Graves methimazole dosage

[Woodsman4]

to follow up on previous posts.. On February 6th I tested labs again then again on March 10th and they were as follows. With the coinciding medication adjustments noted at each lab

August 8 10mg MMI daily

FT4 1.38 range 0.82-1.77

FT3 2.88 range 1.81-4.06

TSH 1.44 range 0.45-4.5

September 25 7.5mg MMI daily

FT4 1.82 range 0.82-1.77

FT3 2.86 range 1.81-4.06

TSH 0.901range 0.45-4.5

October 29 7.5mg MMI daily

FT4 1.31 range 0.82-1.77

FT3 2.35 range 1.81-4.06

TSH 2.76 range 0.45-4.5

December 4 6.25mg MMI daily

FT4 1.53 range 0.82-1.77

FT3 3.74 range 1.81-4.06

TSH 2.76 range 0.45-4.5

December 10 5mg MMI daily

FT4 1.43 range 0.82-1.77

FT3 1.39 range 1.81-4.06

TSH 1.93 range 0.45-4.5

December 27 5mg MMI daily

FT4 1.38 range 0.82-1.77

FT3 2.7 range 1.81-4.06

TSH 1.68 range 0.45-4.5

February 6 was on 3.75mg daily reduced after labs to 2.5mg split in 2 doses 1.25am and 1.25pm

FT4 1.49 range 0.82-1.77

FT3 2.59 range 1.81-4.06

TSH 1.64 range 0.45-4.5

March 10 after labs switched to single dose 2.5mg AM

FT4 1.55 range 0.82-1.77

FT3 2.44 range 1.81-4.06

TSH .916 range 0.45-4.5

I started to feel more hypo over the last two weeks and switched one week ago to 1.25mg. One week later from switching I'm still feeling more hypo core tightness, body aches and pains, brain fog, skipped heart beat, low energy, very tired muscle weakness inability to recover and significant joint pain.

I was wanting to be on 1.25mg longer before testing. But am thinking I may need to get off of methimazole entirely..? Can such a small dose make that big of an effect?

Any input is appreciated!

[pennyannie]

Hey there again :

Any change in dose takes around 6-8 weeks to fully express itself in blood test-

though symptoms can be experienced within a couple of days when on an AT drug -

If still on the Propranolol - I'd be inclined to stop that first as this beta blocker also slows conversion of T4 into T3 ?

TSH has dropped this last time - was the blood draw at a different time of day ?

Maybe get your Graves TRab run again to compare to when first diagnosed ?

[Woodsman4 in reply to pennyannie]

I haven't been on propranolol for over a year.

TRab was 25.6 at diagnosis in August of 2023. It was at 6.21 on February 6 of 2025 range 0-1.75

I also had reverse T3 tested in December 2024 and it was 15.1 range 9.2-24.1

All blood draws are at 8:30am on an empty stomach. I'm not taking biotin that's interfering with testing either.

My vitamin D ranges between 85-95 range is 30-100 I was briefly at 125 in December and have since come back down in range after reducing vitamin D supplement. Bloods were checked and calcium level remains in range as of my March test.

All other core vitamins are in range.

I supplement with zinc, vitamin D3 with K2, magnesium, 3 Brazil nuts a day, tumaric and coq10. I am gluten free and haven't drank alcohol in 19 years.

My testosterone has come down to the lower end of the range since September.

My thyroid eye disease is in remission and no longer in the active phase as of September. I'm still being monitored in a TED study but haven't been on medications for that trial since July of 2025

I'm suspicious graves has run its course and I'm no longer in need of methimazole. But as per the Japanese studies on pubmed and Elaine moores advice I was reducing methimazole down to a micro dose for a longer stretch at best chance of staying in remission. I have methimazole compounded in the states to the doses I'm on. So I'm not pill cutting or guessing

Long story short I keep reducing methimazole every 6-8 weeks since September and bloods keep showing me trending more hypo.

[pennyannie in reply to Woodsman4]

Ok - so likely your TRab are still over range so best to stay on the AT drug at the lowest possible dose - as it also dampens down one's immune system - and we know from the research I've think I've already shared with you that the longer one stays on the AT drug the better the longer term outcome is for the patient.

Your T4 has recovered well and at around 77% but your T3 is still too low to function on and at around 28% through it's range .

I think you also had positive and over range TPO antibodies and have Hashimoto's -

maybe a scan or ultra sound would help clarify how damaged your thyroid actually is ?

[Woodsman4 in reply to pennyannie]

Yes I had a TPO of 150 with its range being 0-34. I was under the assumption that 57-88% of graves patients also have elevated TPO (aziz 1996, 150-51) .. this is in Elaine moores book. I was under the assumption that those antibodies are present as a result of Graves' disease and not as a cause of hashimotos? Or is it that 55-87% of Graves' disease patients also have hashimotos present? My doctor explained it that the TPO antibodies are a result of Graves' disease.

