General Medicine

» Elaine Moore - Question - What is a 'Typical' Methimazole Dosage

In response to Question - What is a 'Typical' Methimazole Dosage posted by Phoebe_2007:
Hi,
Methimazole is less likely to cause itching/rash/hives when a lower dose is used. What's important is using the lowest dose needed to do the job. At one time, a 30 mg starting dose was pretty standard. But in recent years, several studies reported that most people can get by on a lower starting dose.
T4 is often falsely elevated in women, and an FT4 (free T4 level) is a better indicator of the amount of available active thyroid hormone in your circulation. The fact that you're still secreting TSH suggests that your levels aren't severely elevated, because TSH usually falls to levels less than .01 before thyroid hormone levels skyrocket. Your uptake of 65% is typical for mild to moderate hyperthyroidism.
You might want to ask your doctor if it would be ok to use a lower starting dose because of your concern with rashes and your low weight.

The general rule is to then lower the starting dose as soon as FT4 falls within the normal range regardless of TSH. You're considered euthyroid as soon as FT4 falls within range. This takes around 6 weeks, and at this time all the hormone stored in your gland is used up. So you just need enough meds to help reduce production of new hormone. The maintenance dose that people stay on until they reach remission is 2.5-10.0 mg/day and methimazole is best taken in 2-3 divided doses. Over time your dose is reduced so you're always on the lowest dose needed to do the job. When you're near remission or suspected of being in remission the dose is reduced even further so that you're weaned off meds slowly. Best, Elaine

» Phoebe_2007 - Question - What is a 'Typical' Methimazole Dosage

In response to Question - What is a 'Typical' Methimazole Dosage posted by daisyelaine:

Thanks very much Elaine. Your information is very helpful. I'm not 100% sure what bloodwork results were but I've requested a copy to be mailed to me. My Endo is a bit difficult to get a hold of (he's in the office only a couple days) but I'll leave a message with his assistant next week about lowering the dose.

Have a good weekend - and thanks again! Phoebe

-- posted by Phoebe_2007

» cowlover614 - Mixed up Help!!!!!

Help not sure what's going on this all started about 3 months ago! I've been on thyroid meds for 14 years. Up untill 3 months ago I wasn't having any problems. First doctor had me taking 88MCG of Levothyroxine. I had been on that dose for about 2 years,I changed doctors he did blood work said my levels were low and put me up to 100MCG I was on that dose for about 8 months. I changed doctors again she checked my blood and kept me on that untill this mess stared. First it started with my eyes swelling and feeling gritty,so I went to see her,and she pretty much said she didn't know what was going on gave me prednisone. I asked her then if it could be thyroid and she told me no. My eyes got better after I stopped taking it my eyes swelled again.I went back she gave me singular and celebrex which didn't help.I went back again put me back on Prednisone and told me to see a eye doctor which I did.He said it was thyroid.So once again I went back to her finally she did blood! She called said I was high and put me back to 88 my eyes still didn't get any better and I ended up in ER with a bad reaction to Pred. They checked my thyroid and told me it was normal.She got results told me she didn't know what they were talking about because I was Higher at the ER.told me to stop meds and to go see eye doctor again. I had enough went about week ago to another doc. he said my thyroid was the size of strawberries felt nodgule's did labs. He also put me on beta blockers I got my labs! T4 7.2-3.8-12.0 T3 136 60-181 TSH0.05 0.40-5.50 Thyroglobulin 1002.0 H ,20.0 and it contained Antibodies Thyroid Peroxdase 627.0 H less then 35. He also put me on methimazole 5mg three times aday. This is my 3rd day on this some of the swelling in eyes have went down but my face is still swollen. I'm lost! Is it Graves or is it TED I'm really confused and I don't know what these labs mean! Anyone have any ideas? Thanks Shirl

-- posted by cowlover614

» Elaine Moore - Mixed up Help!!!!!

In response to Mixed up Help!!!!! posted by cowlover614:
Hi Shirl,
Your low TSH with normal thyroid hormone levels suggests that you probably have blocking TSH receptor antibodies that are contributing to your eye symptoms and falsely lowering your TSH level.
Methimazole can help reduce thyroid antibody production but over time it could cause your thyroid hormone levels to fall too low since they were normal to start with. It would be better if you were tested with FT4 and FT3 levels to tell your thyroid status. And then, a combination of methimazole and thyroid hormone could be used to slow your immune system down while keeping your levels near the high end of the normal range to help slow down the gland's activity. This would help lower thyroid antibody production and reduce eye symptoms.
Prednisone will also lower your TSH level and cause you to have misleading TSH test results. I don't think that you're hyperthyroid but that prednisone or TSH receptor antibodies are causing your low TSH result.

