# Help me understand my test results :(



## psychopika (Mar 1, 2015)

I've been diagnosed with Hashimoto's this year in March (so 5 months ago), Anti TPO were 115, Anti TG were 33. Back then TSH was 1.5, FT4 1.1 [0.7-1.5], so normal function.

In June this year (2 months ago) I started having palpitations and tested my thyroid again. TSH was 0.0018 (suppressed), FT4 2.66 [0.7-1.5] and FT3 7.8 [1.7-3.7]. I was hyperthyroid so I had the TRAb test and it was 5.9 [<1.6] so I was diagnosed with Grave's and overt hyperthyroidism.

I was put on 15mg Methimazole and 6 weeks later re-tested my thyroid and these are my results:

TSH 0.0026 (still suppressed)
FT4 0.86 [0.7-1.5] so normal but low range

FT3 2.8 [1.7-3.7] normal

In the last 2-3 days before these tests I started having a nasty head pressure and lack of focus... possibly similar to what I've read about hypo symptoms. I feel pressure around my ears, nose, head, throat, I feel tense, don't sleep well... could it be that my FT4 is too low? And why is my TSH still suppressed, shouldn't it rise with this FT4?

I will now half my Methimazole dosage to 7.5mg per day for another 3 weeks and test again. Does this sound right?

Thanks so much.


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## Andros (Aug 26, 2009)

Welcome to the board!

Have you had RAIU (radioactive uptake scan?) If not, you need to.

Also the pressure about the head and such could possibly be peri-orbital edema.

To be honest with you; there never was a time where I felt well on anti-thyroid meds. The whole experience was horrible so after almost 2 years of suffering, I had RAI and I am really glad I did.


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## Lovlkn (Dec 20, 2009)

> I will now half my Methimazole dosage to 7.5mg per day for another 3 weeks and test again. Does this sound right?


Yes, your labs would indicate a reduction in your anti thyroid med's. I was on them 4.5 years before I opted for a Thryoidectomy,

If you have both high TPO and High TSI or TRAb - you need to start preparing yourself for the eventual outcome of your situation - a total thyroidectomy. If you have any eye involvement at all do not consider RAI to kill off your thyroid because it could make your eye issues worse.

If I knew what I know today - I would have had my thyroid removed much sooner.

I'm sorry - it's alot to digest. You will likely have difficulty stabilizing until your nasty sick thyroid is removed. I am 11 years post op and can tell you it is the best decision I have made in my thyroid disease journey.


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## psychopika (Mar 1, 2015)

Andros said:


> Welcome to the board!
> 
> Have you had RAIU (radioactive uptake scan?) If not, you need to.
> 
> ...


Thank you Andros!

I haven't had RAIU as I was pregnant at the time of diagnosis (I've lost that pregnancy). As I'm currently trying to conceive again I won't have any radioactive scan. However, the overt hyperthyroidism together with positive TRAb is highly suggestive of Grave's and my doctor said no more testing will be needed if I'm responding to the treatment.

The head pressure is a tiny bit better today, hopefully it will resolve with the lower MMI dose. But I think you are right, it might have been periorbital edema as I felt my face a bit puffier than normal (not obviously so, but there was something different). Today it feels better.


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## psychopika (Mar 1, 2015)

Lovlkn said:


> Yes, your labs would indicate a reduction in your anti thyroid med's. I was on them 4.5 years before I opted for a Thryoidectomy,
> 
> If you have both high TPO and High TSI or TRAb - you need to start preparing yourself for the eventual outcome of your situation - a total thyroidectomy. If you have any eye involvement at all do not consider RAI to kill off your thyroid because it could make your eye issues worse.
> 
> ...


Thank you Lovlkn.

I'm not yet considering a thyroidectomy unless it becomes a real problem. I've never had many issues with my thyroid until this summer so I'm still hoping the Grave's will go into remission after this. I might get hyper episodes in the future but unless they seriously affect my life I will keep the thyroid. I also have a small nodule on it though and if that will grow with time I might take it out anyway.

I don't think my thyroid is very sick in itself, but my immune system is sure acting like an asshole lol. Fortunately no eye involvement yet. I have read that the eye involvement is caused by the TRAb antibodies and they can continue to cause issues even after the thyroid is removed.


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## Lovlkn (Dec 20, 2009)

If you are trying to become pregnant you should NOT be taking Methimazole and need to switch to PTU.

Did your doctor ask about pregnancy when they prescribed it?

BTW



> TSH was 0.0018 (suppressed), FT4 2.66 [0.7-1.5] and FT3 7.8 [1.7-3.7]


I'm really surprised you are not more symptomatic with these labs



> TSH 0.0026 (still suppressed)
> 
> FT4 0.86 [0.7-1.5] so normal but low range
> 
> FT3 2.8 [1.7-3.7] normal


These labs are hypo - TSH does not matter because it lags and is not an accurate reading of where your thyroid hormones are.

1/2 the dose is a good idea to gauge where your hormones will be taking you and hopefully not further hypo


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## psychopika (Mar 1, 2015)

Lovlkn said:


> If you are trying to become pregnant you should NOT be taking Methimazole and need to switch to PTU.
> 
> Did your doctor ask about pregnancy when they prescribed it?
> 
> ...


You are right MMI is not the best option in the first trimester of pregnancy. I have discussed it with a doctor and because of the risks of liver issues with PTU and the uncertainty of when I will get pregnant again, we have decided that I will be on MMI until a positive pregnancy test and then immediately switch to PTU (I have it at home so I can make the switch instantly). This is why I always test very early, starting 9 days post ovulation (I get very early positives in general).

With the previous labs (the hyper ones) I was very symptomatic, my resting heart rate sitting down was around 100bpm, just standing up would send it to 140bpm and after showering as high as 170bpm. I had to stay at home for a few weeks. After the treatment the heart rate is now back to 65-90bmp.

So you would say my latest labs indicate I'm hypo? Is it because that FT4 is closer to the lower limit (0.86)? My normal, healthy FT4 used to be around 1.1-1.3.

Thanks very much for helping me with this


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## Lovlkn (Dec 20, 2009)

1/2-3/4 of range is the goal for both FT-4 and FT-3 so yes, I would consider those labs hypo.

FT-4 should be somewhere 1.3 - 1.5

FT-3 should be somewhere 2.7 - 3.2

Because you are in an active phase of Graves and new to anti thyroid medications it may take awhile to stabilize into those ranges. Expect your doctor to tell you "normal labs" because if they see them in range they often consider labs normal. I've lived this for a loong time and can speak from my experiences.

Also, once you start to adjust med's based on labs it's very unpredictable where you will end up - either more hypo or possibly euthyroid. It's a time and test process and patience is a good thing to have.


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