Initial Dose - Methimazole

[jbnessel]

Hi. I have some symptoms of hyperthyroidism, but not enough for me to even take beta blockers. My labs look like this as of 1/21:

FT3: 1258
TSH: .06
FT4: 3.28

My doc prescribed 30mg/day of Methimazole.  I'm pretty chemically sensitive (can't wear perfume, can't use bleach or fabric softeners, etc).

I'm a little nervous at starting my treatment with such a high dose.  Is 30mg pretty standard, or should I ask my doc to start lower?

Thanks for any help!

[Smilerdeb]

McMillan is 100% right.
I dont think its wise to have RAI if there is even the slightest chance of TED.
And hes also right about researching.
The ATDS (anti-thyroid meds) will buy you time hopefully.
I was on them nearly a year so I became obsessive (so my kids said..lol) and researched Graves, Hyperthyroidism, Hypothyroidism and treatment inside out.
I didnt want any ''OMG ive done the wrong thing!"
I wanted to be sure that what I was doing was the right way for ME.
Everyone is different and some can go into remission with Graves......
I originally wanted a conventional TT ..by the way.
Amazing how things turn out.

[jbnessel]

I do have an opthamologist appointment this week for the TED.  I started the Methimazole today, and I decided to spread it out like Smilerdeb suggested and just keep at the 30mg until there are problems or i get changed at my doctors.

i think i am lucky to have a doctor who recognizes the problems with RAI and TED.  she hasnt suggested it at this point, although I dont know what she will do if the methimazole doesnt work.

And thanks Acker, I think I will do a graph.  That seems smart.

Thanks to all of you.  It is great to talk to people who have been through it already.  Talk to you soon.

[McMillanNelson]

HI jbnessel, Are you on a Beta Blocker like Atenolol ?  That is really important for your high heart rate symptoms , and usually the first thing they put you on if you are having racing heart symptoms.

As Smilerdeb pointed out, It is a good idea to adjust when you take the medication to find what time suites you best. Once you figure that out you should take it exactly the same way every day. You don't want to not take it but do need to discuss the dosage with your doctor.

I encourage you to read as much as you possibly can about all forms of treatment. Since you are on Methimazole that buys you some time to do lots of research beofre you decide on RAI.  In some cases like Smilerdeb's RAI was a good choice for here, others on the forum will share their opinion who have had RAI. Be informed and talk to as many people as possible who have had the treatment suggested by your doctor so you can make an informed decision. And I agree with Smilerdeb, since you mention "slight eye protrusion" do NOT do RAI  you should get checked for TED (thyroid eye disease).  I personally even refused the Thyroid Uptake and Scan because I have eye problems and I did not want to risk the radioactive iodine, even though it is I 123 and lesser type than used for Ablation, I did not see that it was warranted in My case given all the facts they already had form the blood LABs and Ultrasound.

Let us know how you are doing.

McMillan

[Smilerdeb]

If I had taken less dosage, I would be dead.
I had thyroid storm 3 times in 2 weeks not long before RAI and ended up having paddles put on me the 3rd time to get the heart back into a stable rythm.
Each time I was hypo...my meds were decreased by 10mg daily...2 weeks later I was HYPER again.
My hyperthyroidism was uncontrollable.
RAI saved my life.

[acker]

standard initial dose is 15-40mg/day
i was on 20mg/day and in 5 weeks my fT4 went from 31 to 23 [normal 10 -20]
i'm also very responsive to medications, maybe not quote as sensitive as you're describing for yourself.
so after 8 weeks i was at 18 [optimal].
i drew a GRAPH and the line is very straight and consistent. i recommend drawing a graph - just for the 'starting methimazole' phase - (when you start coming off it, it becomes less of an exact science).
i'm not familiar with the normal ranges of the tests you listed - they vary from lab to lab.
here's what then happened to me - my dr kept me on it for a total of 13 weeks - simply too long. i had dropped down to 9 - and felt it! [crappy] i then went from 20mg/day to 15mg/day. hindsight is easy, but i wish i had been on 5mg/day. cause i then went down to 6(!) then was taken off them completely.
that was exactly 4 months ago. i seem to be normalising.
i would get another test right about now...

