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Advice needed on tricky dosage amount of Methimazole for Graves Disease?

Last year, Fall of 2015, I was diagnosed with hyperthyroidism and tested positive for the Graves antibodies.  My doctor started me on 15 mg of methimazole, and I became hypothyroid.  She reduced the amount to 5 or 10 mg. of methimazole but I still became more hypothyroid, and then we went down to 2.5 mg of methimazole at which point my FT3, FT4 and TSH levels were decent. She then took me off the medication at the end of May 2016.  Following up, 6 months later, my FT3 and FT4 were high and my TSH nonexistant, and so I again started on methimazole 2.5mg per day from November until today.

Here are my test numbers and ranges up to now:
                        TSH               FT3              FT4
Range              0.27-4.20      2.40–4.40     0.93-1.70
11/21/16         <0.01              5.69              2.25
1/3/17               0.01              3.32              1.42
3/3/17               0.22              2.65              1.20  

I have an appointment with my Doctor this next week, but she sent me a note that I might try doubling up my methimazole to 5 mg for one day per week, and then continue with the 2.5 mg for the other 6 days, but as I read my 3/3/17 test results, my numbers are a little low, not high.  If the optimum for FT3 is 75% of the referance range then that number is 3.90 for my lab, and if the optimum for FT4 is in the top half of the reference range, the 50% point starts 1.32 for my lab, and so I think I should be taking a little less methimazole rather than a little more.  My doctor is very open to any input from me.  Does anyone have any advice?  Should I skip a dosage fo methimazole a day or two each week, or should I drop down to 1.25 mg every day or a few days each week?
6 Responses
Avatar universal
In trying to answer your question the most important consideration is symptoms, not just blood test results.   So please tell us about any symptoms you are having currently.  
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I haven't been feeling too bad but I am a little lazy, and I still have trouble sleeping soundly.
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Sounds like you are doing pretty well.  Your Free T4 and Free T3 are toward the hypo side, but people can have different levels at which they feel best because there are a lot of things that affect tissue thyroid effects.  By tissue thyroid effects I mean cellular thyroid hormone levels and how it is being metabolized to provide the energy needed for the body to function adequately.  So in view of your few symptoms and also lab results, there is no pressing need to change your dosage.  If you do decide to tweak the dosage at all, my opinion would be to skip a day and see how you feel with that for a few weeks.
Avatar universal
Thanks for your input. That was what I was thinking, skip a day per week, and recheck in a couple months, but I was curious what others thought. I did feel great in early January when my numbers are a little higher.
I agree with gimel. How you feel is a huge part of making any dose adjustments. I always felt better in the mid to upper range of the ft3 and ft4. There was a fine line for me though and I felt it. You will get to be VERY in tune with your body and know when something is off. You are wise to question your md and very fortunate to have found an md who listens to you and who is open to suggestions. So many people just do not know how much the thyroid regulates and how awful an imbalance can be. There are mds who are fixated on numbers. I also have Grave&#39;s. I was diagnosed in 2011.  I have been through the ups and downs many times. It had been a rough road but I thank God for this website--it really helped me--it saved my sanity and very possibly my life. I am happy to say that I have been in remission now for almost 1.5 yrs--that means no more anti-thyroid pills (I took the PTU because I was allergic to methimazole). So there is hope for you too. Gimel also helped me as I managed my Grave&#39;s...I am very thankful for him--it is nice to see that he is still helping others. His information was extremely helpful. So gimel...keep on making a difference:) And dolomed listen to your body and always keep learning about your Grave&#39;s. May you have healthier days in your future and may remission find you also.
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Good to hear from you that you are doing so much better.  Please keep us posted.
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