I can definitely get an ultrasound of my thyroid. I've never had a multinodual goiter but have had a small diffuse goiter at times.

My main concern is that I'm holding myself in a hypo state by being over medicated on methimazole. My reduction from 10mg in august of 2024 to 1.25mg April 2025 has been done by more or less a reduction of 1.25mg every 6-8 weeks. Which isn't very aggressive. My instinct, as my eyes have moved rapidly out of the active phase in august-September and graves at that same time started to also reduce its active stage, is that I'm moving closer to remission and am just behind you on reducing my methimazole.

I also have a LDN prescription I haven't started but could try too. I just didn't want to move too many needles at once

I also have HSV-2 and have had two outbreaks in this timeframe since August. Both of which led to a rather sharp dip into the hypo range by symptoms and also by blood work confirming a reduction in thyroid hormones. Could it be that this viral load during those outbreaks has made me briefly experience a more hypo phase?

also doesn't methimazole block t4-t3 conversion? It seems if my TSH is ok and T4 is ok that I'm not converting correctly to t3?

Early on in my graves journey I was also very T3 dominant and it remained over the range while T4 was near the high end of the range

[pennyannie in reply to Woodsman4]

When the thyroid malfunctions several sets of antibodies can be found positive -

but Graves treatment takes precedence as Graves is considered life threatening if not medicated -

and Hashimoto's it is not treated with a AT drug anyway - but the thyroid does become damaged and lose some functionality..

So maybe we are spitting hairs - but I have Graves but I don't have Hashimoto's !!

I'm wasn't aware that you had already had issues with diffuse goitres - was there any treatment regime or were all 3 times become a watch & wait scenario ?

As for the vitamins and minerals - I now aim for a ferritin at around 100 - folate around 20 - active B12 125 ( serum B12 500++ ) and vitamin D at around 125.

I have no experience of Low Dose Naltrexone and can't see how this would improve your thyroid function and low T3 -

I hope you have restricted your gym activities as exercise will deplete your T3 faster, than say, going for a walk - as at this point in time you haven't enough T3 circulating to do your chosen sports - I know I've said this before and sorry to be a bore.

[Woodsman4 in reply to pennyannie]

The goiters were non toxic and just a uniformly enlarged thyroid gland. Watch and wait and they reduced in size.

All of my core vitamins are in that range. Although in the states my lab uses different measurements but they are all very close to your levels when converted to those units.

I have continued my strength training but am not remotely entering any sort of zone 2 or high intensity training. I did ride a bike at moderate intensity for about an hour and didn't feel well for a few days following (felt more hypo)

[pennyannie in reply to Woodsman4]

Your T3 is not at a high enough level to allow you to exercise and not be exhausted for a few days afterwards - as your ability to find more T3 very limited and it is too low a T3 for you that is causing all the symptoms being tolerated.

Within Graves there are 3 further subsets of abs - blocking, stimulating and neutral - and anyone of these can be dominate at any given time - the neutral not doing much at all with the blocking or stimulating still impacting one's thyroid function - and am guessing you are currently in a blocking phase with your conversion of T4 into T3 which may resolve itself.

I'm not sure I've explained that very well as it's many years since i read Elaine's ' take ' on all this - so I apologise in advance if I've got this bit wrong - your learning curve is much fresher than mine - though when hypo even reading and holding onto information is a challenge and sometimes a step too far.

Is there a history of thyroid issues within your family as you have certainly had more than your fair share of ' issues ' - just wondering if mainstream medical had intervened earlier, when you ' just ' had a goiter - would things have not developed as they have ?

Going forward you may well be with Graves but hypothyroid and am guessing mainstream medical will not consider thyroid hormone replacement until after you have had a thyroidectomy.

just found this research and thought it might be of interest :-

academic.oup.com/jcem/artic...

[Woodsman4 in reply to pennyannie]

Thank you. That's great stuff. Yes my aunt and grandma both had graves. My grandma had her thyroid removed and aunt had RAI.

It would have been hard to stop mine early or catch it early as it came on very quickly. I'm an arborist (tree surgeon) and had an injury at work resulting in not being able to walk and had to have a back surgery to correct it. During this stay in the hospital I was given my first and only Covid vax (I was a hold out). I got violently ill after receiving it and thats when all symptoms started. Lost around 50lbs in 3 weeks, had massive panic attacks all day, started shaking, sweating and my heart was pounding and had arrhythmias all day. I was still in the hospital recovering and they just chalked it up to my back issues, stress and me being stuck in fight or flight. Didn't test my thyroid until I finally got out of the hospital to see my naturopathic doc. So from vax to diagnosis was only about a month

[pennyannie in reply to Woodsman4]

Oh my - yes - genetic pre-disposition and then the perfect storm - stress and anxiety through the roof - I'm so sorry :

pmc.ncbi.nlm.nih.gov/articl....