# back from the endo- new labs



## needanswers (May 4, 2013)

Hi everyone,
I just came back from the endo. My last visit was at the end of June when he upped my tapazole from 5mg once daily to 10mg once daily. My bloodwork has sort of looked like free T4 in the 70s, then the 50s, then the 30s, and last time a month ago done by my GP was 28 (reference range 7.2-21). Free T3 followed the same pattern: 15.9, then 11.6 (reference range 2.9-6.0). TSH has always been undetectable.

Todays labs with the same reference ranges are:
TSH <0.03
Free T4 9.9 (7.2-21)
Free T3 3.9 (2.9-6.0)
ALT 55 (4-43)

Based on this, he cut my dose to 5mg once daily, with bloodwork to be done in three months time. Wouldn't add in TSI, TRab, or anti-TPO. He said that my liver is a bit up, but that still within the "correct" reference ranges and not to be concerned about. I've been feeling a bit tired lately with major hair loss, but otherwise good overall compared to that hyper feeeling that's gone. I was hoping to do bloodwork at 6 week intervals even if not seeing him for a few months, but he didn't feel it was needed.

Overall, I'm happy to see that my levels decreased on only 10mg tapazole daily so I was feeling pretty good with this. Any thoughts. Thank you so much for the information and support.


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## StormFinch (Nov 16, 2012)

Looks like your Frees have dropped rather low which is probably causing the tiredness and hair loss. Hopefully that will correct itself with halving your dose. Monitor how you feel and if it continues after the next month or two, or gets worse, call and request another blood panel. How long have you been on treatment total?


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## needanswers (May 4, 2013)

Not quite three months on treatment so far. The first 6 weeks were on 5mg tapazole daily, the next 8 on 10mg tapazole daily. Do you think ALT looks ok from what you know? He said it's normal with Grave's and felt it was fine, though it was flagged as being abnormal. He said not to get too caught up with the numbers, but to go more on how I feel.


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## StormFinch (Nov 16, 2012)

I believe mine looked similar on the MMI and was told the same thing. As long as you aren't having liver related symptoms; jaundice, pale stool, abdominal pain and nausea, then you should be alright. Limit any high fat, salty or smoked foods and alcohol, plus up your intake of sulfur rich foods like the onion family, eggs, legumes and/or beef, chicken & fish in addition to high fiber fruits and vegetables to help your liver detox. Also remember to drink plenty of water.

If you're aiming for remission then you probably don't need antibodies ran again until your a year to 18 months on the medication since that's the suggested time frame for dosing. TSI will need to be done and under 100, and I believe some say under 50, before you come off the meds. You might also want to split that pill and take it twice daily. Technically the dosing is supposed to be 3 times a day, but I could never get that little pill down to more than half without destroying it.


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## needanswers (May 4, 2013)

Thanks so much everyone.

About doing MMI 2-3 times daily, everything I'd read said to do the same, even the printout from the pharmacy. My doc insisted not to, and only to take once daily. So I looked at the guidelines for the management of hyperthyroidism frm the American Association of Clinical Endocrinologists (2011) which is supposed to outline best practices for management of various causes of hyperthyroidism, and they say to dose once daily for MMI and PTU needs to be given 2-3 times daily. Everything I've read online however, seems to say 2-3 times daily for MMI. It's just these guidelines and the guidelines on the UpToDate database, both of which are supposed to be best practices, I thought.


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## StormFinch (Nov 16, 2012)

Yeah well, AACE also says that TSH should be the only guage in the dosing of hypothyroidism, that anywhere within the normal range is fine, and dessicated thyroid should not be used in the treatment of hypothyroidism. I take everything they say with a shaker of salt.  The manufacturer's insert for Tapazole, the name brand MMI, as well as Methimazole itself says 3 times per day in 8 hour intervals. Gotta love inconsistencies in instructions.


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## needanswers (May 4, 2013)

Thanks StormFinch! Glad to know that the AACE is so updated on how to manage hyperthyroidism...

I'm going to start splitting into two doses (I won't be able to cut the small pill into 3).

I'm so glad that there are websites such at this one. Thanks again.


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## StormFinch (Nov 16, 2012)

Lol what do you expect out of a group who has their symposiums funded by the drug companies? The more undermedicated we are the more likely we'll be to take other prescriptions... anti-anxiety and depression meds anyone? 

And you're very welcome.


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## Andros (Aug 26, 2009)

needanswers said:


> Thanks so much everyone.
> 
> About doing MMI 2-3 times daily, everything I'd read said to do the same, even the printout from the pharmacy. My doc insisted not to, and only to take once daily. So I looked at the guidelines for the management of hyperthyroidism frm the American Association of Clinical Endocrinologists (2011) which is supposed to outline best practices for management of various causes of hyperthyroidism, and they say to dose once daily for MMI and PTU needs to be given 2-3 times daily. Everything I've read online however, seems to say 2-3 times daily for MMI. It's just these guidelines and the guidelines on the UpToDate database, both of which are supposed to be best practices, I thought.


Methimazole has a short half-life of 5 to 6 hours so dosing 3 times a day gives more stability; I would think.

And you do have to be cognizant of the liver enzymes.

What do you plan for the long haul here? Do you think you might be better off to get your thyroid out?


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## needanswers (May 4, 2013)

Everytime I'm dealing with a medical issue, whether it be my own or for my kids, why does it always seem to come back to gain for the drug companies? Is this the new reality? (sigh)....
OK, thanks for letting me rant.

Thanks for the advice Andros. My immediate plan for the next three months is to split the 5mg dose twice daily and monitor how I feel. If feeling ok, then I'll wait until my bloodwork at the end of November and see where things are at. Otherwise, I'll try to get bloodwork in between if I feel unwell. More long-term, I'd like to stay on the tapazole for another 9 months or so (so that would be a year in total) and see where to go from there. Initially my family doctor told me to have the RAI almost right away. I'd like to wait and see. I'm in Canada, and they'll push for RAI before surgery in my case, so I'm told. So far, my endo thinks MMI for 12-18 months or longer if needed and doesn't think I'll need the RAI. In my opinion he's guessing as there's no way to know at this point if I'll ever get to remission, whether short-term or lifelong. Does that seem reasonable?


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