could I stop ATD'S

[Lorilynn]

Hi, I was dx with graves 10 mos ago.  I started treatment in June of 07.  My labs at DX were, TSH 0.01 (0.3-5.7)
Freet3 5.46  (1.5-4.1) Freet4  2.09  (0.58-1.64)  TSI 232  (<130)   I started on 20,mg of MMI aday. After  6 weeks,  of being on ATD's 20mg of MMI,...my labs showed hypo , so I went down to 5 mg of MMI aday, and my endo prescribed me 50mcgs of synthroid a day , to help with the hypo symptoms.  I stayed on this combo for 9 mos.(with stable in range labs)   After the 9th month labs test, my TSH was at 4.05, so my endo told me to go down to 2.5 mg of MMI a day, and stay on the 50mcgs of synthroid as well.  So I did that for one month, now my labs after that month with that  dose are:   TSH 2.08  (0.3-5.5)  Freet3 2.4   (2.3-4.2)  Freet4  1.13  (0.80-1.80)  TSI 160.  My endo wants me to stay on this dose until my TSI goes to 80.  Do you agree with this protocol, that my TSI needs to be around 80?   My free's are on the very low end, it seems I don't need ATD's anymore, but he is basing my remission on my TSI alone.  Do you agree with this?  And if not, why?  What would you advise if I were your patient?

[GravesGirl]

Hi!
have you ever been off the atd's at all? My doc doesn't do block and replace either I don't think. When my tsh went up to 6 he told me to take 5 mgs 3 times a week. It wasn't enough, my tsh went down to .30, so he said 5 times a week. At last lab a few weeks ago my tsh was around 2 and the frees were toward the bottom. I think you need to be weaned off the atd's more. Your labs sound pretty good, if you feel good, stay on this dose, your tsi is still high which means you have active Graves and would probably relapse if you got off them completely. Most people slide right back to hyper pretty quick if not in remission.

[Mark Lupo, M.D.]

You posted most of this question a few days ago -- I don't use block/replace.  The TSI may not normalize in the near future, so it is not usual to wait until the TSI is normal, but the high TSI increases the risk of relapse off MMI.  I usually use MMI only down to dose of 2.5mg every other day then stop once TSH is in normal range.