Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
Hyper or Hypo?
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Hyper or Hypo?

I was diagnosed with Grave's disease over two years ago.  I was told my levels were off the scale and promptly placed on 40mg of carbimazole daily and sent to see an endocrinologist.  This was then reduced to 20mg daily and, having changed my GP to one who is more open, I have at last been told my results from my recent blood test:

Free T4  14pmol/L
        T3  2.3nmol/L
      TSH not detected.

I am so tired now and feel ill but forgot to ask the GP what this meant when he asked if I understood or if I had any questions - I wasn't used to being asked this!!!  I assume he thought my laack of questions meant I knew all about my thyroid having had bother for over 2 years.

So am I hyper or hypo???  Why do I feel worse than I ever did???

Regards
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Graves Disease causes Hyperthyroidism - it is when your immune system attacks and over-stimulates the thyroid, resulting in too much thyroid hormone being produced.  The carbimazole decreases thyroid hormone production.  The initial dose of 40mg is fairly high so the levels may have decreased quickly and now your body is trying to adjust to that -- it will be important to monitor levels closely (usually every 4 weeks in the beginning) but you have been on medication for 2 years it seems.  The undectable TSH suggests that you are still hyper - the ranges for T4 and T3 vary from lab to lab, so I am not sure if these are elevated.  The medication may need adjustment to keep the levels normal.  Alternatively, if you still have abnormal levels after 2 years of treatment, it may be time to consider radioactive iodine or surgery.
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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
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