On ATD's, still feeling hyper at times

I've been on methimazole since the beginning of August for Graves disease and hyperthyroidism.  For the past 3 weeks I've felt really good and then yesterday all of a sudden I started feeling hyper again.  Shakiness, legs feeling like wiggly jello, pounding heart (although the atenolol keeps heart rate between 70-80), etc.  My TSH was 0.17 about 3 weeks ago, and one week ago it tested at 0.27.  I have my FT3 and FT4 labs done next week.  Is it normal to occasionally experience hypER symptoms while on ATD therapy?  My methimazole dose is 20 mg. twice a day. Thanks much!

[Mark Lupo, M.D.]

It's possible to still have some symptoms, but typically two months into fairly high dose ATD (ie, methimazole 20mg 2x/day) the thyroid is pretty well depleted of thyroid hormone  Sounds like things are going well over-all with continued improvement in TSH.  I would take it one week at a time - follow the tsh, t4, t3 every 3-4 weeks and re-evaluate.  If not improving, may be best long-term to do radioactive iodine (presuming you don't have active eye disease or are planing a pregnancy anytime soon).

[tnt406]

Hi no I am not on any medicines at all.I don't see my neurologist until October 11th.I am still feeling terrible.My throat stays sore constantly.I had a DNA done in March,my neurologist told me over the phone that it tested for lupus all so.She said it came back negetive.Do I still need the ANA test done,since I had the DNA?I just want to start feeling better again.I hate feeling this way.I'm thinking about going and seeing an Amish Doctor.He sells herbal medicines,for treatments.Do you think herbal medicines would heal me?I am desperate.He gives some people with cancer 35% hydrogen perioxide for a cancer treatment.I don't know what else he gives out,but I am willing to try any thing now.Thank for any information you can give me.TNT406.

[Mark Lupo, M.D.]

does not sound like you need the ANA test.  I don't have any experience with herbal treatments - I am not opposed to them as long as the risks aren't high and the cost isn't prohibitive.

[abcsoup]

Dr. Mark,
Thank you for your response. I have had eye symptoms and have been under the care of an opthalmologist.  Therefore I am scared to pursue RAI as a form of definitive therapy.  I would however be open to surgery as a permanent solution.  How often is surgery used to treat Graves disease, and also, how can my FT4 and FT3 levels be in the normal range, and my TSH be abnormal?  Thank you very much!

[Mark Lupo, M.D.]

The TSH is a very sensitive hormone that is made by the pituitary in response to careful balancing of thyroid hormones -- even if the t4/t3 are normal - the pituitary may still keep the tsh low in order to not over-stimulate the thyroid.  With Graves disease the TSH can sometimes be hard to interpret - ie, stay low for a few comlicated reasons.  

Thyroid surgery is seldom needed for Graves, but it's a possibility.  Keep on course for now and see how the meds work.