Good News?

[Bushwhckr]

I was diagnosed with Hyperthyroidism a few weeks ago and the doc put me on Methimazole. I went back today for blood work and an ultrasound.

The results were that my TSH was even lower than last time it was checked a few weeks back. Then it was .037 and today .014. The statement he made was "Overall, the thyroid appears symmetrical and heterogeneous in appearance. No distinct nodules or cysts are noted right or left thyroid lobe at this time. No suspicious lymphadenopathy is noted right or left neck level II-V at this time. the gland is heterogeneous and slightly enlarged consistent with suspected Graves disease"

...Whatever all that means. He's put me on Methimazole four pills a day-two twelve hours apart. I'm hoping this will cure it and not have to take RAI, which I'm dead set against.

[Bushwhckr]

I went for a lab only recently and the results were most promising. They called me later and said the thyroid was now normal and he's taken me off the Methimazole. He wants me to come back in a month to see how things are going.

[goolarra]

I still wish you'd get your doctor to order FT3 as well.  Your FT4 has come up to 34% of range, which is better than last time, yet your TSH is much higher.  When FT4 goes up, TSH should go down.  If your doctor had been following your TSI, and it were going down, that could be attributed to remission.  The other possibility is that even though your FT4 went up, your FT3 might have gone down, creating the spike in TSH.  Questions that can only be answered with more comprehensive testing...  

It's hard to know which symptoms are thyroid related and which aren't.  

[Bushwhckr]

I'm feeling ok for this age I suppose. I don't know what normal really is anymore. I get what a friend of mine use to call "a sinking spell" around 7:00 each night but that may be the sign of the times.

[goolarra]

Thyroid problems definitely try your patience, especially when things are changing.

Your FT4 has come up some, which it needed to do.

How are you feeling?  

[Bushwhckr]

Well, the saga continues. Today I went back for yet another check up and while the FT4 was even better than last time at 1.10, the TSH went high at 7.67 as opposed to the .262 it was last time.

So, now he's put me on 5mg every other day for a month and then a recheck. Last time I was taking 5mg daily. Seems this will never end.

[Bushwhckr]

About the only symptom I ran across at the Mayo Clinic was Increased sensitivity to cold but, I think that's been going on for some time even prior to having any thyroid issues at all. Probably due to age plus these blood thinners(Plavix and Warfarin).

[goolarra]

Just keep an eye open, then.

[Bushwhckr]

I don't really have any of those symptoms.

[goolarra]

You can google the long list.  The major symptoms are fatigue and/or sleepiness, weight gain, constipation, hair loss, depression, muscle pain.  There are many more, but some of those are usually among them.

[Bushwhckr]

I guess I'm still not sure what  hypo feels like. I had a lot of crazy feelings after my surgery July a year ago but was hyper at that point but didn't know it till after the tests.

I suppose I could google hypo symptoms and find out.

[goolarra]

If you feel well, that's what counts.  If you start having any hypo symptoms, be sure to go in for blood work earlier than scheduled.  22% is pretty low in the range.

[Bushwhckr]

The TSH is much better than last time as it was .006 back in June. I'm feeling ok. I don't know what normal is anymore but for the age about as good as it gets, I suppose. No irregular heart beat or high/low blood pressure. That's good at 130/65.

[goolarra]

So, now your FT4 is bordering on being a little on the low side.  It's 22% of range.  Your TSH is also on the low side considering how low your FT4 is.  That's a bit of a contradiction.  You really should insist on FT3 next time around.

How are you feeling?

[Bushwhckr]

Ranges for the FT4 are .71-1.85 ng/dl

for TSH .490-4.670 uIU/ml

No FT3

[goolarra]

What are the reference ranges on those two sets of labs?  Your FT4 has to be bordering on hypo by now.  No FT3?

[Bushwhckr]

There's few doctor's like that around here...little choice. They ask me each time I go about "am I still taking this and that". They know what I'm on. They just verify that nothing's changed.

[gypsy_dancer]

I can't believe you're with the same doctor.  You still don't know what your TSI is.  I keep of running list of things to ask or suggest and take it with me to the doctor.  I also take a list of all my medications, dosages, and supplements.  The way I see it, I'm paying the bill -  I decide what happens on my dime.

[Bushwhckr]

Well-after much ado and nine months of trying different meds and techniques we finally hit on something yesterday. It had been about six weeks that I had been on 5mg of Methimazole and the blood work yesterday yielded this...

