Diagnosis now Graves, but if T3 and T4 now in range, do I need medication?

[HealthyBefore]

Latest blood test shows I actually have Graves, although GP originally thought it was Hashimotos due to TPO antibodies high.

Also have had an ultrasound of thyroid showing small non cancerous nodules.

I have hyper symptoms but propranolol is reducing BP and HR nicely and T3 and T4 in range,. I was told though that the TSH antibodies value is actually a good way of judging how 'bad' the Graves is, but dont know if the above value is high or moderate? and I have been referred to an Endo who might want to put me on Carbimozole.

So my question is, if I feel ok and my T3 and T4 are in range, why do I still have high BP and HR, and is it ok to just rely on how I feel and propranolol to keep my heart healthy? Do people with Graves come off their meds using T3 and T4 as the indicator? or is it dangerous to not be on meds when my TSH is <0.01.

thank you for any help you can give,

[helvella]

I suggest you read this article:

Overlooked: How many Hashimoto’s patients with TSH-Receptor antibodies?

thyroidpatients.ca/2020/04/...

And read around other related articles there.

I assume you had a plain TSH receptor antibody test that cannot distinguish blocking from stimulating antibodies?

To answer your direct question, I can see no reason to take carbimazole unless thyroid hormones are high, or there is evidence they will rise if you do not take it.

All carbimazole really does is prevent more thyroid hormone being made in your thyroid and then released. If there is no problem of excess thyroid hormone, there is no point in taking it.

[HealthyBefore in reply to helvella]

That makes sense, but I then wonder why I have hyper symptoms such as high BP, HR and very skinny...and yet my T3 and T4 are in range?

[helvella in reply to HealthyBefore]

That needs me to look at it from the other direction!

Maybe where you need to be would be not just "in range" but at the optimal points for you? And those points might will be significantly lower than were you are.

It might help if you posted the test result you have. There are some calculators which allow you to enter your results and express them as "percentage through range". Doing that can help to illuminate in some cases.

Thyroid Test Results Calculators

healthunlocked.com/thyroidu...

Many members here feel that TSH results, while potentially useful for picking up people who are overtly hyperthyroid or hypothyroid, are not very much use in managing the medication for an individual.

This is a link to a very good article in the British Medical Journal discussing what the 'normal range' really is. Very readable.

The normal range: it is not normal and it is not a range

This blog has the abstract of this paper plus link to the original full paper. Also includes some extra links to a video and some other related information.

Last updated 10/02/2025

Link to blog:

helvella.blogspot.com/p/the...

[pennyannie]

Hello HealthyBefore -

When the thyroid malfunctions several sets of antibodies can be found positive and over range in your blood analysis.

If Graves antibodies are found positive this Auto Immune disease is considered life threatening if not medicated - and though there is no cure for an AI disease -

an Anti Thyroid drug is prescribed for Graves as the T3 and T4 levels can keep rising higher and higher and ultimately cause extreme pressure within the body and cause heart damage.

With Graves there are at least 3 known subsets of abs - though the NHS does not usually identify which set of Graves antibodies are prevalent as the abs can change places during this first phase of Graves.

Some abs Block thyroid hormone - some abs Stimulate thyroid hormone and some abs are Neutral and do nothing much - BUT - at any given time these 2 extremes of symptoms can change places - as they vie for control of your thyroid - with you experiencing a roller coaster of hyper / hypo / hyper symptoms but with none of the fun :

with the Stimulating abs ' taking off ' causing scary hyper type symptoms and similarly those with Blocking antibodies are with little if any stimulation and already dealing with hypo type symptoms.

All the AT drug does is dampen down your immune system and semi-block your new own daily thyroid hormone production , so to try and maintain your T3 and T4 thyroid hormones around mid point in the ranges, and as symptom free as possible, while we wait for your immune system to calm back down again and hopefully your thyroid reset itself without the need for any drugs.

Graves antibodies have hi-jacked your TSH - and are stuck down on, and pressing down on the fine hair like follicles of the TSH receptors within your body - which in turn automatically causes increased thyroid hormone production which then causes you to go the doctor - and get a diagnosis.

The NHS generally suggest a treatment window of around 15-18 months with an AT drug - Carbimazole or Propylthiouracil -PTU - though we do now have research suggesting the longer the patient stays on the AT drug the better the long term outlook for the patient -

pubmed.ncbi.nlm.nih.gov/338...

ncbi.nlm.nih.gov/pubmed/306...

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