# should I be going hypo?



## treesmith (Jan 21, 2013)

Hi All,

Please let me know what you think of my lab results. I'm concerned about going hypo and wonder if it is part of the process when being treated for Graves.

In July my TSH was .05, T3 Free 9., Free T4 2.38
Sept. TSH was .05, T3 Free 9., Free T4 .60
Oct. TSH was 1.89, T3 Free 2.3, Free T4 .62
Dec. Free T3 2.4, other results not sent

Methimazole reduced now to 2.5 mil once per day

Feeling better, but still lots of anxiety, depression and very cold. Endo. not helping me with mood issues.

Thank you for your insights!

Treesmith


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## StormFinch (Nov 16, 2012)

Could you please post the ranges for your results? Each lab has a different set of normal ranges so it's hard to tell the full story with just results.

It would also help if you could add what dosage of anti-thyroid you were on during each test.

Thanks and welcome to the forums!


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## treesmith (Jan 21, 2013)

Thanks for your response.

TSH (0.25-5.0)
T3 Free (2.3-4.2)
T4 Free (0.70-1.55)

In July my TSH was .05, T3 Free 9., Free T4 2.38 10MG x 3 per day Methimazole
Sept. TSH was .05, T3 Free 9., Free T4 .60 10MG x 2 per day
Oct. TSH was 1.89, T3 Free 2.3, Free T4 .62 5MG x 1 per day
Dec. Free T3 2.4, other results not sent 5MG x 1 per day

Taking 2.5 MG of Methimazole once per day since Dec.


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## StormFinch (Nov 16, 2012)

Ugh, I wish your doc had sent your FT4. You might want to get an actual copy of your labs every time you have them run. Some people have had good luck adding CC patient to the lab slip, I usually had to go back in for a hard copy until I started seeing a doc with a patient web portal.

Anything under 15 mg of Methimazole is considered a maintenance dose. It_ looks _like your doc is trying to get you down low enough on the meds to allow your labs to come back up a little, but that he didn't drop your dosage fast enough. A) MMI (Methimazole) works quickly, B) most of your T3 is converted from T4 so a there is lag time between a low T4 and a drop in T3, and C) there is an even greater lag time between a drop in your Frees and a drop in your TSH. If your doctor is only really looking at your TSH run, don't walk, to another doctor.

Being made hypo isn't part of the treatment for Graves, but you do need to be on the meds long enough to get your antibodies down so that you have a chance to go into remission. On the other hand, you can be thrown into being hypo by a heavy hand with anti-thyroid drugs so it's a fine balancing act.

The coldness as well as the depression may be from being below range. Did you have the anxiety when you were full blown hyper? I know I had it left over after my thyroid was removed and still get an occasional, sporadic attack.

If you can, I know the pills are small and you may be working with half of one already, try to split your current dose so that you're taking 1.25 twice a day. And, if it were me I'd go back in as quickly as possible for another set of labs plus ask to also have a TSI (Thyroid Stimulating Hormone) test run if your doc isn't running them. If a TSI shows 20% or under, <.20 typically, then you can safely come off the drug. If your Frees are still low but you antibodies are high then there is a method called Block and Replace, where you stay on a maintenance dose of MMI and take levothyroxine to help raise the low T4, but you really need to have a doctor that's familiar with it, or at least willing to do their research.

Here's my personal favorite website for Graves tests: http://www.livingwithgravesdisease.com/diagnosis/lab-tests There's a good explanation for the TSI halfway down the page.


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## treesmith (Jan 21, 2013)

The rest of my lab report arrived for December. Please consult with numbers in prior entry.
T4 free .94 (.7-2)
TSH 4.96
What do you think of these results? Am I receiving good care?
I have an Endo appt. next Friday. Should I expect to be taken off methimazole and given an antibody test to see if I'm in remission? If so which antibody test is appropriate? Thanks everyone, I'm glad you are all out there!


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