To the doctors, nurses, and experienced people out there.
6 months ago, my tyroid level was pretty high at: FT4 level is 6.37 ( 0.89-1.76) normal.
I have been taking methimazole 10mg 3times/day.
Today, my T4 level have dropped to 1.02. I am assuming that is a normal level.
My doctor recommended me to go for a radioactive iodine scan , which i reluctant to go because:
1) I do not want radioactive in my body if possible as I have done catscan, xray many times this year for other problems.
2) I was suggesting if he could slowly let me off on the medication maybe 2 times a day to 1 times a day and check my blood level to see if the FT4 is increasing. If it is not increasing we can say that I am either in remission or I do not have hypertyroid or nodules that are acting up for now. If the tyroid level goes up again with lesser medication, then I would go and do a radioactive iodine check.
Would anybody out there recommend what is the best for me? and would my alternative number 2 work?
Were you diagnosed with Graves? Was TSI tested at the time?
TSI is a simple blood test, and it can show that the disease is going into remission. If TSI is still above range, you can be fairly certain that you are not in remission. If TSI isn't conclusive, then you can decide on the radioactive scan with more information in your pocket.
Is your hyper well-controlled on methimazole? It looks like it is from your FT4. Did your doctor test FT3 as well? Did he tell you what he hoped to learn from the scan that he doesn't already know?
When i was diagnosed by touching and looking at the Ft3, FT4 levels, he believed I have Grave's disease. Therefore, i ahve been taking methimaziole. And now, my FT4 level is low pretty much normal range as far as i know.
But according to him, he said that the scan will tell if i have nodes on the tyroid.
The solution now came to : cutting down the Methimazole to 1 a day (10mg), and skip the lopressor.
In 4 weeks, We will be checking the FT4 again.
He said that we don't do the TSH/TSI now because it comes down slower than FT4 usually. Therefore, in 3 months time later, he will do a FT4 and TSI. Any comment on this?
I am worried that i might go into hypothyroid which i do not want, i prefer to go slow all the way down to normal rather than hypo.
Yes, your FT4 looks like low-normal range. Ranges vary lab to lab, so they have to come from your own lab report, but 1.02 is considered low-normal on most ranges.
If you want to find out if you have nodules (nodes) on your thyroid, you could have a thyroid ultrasound. It's a totally safe procedure, painless and involves no radiation or drugs of any kind. If the ultrasound showed nodules, they could be evaluated from that to see if any further testing is necessary. An ultrasound is much less invasive than a nuclear scan.
You will certainly know by cutting down on your meds if you still need them or not. However, if you do still need them, you will probably get hyper symptoms back as well.
TSH and TSI are two different tests. TSI (thyroid stimulating immunoglobulen) is the antibody that causes Graves'. With Graves', TSI is elevated. Once on meds, TSI can be used to evaluate the success of treatment, and it can also show if you might be going into remission. When TSI goes down, it's a sign that you might not need (as much) meds anymore. Once again, TSI is a simple blood test and totally non-invasive, except for the needle in your arm.
If I were you, I think I'd ask for the TSI test. Of course, you have no pre-medication level to compare it to, but if it is elevated, you will know not to cut your meds (or maybe only to cut them very slightly).
I am feeling much better than last time. My heart beat before this was at 120bpm, now it is as low as 86bpm. I don't feel that tired or hungry anymore as well in the middle of the night, neither are my hands shaking.
The doctor told me to cut the methimaziole to 1 tabs for 1 more month plus and we'll do the scan at the beginning of the year next year. What do you think? Should i go to my personal doctor instead of the specialist and request for a TSI Test?
If I were you and had a doctor who would order it, I'd probably have the TSI. Unfortunately, you have no TSI from before you were on methimazole to compare it to, but I think you could still get some valuable information out of it.
If TSI is high (above range), you will know that you can't come off of meds. If TSI is elevated, but in reference range, you might be going into remission and can wean off meds slowly. If your TSI is negative, then you most likely don't have Graves' (and never did), and you really have gained no more information. In either of the first two scenarios, you could save yourself from having hyper symptoms again. Also, once you establish whether or not TSI is elevated, you can use it from now on to help with your decisions.
An ultrasound doesn't entirely replace a nuclear scan, but there is a lot they can tell from it. Have you disussed your concerns about the radiation with your doctor and asked if he can order a less invasive test instead?
A low TSH tells you that you are hyper. You said up in your original question that your FT4 was very high, which also indicates hyper.
Ask your doctor about TSI. If he's not aware of your recent exposure to so much diagnostic radiation, he may be willing to work with you to find other ways to achieve the same thing. Your idea of cutting back on your meds will work, too, but a TSI could possibly save you the hassle of going hyper again. It's such a simple, non-invasive and inexpensive test (compared to the nuclear scan), and it COULD (won't necessarily, but could) give you all the information you need to know what you should do from here.
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