How Long Does Medication Take to start Working

[wkingmom]

I had my thyroid tested 7/20/2015

Lab results:

TSH             My value 0.533   (Standard Range 0.358- 3.74)  
T4 FREE     My value 0.72     (Standard Range 0.76 -1.46)
T3FREE      My value 2.6       (Standard Range 2.3-4.2)

My Symptoms:
Weight loss of 15 lbs in the past year
Fatigue - 18+ years
Always cold - 18+ years
Sleep for 8 hours but feel like I haven’t slept at all - 18+ years
Shortness of breath - 1 yr
Heart palpitations - 1 yr
Depression - don't know how long
Poor memory/concentration - 1yr

First doctor I went to told me my lab results were "normal".  I went to a different doctor and showed him the lab results.  He ordered a few more tests, he had me tested for TPOab which came back negative.  Then he had me go get a scan of my thyroid.  The scan showed that a part of my thyroid is overactive, basically I have a "hot" nodule.

He prescribed me methimazole 10 mg and says to check back with him in four weeks.  He says if the medication does not help then we will need to consider radioactive iodine treatment or surgery to remove the nodule, but he wants to try medication first.

About how long does it take for medication to start working?  Should I notice a difference after four weeks or should I give it a longer time period?

Also, what do you say to people that don't take your condition seriously?  I have a very good friend that noticed how much weight I have been losing.  But when I told him that it's because of my thyroid, he was very dismissive.  He said he thinks thyroid problems are the newest "fad diagnosis".  I told him I think depression is the fad diagnosis, that a lot of people are being told they're depressed when they actually probably have problems with their thyroid.  When I told him I'm tired all the time he said "everyone gets tired".  

My boyfriend said a lot of the same things, that "everyone gets tired" and that "everyone forgets things".  Fortunately he now understands what I'm going through and doesn't make those comments anymore.  

But I don't understand why people are so dismissive of health issues.  Do they think telling me I'm like everyone else makes me feel better?  Or that I shouldn't worry?  Why do they think say things like this?

[wkingmom]

Thanks, will do!

[Barb135]

I'm to hear that you nearly passed out in the shower, but glad to hear that you're stopping the methimazole... I suspected the endo was looking too closely at the TSH and closely enough at the FT3 and FT4 or your symptoms.

It's good that your new doctor is willing to look into the secondary hypothyroidism... I think your "so called" hyper nodule, has burned itself out, if it was ever really hyper to start with... At least, you'll get all the med out of your system, get new labs and start over... a new beginning.  

Make sure you keep us posted.

[wkingmom]

I don't have access to the files right now because I'm at home, but I don't think they did a Free T4.

And it looks like you were right about the methimazole.  I got so sick this morning, I almost passed out in the shower.  I've been dizzy, nauseous and faint all day.  This afternoon I started throwing up.

But I did manage to keep my appointment that I had today with the new doctor that I mentioned.  She is a holistic doctor, and she explained that some people are sensitive to methimazole and recommended I stop taking it.  She didn't have to tell me twice, it's obviously making me feel worse, like ya'll said it would.

I am NOT going back to the endo dr that prescribed this medication, I was already having second thoughts about him, he put a lot of stock into the TSH and not enough into my symptoms.

I did ask the holistic Dr about secondary thyroidism like ya'll said.  She said that could be a possibility.  She said even though I have a hyper nodule, she didn't think it was necessary to treat it with medication.  Right now she wants to detoxify me, reduce the inflammation and then get to the root cause of my symptoms.  She wants me stop taking the methimazole and then come back in two weeks for blood tests.

Overall, I was very happy with her approach, everything she said made sense and she listened to all my complaints.  I will be going back to see her.  

[Barb135]

Thyroid problems often tend to run in families.  

Unfortunately, Total T3 is an obsolete test, but yes, since your Total T3 was over the reference range in 2004, it's entirely possible that you could have been hyper, then.  Did you have a Free T4 done at that time? If so, what was it, with reference range?