Facial swelling and angioedema are often related to thyroid antibodies in people with hypothyroidism. The treatment is usually increased thyroid hormone to keep levels near the high end of the range, which again slows down thyroid gland activity and reduces thyroid antibody production. Best, Elaine

» bonniem7 - recurrent Graves

Hi,

I have had Graves disease for the most part of 4 years now. I was diagnosed in Japan, took a drug called neo-mercazole, which seems to be something like methimazole. I switched to methimazole upon return to the US, and eventually was taken off. Things were fine, then my symptoms started again a few months later. Now I'm on methimazole again, and my doctor has been slowly reducing my dose, but last month my thyroid suddenly went crazy again. My T4 was high, my TSH was low. My doctor increased the methimazole a lot, gave me atenolol, and is really pushing me to have radioiodine. The sudden craziness of my thyroid does scare me, and I want to do something, but I'm not sure radioiodine is the answer. I also sing in my spare time, so I'm not sure surgery's a good idea. And I'm 28, and female, and want to have children someday. Also, Hashimoto's runs in my family. We have some evidence that what we have is an autoimmune disorder.

Do you have any suggestions? The literature on radioiodine is conflicting, but after four years of this and some unpredictability in my thyroid, I'm confused. Thank you.

-- posted by bonniem7

» cowlover614 - Mixed up Help!!!!!

In response to Mixed up Help!!!!! posted by daisyelaine:

Thanks so much at least someone is helping me. I'm still not understanding all of this. I'm not sure if I should keep waiting on this doc to set me up with an Endo or try to go to another reg doc. May be they can do a FT4 and the FT3. I know this morning my eyes were really swollen.Can eating alot of salt make it worse? Got dizzy and total brain fog.Also my eyes just kept pouring water.I just sat here and cried!!! That really doesn't help but I'm really worried and never been so tired in my life!! How long does it take for that methimazole to do something I'm about tired of this. I know it's not a over night thing. Someone told me to get kelp and take a whole hand full what does that do and someone else told me I have cancer. [I told them gee thanks] like I needed that! Also said take alot of vitamin c. All kind of answers but I don't want to make things worse.So now I'm not not to sure what to do can you help please? thanks Shirl

-- posted by cowlover614

» Elaine Moore - recurrent Graves

In response to recurrent Graves posted by bonniem7:
Hi Bonnie,
The normal course in Graves' disease is for periods of remission to alternate with periods of symptoms until complete remission occurs. If you can figure out what environmental triggers are causing your relapses it will help you in achieving permanent remission. Common triggers are allergies that aren't controlled, excess dietary iodine in fast/processed foods, aspartame in diet sodas, stress, estrogens, cigarette smoke, and low selenium levels.
It could also be that you weren't truly in remission when your meds were stopped. You'd want to confirm this by either a test for TSI, the autoantibodies that cause Graves' disease to see if your immune system stopped producing them or normal secretion of TSH when you're on a very small dose of meds like 1.25 mg methimazole or carbimazole for at least 6 weeks. Often, meds are stopped because the dose has been to high and results are misleading.
Permanent ablation with radioiodine and surgery can both affect your voice so this treatments aren't generally recommended for singers. Of interest, I hear from lots of singers with Graves' disease. Best, Elaine

» Elaine Moore - Mixed up Help!!!!!

In response to Mixed up Help!!!!! posted by cowlover614:
Hi,
Your major thyroid hormones are T4 and T3. Although these levels are often falsely elevated in women ant the FT4 and FT3 levels would be better tests, your levels of T4 and T3 are only slightly elevated.
It's very likely that the methimazole will lower your levels too much and cause symptoms of hypothyroidism, such as eye swelling, depression, fatigue, and brain fog.
TSH is a pituitary, not a thyroid hormone. Your low TSH level can be falsely decreased or you could have subclinical hyperthyroidism. In either case, meds aren't usually used because they can lower your thyroid hormone levels too much. And it sounds like this is what's happening.
Do not take kelp. Kelp triggers autoimmune thyroid disorders. You may want to call your doctor and report your symptoms and see if you can have your FT4 and FT3 levels tested. Best, Elaine

» bonniem7 - recurrent Graves

In response to recurrent Graves posted by daisyelaine:

Thank you. My doctor doesn't like to talk much, and he told me there were basically no risks to radioiodine. I had no idea it would potentially harm my voice. I really appreciate you doing this, and I think many others do as well.

-- posted by bonniem7

» cowlover614 - Mixed up Help!!!!!

In response to Mixed up Help!!!!! posted by cowlover614:

Thanks Elaine! Got an appointment! Hope this doctor will do the FT3 and Ft4. Feel better today alot of the swelling is down today! Shirl

-- posted by cowlover614