Graves hyperthyroidism: 6 weeks on, antithyroid meds working well

[Juli_a]

Hello a nice update to share. Not out of the woods yet but getting there. Diagnosed Graves Nov 2024

Did not recognise my symptoms and caught accidentally (!) on an US of the neck when I thought I had enlarged lymph nodes (I didn't).

Was trying to conceive.

Dec 2024 tests

FT4 - 42 (9.5 -22.7)

FT3 - 16.5 (3.5 - 6.5)

TSH - <0.05 (0.55 - 4.78)

TPOab -7 (0-60)

TRAb - 3.0 iu/L (below 0.9)

After 6 weeks of antithyroid meds and propanolol (300mg PTU a day, 30mg propanolol)

FT4 - 16.9 (9.5 -22.7)

FT3 - 5.6 (3.5 - 6.5)

TSH - <0.05 (0.55 - 4.78)Symptoms gone!

Next dose prescribed 200 PTU a day. Propanolol TBC. Next test end of Feb 2025

I had no side effects. Natural result of slowing metabolism, gained 4 kg in 2 months, which is better for me, but don't want to gain any more.

I found the tablets to have bitter aftertaste so best taken after food.

I got myself a medicheks platinum panel but not got round to doing it yet.

Taking vitamin D everyday since January, but will decide on the rest of the vitamins after medichecks result.

Not excluding any foods but really focusing on fruits, veg and healthy fats and proteins.

Comments on any part of the message welcome. Take care all 🙂

[PurpleNails Administrator]

ft4 & ft3 back in range, TSH will take longer. Good the PTU was reduced. So many drs go by TSH and would maintain or increase PTU to see TSH rise quickly.

You also have a retest scheduled so if dose need adjusting again you are monitoring.

propranolol is usually intended to be given temporarily to relieve symptoms while PTU addresses the cause of symptoms.

It does have a mild anti thyroid benefit but I found propranolol very difficult to reduce & should be done gradually. I was very unwell when specialist stopped a high dose abruptly, GP put me back on them permanently for migraines prevention.

[Juli_a in reply to PurpleNails]

Thank you for sharing PurpleNails. There was sadly a bit of a lag between test coming in and the dose adjustement but at least it happened. I'll bear in mind re propanolol withdrawal, I don't mind it but would like to start reducing it, as I no longer need it for the symptoms.

[TiggerMe Ambassador]

Great news, thanks for sharing 🤗

[pennyannie]

Hey there again :

So - all things considered - this is looking good -

your T3 and T4 are back in range and hopefully this was just a ' blip ' - but it's best to stay on the AT drug as long as possible as previously explained in the links I've already sent to you.

Your Graves is still in control of your TSH - hence the o/range Graves antibody and the suppressed low TSH as one would expect this early on in the treatment plan.

The AT drug will likely now be reduced down with the aim to try and maintain your T3 and T4 at around mid point say 50% through the ranges - as too low in the ranges and you 'll likely experience the disabling symptoms of hypothyroidism.

Currently your T4 is coming in at around 56% with your T3 at around 70% :

I read you need to reduce Propanolol very slowly ?

We will be better placed to help you better once you have these new blood test results =

and I can now share a different link into Elaine Moore's website as I think the one I gave you is not working -

web.archive.org/web/2024122...

[Juli_a in reply to pennyannie]

PS Please could I ask if this FT3 FT4 ratio is good? I don't think I understand where they should be in relation to each other, and if it matters for hyper....

[pennyannie in reply to Juli_a]

It doesn't matter when hyperthyroid and generally it is referred to when someone is hypothyroid and taking thyroid hormone replacement -

It is just a way of checking how well the body is able to convert the T4 - thyroid hormone replacement into T3 within the body - and the suggestion is that once the T4 result is up in the top quadrant of its range at around 80% the T3 result should be around a quarter of the T4 result with the conversion ratio at around 1/4 - T3/T4.

So, anyway, your levels are what is called inverted, with the T3 higher than the T4 - but this is not unusual when hyper and hopefully this will adjust down to normal, with your T3 running slightly below your T4 reading by the next thyroid blood test in 6-8 weeks time.

[Juli_a in reply to pennyannie]

I see thank you so much!

[Juli_a]

Thank you very much Pennyanne. I'm trying to sense in my body where I feel best in the range but thinking back to the time of the test 50% in felt just right like old me! Having read others' experiences I was worried drs may advice to keep high dose in light of low TSH and potentially cause me to go into hypo, but thankfully drs are advising slow and steady approach. Happy to be ticking with a lower dose ATD. Also, got advice from Dr to reduce propanolol gradually which i will start to do. And thanks for resending the link and for your comments

[pennyannie in reply to Juli_a]

Your TSH is currently pretty much under the control of your immune system and it will be the last biomarker to move, if it ever does, and why you must be dosed and monitored on your T3 and T4 readings.

You were diagnosed by Graves antibodies circulating in your blood - and we have no way of removing these abs - and with Graves these abs tend to get stuck on the fine hair follicles of the TSH receptor sites - pushing / squashing down these fine hair like structures, which in turn, pushes down the TSH receptors which in turn ramps up your thyroid hormone production with you then finding out you are hyperthyroid.

Graves is an Auto Immune Disease that can wax and wane throughout one's life and you must always be monitored and dosed on your T3 and T4 blood test results and not a TSH seen in isolation which is sadly all you get tested in primary care when hypothyroid, irrespective of how you came by become hypothyroid, as I don't think the computer is programmed with anybody's health issues, nor the vagaries or nuances of Graves Disease.

Does that help explain anything ?

[Juli_a in reply to pennyannie]

Aaaahhh I see, very interesting! Thank you makes complete sense