# tapazole 10 mg 3xday



## talley (Jul 28, 2012)

Is this too much to start? My endo gave me Graves diagnosis today - went over the RAIU test and other bloodwork this morning. From other's posts, it sounds like starting at 30 mg is a lot...should I question this and ask to start at a lower dose? I don't want to be thrown into hypo.

TSH - <0.006 (0.450-4.500)
T4, Free - 3.85 (0.82-1.77)
TPO - 76 (0-34)
T3 and T3 uptake - high (don't have numbers

RAIU 6 hr 53.8 (normal 8-20)
24 hr 64.8 (normal 12-30)

ALT (SGPT) - 68 (0-40)


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## Andros (Aug 26, 2009)

talley said:


> Is this too much to start? My endo gave me Graves diagnosis today - went over the RAIU test and other bloodwork this morning. From other's posts, it sounds like starting at 30 mg is a lot...should I question this and ask to start at a lower dose? I don't want to be thrown into hypo.
> 
> TSH - <0.006 (0.450-4.500)
> T4, Free - 3.85 (0.82-1.77)
> ...


It does not sound like a lot. Is your doc having you split the dose? Anti-thyroid meds have a short half-life of about 4 hours so .....................


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## hyperinnyc (Apr 18, 2012)

Hi Talley,

I was on 45mgs to start - 3 pills 3x a day. I was that bad - super skinny, heartrate through the roof, sweating, shaking, anxiety, insominia, barely walking, fever - the works. So no, I do not think that is too much. After a year, I am now on 5-10mgs a day which still doesn't regulate my condition.

Good luck!


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## webster2 (May 19, 2011)

I started at 5mgs 3 X a day and went to 10mgs 3 x a day. It helped. Best thing ever was to lose the monster. I feel great now.


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## slivola (Jun 27, 2012)

I started at 30mg once/daily and within 7 weeks, my Free T4 and T3 tests were in range, in the mid-upper ends which is great. I lowered to 10mg last Friday hoping for maintenance. I have researched that 20mg to start off with has the same effect with lower risk, but I think you will be okay on 30mg. My starting labs were almost the same as yours (see my signature below.) Even my liver ALT was exactly the same as yours- mildly elevated and I retested 2 weeks into meds to make sure it was decreasing and it did to almost in range. By the end of my 7 week cycle, ALT was in range. I would encourage you to get your ALT retested in 2 weeks just to make sure you don't have any liver related side effects from the medicine.

Regarding your dose, just make sure you lower it to be in the 5-15mg range on your tests are in range (TSH will take a while to change, so don't focus on that.)

Thinking of you!!


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## talley (Jul 28, 2012)

Thanks so much for all the responses! I feel much better now starting the medications - will fill the Rx and start Monday


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## talley (Jul 28, 2012)

so I haven't had the Rx filled yet...other than the heart pounding I don't feel _that_ bad...

I emailed the endo today and asked if I could start at a lower dose - she said I can "Lets do 10 mg twice daily or start at 1 10 mg daily and we can recheck in 6 weeks as planned. Go ahead and get the script but do the lower dose."

Would you do the 10 mg twice or 1 10 mg once a day? I thought it was supposed to be spread out during the day?

I would rather start slow as Webster2 did and increase so I am leaning towards 1 10 mg tablet a day...

TSH - <0.006 (0.450-4.500)
T4, Free - 3.85 (0.82-1.77)
TPO - 76 (0-34)
T3 - 303
TSI - 222
T3 Uptake - 41

RAIU 6 hr 53.8 (normal 8-20)
24 hr 64.8 (normal 12-30)

ALT (SGPT) - 68 (0-40)


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## slivola (Jun 27, 2012)

I am relieved to hear you will not be starting at 30mg. Each person responds differently to medication, and this is very much a guessing game. I feel that your instinct is saying to take 10mg/1 day, so you should follow it. I would have started at a much lower dose had I been introduced to these boards sooner. Technically it is better taken twice a day so that it stays in your system longer, but most people take it once a day (myself included) since it's easier to remember. Once I get into the lower doses, then I think I will split it up 2x/day. If you want to split your dose, you can buy a pill cutter when you pick up your Rx or at any drug store and take 5mg 2x/day. I would suggest not retesting until 6-8 weeks so that your thyroid had fully cycled through and you'll really know where you're at. It is highly unlikely you will go into hypo during that time period, so you'll be fine.

