mineral which can usually be taken safely at over the counter doses, without testing first, blood tests tend not to be reliable as body is good a regulating blood levels excess will be excreted.

I lowered by 5mg per day every 2 weeks. Sometimes 10mg over space of a week. Was down to last 20mg per day. Then thyroid level rose & doctor wouldn’t increase carbimazole because levels were in range, but suggested more propranolol.

[pennyannie]

Hey there :

What is happening regarding your eyes ?

Please ensure all drops, lotions and potions are Preservative Free - even those prescribed :

[Woodsman4 in reply to pennyannie]

Eyes got much worse in December. But are actually doing very good the last week or so and actually feel somewhat normal now.

I am eating 3 Brazil nuts a day and using preservative free drops 👍🏼

[pennyannie in reply to Woodsman4]

Your seeing a specialist aren't you?

[Woodsman4 in reply to pennyannie]

Yes. I am.

[pennyannie in reply to Woodsman4]

Is there some liaison between the ophthalmologist and the endo as to the titrating of the drugs ?

[Woodsman4 in reply to pennyannie]

No there is not. The ophthalmologist thinks I was on the right track and suggested that as hormone levels approach normal eyes will become more stable. The ophthalmologist was concerned why the endo had me on such a high dose of MMI without reducing it when I was very hypo, but didn't want to step on toes. I am now being treated by a naturopathic doctor and the ophthalmologist who are happy to be working together

[pennyannie in reply to Woodsman4]

Oh good - I'm glad you've returned to the naturopathic doctor -

TBH - didn't really understand why you decided to leave and go into the mainstream:

[Woodsman4 in reply to pennyannie]

It was a mistake. He was possibly the worst Endo ever. He told me naturopathic doctors need to stay in thier lane and nothing I was doing was correct and kept me on a high dose of MMI all through December, to the disbelief of the ophthalmologist

[pennyannie]

Sorry to read that - but I'm not surprised as per my reply on a previous post :