FT4-0.96
TSH-.262

That's a vast improvement over last time back in June when they read...

FT4-1.58
TSH-.006

He's keeping me on the 5mg for two months and another test to see where we are.

[Bushwhckr]

The INR results depend on several issues. Vitamin K will reverse the effect of Warfarin so I have to be careful of the leafy green vegetables I have and the quantity, that included broccoli, slaw, any greens and especially collards and Kale that have a lot of Vitamin K.

Moreover, to add to the tight rope I walk with keeping the INR within my therapeutic range is whether I'm hyper or hypothyroid. One will lower the effects of Warfarin while the other will increase it. Hypothyroidism is associated with a decreased response to Warfarin while Hyperthyroidism has the opposite effect. Add to that the Methimazole or Lovathyroxine and it's a thin line to try and establish.

I bleed easily with a range between 2.5-3.0 anyway regardless the meds I take. I just had an arteriogram and had to stop Warfarin for five days and start Lovanox shots instead. That brought my INR to 1.1 in those five days-perfect for someone cutting into your artery. However, it takes some days to get the INR back up to at least 2.5 so I had to continue the shots until the INR got to at least 2.0. I'm sore, black, blue and yellow from the shots but I'm back up to 2.3 by giving myself 6mg each day instead of my usual 4mg. I'm sort of my own doctor when it comes to judging how much I need to take and monitor it more accordingly.

[goolarra]

Here's what drugs.com has to say about the intereaction of Warfarin and methimazole:

"Using warfarin together with methimazole can cause you to bleed more easily. You may need a dose adjustment in addition to testing of your prothrombin time or International Normalized Ratio (INR). Call your doctor promptly if you have any unusual bleeding or bruising, vomiting, blood in your urine or stools, headache, dizziness, or weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor."

I'm sorry that I don't know much about INR and really can't give you any advice.  However, it would seem from the above quote that methimazole would increase the effectiveness of Warfarin (i.e. thin your blood even more), doesn't it?

[Bushwhckr]

I'm at a stage now I don't know if I'm hyper or hypothyroid. I had an arteriogram Wednesday and had stopped my Warfarin for five days in lieu of giving myself Lovanox shots.

My INR range is 2.5-3.0. The day of the operation it was 1.1-subtheuropeutic as it should have been having stopped the Warfarin. I was told to continue the Lovanox shots while taking the Warfarin after I came home until the INR got back up to a little over 2.0.

Normally, I take 4mg daily but when I got home Wednesday afternoon and because the INR was already low I took 6mg but didn't take the shots. Thursday I took another 4mg and took 5mg of the Methimazole they thyroid doc wanted me to take. I took another one this morning and later checked my INR and it was only 1.3. That's very low considering I'd taken a total of 10mg of Warfarin since Wednesday.

I'm inclined to believe the Methimazole is in part the cause of this and think I'll stop it until the INR gets up or I can risk blood clots. It seems to be a tight rope I'm walking.

[Bushwhckr]

The T3 was 3.61 about two weeks ago when I went to the family doctor for blood work. I don't know why that wasn't checked with this doctor.

A couple months ago I asked the lab to check the TSI along with the usual tests he wanted. I never heard about that so when I was at my family doctor a couple weeks back I asked her about it and she said she thought they sent it to h er. Upon checking for it in the computer she couldn't find evidence of it. I still don't know what that results were.

I don't know what hyper is suppose to feel like. In fact, I'm not sure what normal is anymore. I know this. I'm about over it all.

[goolarra]

I'd strongly urge you to get a second opinion.  Your FT4 is in range.  He didn't bother to test FT3 (first mistake).  He's recommending surgery or RAI, neither of which is to be taken lightly (and I know you aren't taking them lightly), based on TSH alone (second mistake).  He still hasn't run TSI (third mistake).  Do you feel hyper?  If not, then why have surgery or RAI?  Just to "correct" your TSH?  Once again, this guy is making me very nervous.  

[Bushwhckr]

Here's the story. I just returned from having the blood work done and the FT$ is well with range at 1.58. However, the TSH is .006-just what it was back in February.

He's still suggesting the RAI but wants to try a reduced dosage of the Methimazole which will be 5mg rather than the initial 10mg. I'm getting frustrated with all this as it's been going on since December. I won't do the surgery and rather not take the RAI either. It seems a Catch-22 situation.