Also, did you get a beta blocker for your heart? It is very important to take that at first to lower your heart rate- there can be heart damage caused by resting pulse over 100 for a prolonged period of time. Typically your pulse will be lowered by the end of your first cycle on meds and when you test in range, then you can wean off of the beta blockers since the anti thyroid meds help with that. I take my beta blocker and methimazole at night. I had read that beta blockers and sometimes methimazole can cause fatigue, so I figured they would help me get a good night's sleep. And they do!

I'm happy for you that your endo was so open to lowering your dose! You're off to a good start!

You will start feeling better within a week and by two weeks you should be feeling significantly improved.


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## slivola (Jun 27, 2012)

I also wanted to mention the scientist and medical writer, Elaine Moore, who has an extensive website about graves. You can search or register & post a question to her in her Question and Answer forum. She usually recommends 20mg for a starting dose, but I've heard of some people starting as low as 5mg. Then she says 2.5-10mg for maintenance once your labs are in range (except TSH which usually takes a while to increase and that's fine.) Here's the link:
http://www.elaine-moore.com/QA/tabid/57/Default.aspx


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## talley (Jul 28, 2012)

Slivola - I think I should probably start with 20 mg but I really hate the idea of starting something so high. I'll move my appt back a few weeks so that I have at least 7 weeks after starting the meds. 
Did your Graves come on suddenly? Its hard to know since I have had mild sx for a long time - and I was dieting when I lost the 20 lb recently so I'm not sure if it was the diet or the Graves...I do know that I am eating A LOT now and not gaining which has to be the Graves. Will need to go back to light eating once I start the meds.
Oh, yes, I am on Propranolol, my primary doc started me on it when she got my labs.
Thanks again!!


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## slivola (Jun 27, 2012)

talley- so glad to hear you're on propranolol. You'll be able to reduce your dose once after your first round of medicine.

20mg is a safe starting dose, even Elaine Moore acknowledges that and she is more conservative with dosing than most. Here's a thought- how about 15mg? Cut one pill in half for the extra 5mg. It will be high enough to work but low enough for your peace of mind. Either way, you really need to start taking the medication so you can feel better!

My symptoms came on very strong during the last weekend of April. I remember being at a park with my family and needing to come home to rest. I felt winded with some pressure on my chest if I touched my sternum. I went to the doctor a few days later and was told that it was from working out too much. I questioned why my resting pulse in the office there was 100 and I was told I was fighting something. I went in three more times and finally someone checked my thyroid and I was diagnosed at the end of May. I was waking up plastered in sweat even when sleeping with no blankets. My hair was shedding, my heart pounding, I had to eat a ton of food to maintain my weight (as soon as I started loosing a few pounds, then I started weighing each day to gain most of it back.) I also noticed my upper eyelids retracting a little bit so I saw a specialist for that. Luckily, they went back to almost normal within a month of taking the medication, but I know that can change easily, especially if I swing into hypo (hypo can trigger/worsen TED.)

Whatever dose decision you make will be fine. I personally would have started on 20mg because my symptoms were almost unbearable. I couldn't function by the time I got my medicine and I have a young child at home who needs my attention. There were a few days I couldn't work and couldn't even get out of bed to pick my child up at school. I felt like my body was shutting down, so I needed help ASAP.

Hang in there and let us know how you're doing. You should start feeling better in a week and really good in two weeks. It's highly unlikely you will go into hypo, but you will most likely get in range or almost in range of normal. Feel better!


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