[jbnessel]

Thanks for the response.

Do you feel like the spikes or the switching from hyper to hypo wouldn't have happened if you had taken less dosage?

[Smilerdeb]

McMillan is right.
I went from hyper to hypo on anti-thyroid meds every 2 weeks (drug sensitive too) so to try and avoid this....I took mine in 3 doses spread out during the day.
I was on 30mg daily and took 10mg doses at brekky, noon and bedtime.
That way  you avoid the hyper 'spikes' when the meds wear off, especially during the night when the thyroid 'dumps' around 3-4am.
Do you find you wake up with racy heart and bad heat around that time?
If so..space out the doage and take the last dose at bedtime.
get a TSI test done to rule out Graves Disease and if the antibody test does show Graves...then do not opt for RAI if you have any sort of eye problems.
Book into an Opthamologist for your eyes to be checked....(not an Optometrist).
So many have RAI for Graves without making sure they dont have TED (thyroid eye disease).
Research all you can before you decide anything...the Methimazole buys you some time too. Dont rush into anything.

[jbnessel]

Thanks so much for getting back so quick!

I was diagnosed with Graves'.  I had a radioactive uptake test and it showed no nodules, and slight enlargement of the thyroid consistent with Graves'.

In looking at my paperwork from my last lab test, I don't think my doctor did an antibody test.  Just FT3, TSH, FT4 and liver tests.

My symptoms include: tremor, high blood pressure, high heart rate, trouble winding down, increased appetite, slight eye protrusion, less duration of my period (i like that one!), exhaustion after about 10 hours of being awake.

I think my doc just wants to load me up with the antithyroid meds, but I like taking things slow and easy rather than being bludgeoned.

Thank you for any thoughts.
  

[McMillanNelson]

Hi jbnessel, What was your diagnosis? Have you had an ultrasound?

I discovered after an ultrasound that I have Toxic Multinodular Goiter. I went for almost ten years going back and forth with symptoms and doctors only looking at my TSH and giving me antidepressants, cholesterol and high blood pressure medication but always missing the underlying problem.

Have you had antibodies tests for graves or Hashimotos ? If possible please post your full thyroid blood numbers and the reference ranges.

What are your symptoms?  My doctor put me on 10mg Methimazole. I found that by changing my diet drastically, cutting out all fast food, soda, cutting back on caffeine, cutting out goiterous vegetables etc, that alone made a big difference in my symptoms and I finally got back some energy and have less brain fog.  

I think the dose of Methimozole I was on was lower than most people, but a large part of this depends on the particulars of your case.  The problem I had with my doctor was I was at first only given two options, 1) RAI Ablation to kill off the toxic modules and probably most or all of the thyroid or 2) surgery.

I refused those two options and asked for a medication while I research my situation. Methimazole is an anti-thyroid drug which will cut the production of hormone, in my case too much. I asked to lower my dose. Eventually I was so Hypo I had to stop taking it. Now that is just me, and you have not said what your diagnosis is. I certainly would suggest you talk to your doctor about the dosage if you are concerned and want to start with a lesser dose and work your way up until you find what is right for you.  Everyone is different. Some people take more than 30 mg a day, and I am sure some others will comment.

Pleases post some more details so that we can better help you. The easy thing you can do, is start immediately by taking a look at your diet and make changes if you need to and read labels. I urge you to learn as much as you possibly can so that you can ask your doctor informed questions and you can actively take control of your treatment.

Often times with thyroid disease we all seem to have a hard time finding a good endo doctor those that do are lucky.  In most cases the usual plan for many thyroid diseases it to kill off the thyroid and just give you hormone replacement because that is easier to control but many of those treatments are not reversible so I urge you ask as many questions as you can and learn as much as possible so that you can make good decisions.

McMillan