# Help with labs while on methimazole



## jolie.etoile (Mar 15, 2014)

I was hoping someone could have a look at my lab results. I'm heading to a follow-up appointment next week, and it will be my first chance to talk about any of my March results.

27 Aug 2013
TSH 2.21. Range: 0.4-4.2
First signs of hyperthyroid. I had an episode, which passed. Dr said to come back if the symptoms returned.

6 Feb 2014
TSH 1.28. Range: 0.4-4.0
FT4 1.8. Range: 0.8-1.9
More hyperthyroid episodes, more frequently.

27 Feb
TSH 0.23. Range: 0.4-4.0
FT4 1.8. Range: 0.8-1.9
Reran by my GP based on worsening symptoms. Sends me to endocrinologist.

3 Mar
TSH 0.32 Range: 0.4-4.2
FT4 1.4. Range: 0.6-1.5
FT3 3.9. Range: 1.5-3.5
TPO AB less than 0.3. Range: 0.0-9.0
Stim index less than 1. Range: index less than 1.3
Thyroglobulin AB 31. Range: less than 116
Started 5mg methimazole daily.

18 Mar
TSH 0.109. Range: 0.4-4.2
FT3 3.4 Range: 1.5-3.5
Symptoms had got worse, methimazole upped to 10mg daily.

2 Apr
TSH 0.083. Range: 0.4-4.2
FT4 1.4. Range: 0.6-1.5
FT3 3.2. Range: 1.5-3.5
Pre-visit labs. Office called and upped my methimazole to 20mg daily.

I have continued to have symptoms, and I haven't felt much better since starting methimazole. Is it normal for tsh to continue dropping even though free T3 is also coming down?

I have seen some small improvements in my symptoms, but I am still feeling pretty uncomfortable. I hope the 20mg dose is more helpful. I haven't seen my dr since my initial visit, so I feel a bit lost with all this. I don't like not knowing what to expect.

Thanks for the help and for giving me a place to ask questions.


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## Dory (Jul 23, 2012)

I have been on methimazole for 5 weeks and my TSH hadn't budged from <0.01. My FT4 is borderline low, and T3 has come down to just below the mid mark on the range.

My Endo started me on 20mg of Methimazole. It took me 2 weeks for my FT4 to start to come down, then Endo decreased to 15mg Methimazole. It took about 4 weeks to start to feel better. As of today, I am off the beta-blockers, and my Methimazole has been decreased to 10mg a day.

With al that being said, my liver enzymes are through the roof, and my red blood cells are wacked out.

I can post my labs if you would like to see the progression. I can't say that what's happening to you is normal, but since my TSH is still so low, I would think that you are on the right track, just going the other direction from me.


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## jolie.etoile (Mar 15, 2014)

Thanks, Dory!

Four weeks is about what it's taken me to start feeling better as well. A dose of 20 mg finally seems to be able to slow things down for me. I'm hoping my doctors visit this week will help shed some light on what's going on. A reason why my thyroid is hyperactive would be nice 

I'm glad that you're on the mend! This hyper business is pretty rough stuff.


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## Lovlkn (Dec 20, 2009)

> Is it normal for tsh to continue dropping even though free T3 is also coming down?


Jolie,

TSH isn't a reliable test to dose by and can lag up to 6 weeks. While taking a blocking medication such as methimazole your body is in a recalibration phase and the Free's are the only test to know your current active hormone level. Are you splitting your doses or taking all at 1x? Beware that you are on a hefty dose for your current lab's. Be sure and go have labs if you start feeling sluggish.

Has anyone suggested a sonogram of your thyroid to determine if nodules are present and causing the hyperactive labs?


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## jolie.etoile (Mar 15, 2014)

Thanks, lovlkn!

That's pretty interesting. I am splitting the dose 2x daily. I can tell when it's time for the second dose. I started feeling better when I started the 20mg, but maybe that's a coincidence and I would have started feeling better on 10 as well. I haven't noticed any symptoms of hypo yet, but I will definitely be on the lookout. I'll talk to my dr about it today.

They did a sonogram several weeks ago. The results they posted on their online system just said thyroid was "normal", included some measurements if it, and said there's a "possible parathyroid adenoma". They ran the parathyroid labs and everything came back just fine. I don't have any of the classic parathyroid symptoms, either. The ultrasound is another of my many questions for the dr.


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