There are 2 antibody tests for Hashimoto's... those are the TPOab and TgAb... If your doctor only did the TPOab, but not the TgAb, you could still have Hashimoto's and missed the diagnosis... It's not unusual for someone with Hashimoto's to have periods of hyper and normal alternating with periods of hypo in the early stages, ultimately ending up permanently hypo.  What is unusual is for one's TSH to be as low as yours is, when one has primary hypothyroidism, which is why, both goolarra and I suggested secondary hypothyroidism...

Primary hypothyroidism is when the thyroid, itself, fails; secondary hypothyroidism is when there is a lack of pituitary stimulation to get the thyroid to work.

The TSI test is the definitive test to determine whether or not a person has Graves Disease.  Graves Disease is "always" associated with hyperthyroidism.  It's possible for one to have both Hashimoto's and Graves, with one or the other being dominant at a given time.  It wouldn't hurt to have this test, as well as the TgAb, just to make sure the bases are all covered, but I still think you have pituitary involvement.

[wkingmom]

Thanks Barb, I will. I was talking to my dad about all this and he told me that his mother had problems with her thyroid, but didn't know much details. All he knows is that she had a goiter that had to be monitored, and this was when she was in her 20's.  I never knew this before and will tell the doctor about this family history.  

I was looking up my old medical records, and I did find a note from a doctor back in 2004 who wrote that my T3 was slightly elevated.
Total T3 was 203 - Standard Range 60-181
and my TSH was 1.02 - Standard Range .47-4.68

I've been suffering with these problems for almost 18 years now, they started with my first pregnancy.  Is it possible I could have been hyper, then over the years turned hypo?

Another question - the previous doctor did test me for TPOab - thyroid peroxidase antibodies.  He said that came back negative.

But there are a couple of other tests he did not do.  There's the TGab - thyroglobulin antibody and then I think there's another test TSI.

I read before somewhere on this forum that TGab is a good indicator of Grave's disease?  Do I have that right?

[Barb135]

Good idea to get another opinion... don't wait for the next doctor to suggest secondary hypothyroidism... tell them that's what you suspect.  

[goolarra]

Yours is a different case because you are taking both T3 and T4.  Your TSH is low (suppressed) because that often happens when you take T3.  But, you're right, it would be the low FT3 that's giving you the hypo symptoms.  As I pointed out in your thread, FT4 is quite high at 78% of range.  So, apparently, you do not convert well (many of us don't).  Typically, once medicated for hypo, FT4 should be about 50% of range, and FT3 should be in the upper half of range.  Also, if you convert well, FT3 should be a higher percentage of range than FT4 is of its range.  Your FT3 is a lot lower than your FT4, which indicates you might need to increase your T3 dose (and decrease T4).

[guerrak2]

what about low TSH (.11), low FT3 (2.4), and High FT4 (1.57)? Is this hypo because of low FT3?
Thanks!

[wkingmom]

Thanks Barb and Goolarra for that info.

I am going to seek a second opinion.  Actually, this will be a third opinion.  Hopefully it's a charm.

[goolarra]

Typical labs:

                    TSH      FT3      FT4
hypo            high       low       low
hyper           low        high      high
secondary    low        low       low

[Barb135]

No, you're misunderstanding... If FT4 and FT3 are low, you're hypo, not hyper.  If you were hyper, your FT4 and FT3 would be high, not low...

Typically, when you're hypo, TSH is high, but it looks like you might have pituitary involvement that's keeping yours low, which makes a lot of people (even doctors) think you're hyper, but you have to look at FT3 and FT4, not just TSH...  

Your FT4 is below range and your FT3 is in the toilet, making you hypo, not hyper...

You might suggest to your doctor that you could have Secondary Hypothyroidism...

[wkingmom]

Hey Barb, you're not the first person to say I'm hypo, not hyper.  I'm really confused and don't know what to think.  From what I understand, if your TSH, F4 and F3 are low, that means you're hyperthyroid.

I know I have a lot of hypo symptoms, but I also have hyper symptoms, such as anxiety, shaky hands and muscle weakness.

[Barb135]

If one is "really" hyperthyroid, one does run the risk of thyroid storm; however, in this case, with the labs presented above, there is absolutely NO chance of thyroid storm.

I'd have to wonder if there could, however, be a chance of myxedema coma from too little thyroid hormones by giving someone methimazole when they don't need it. Myxedema coma is another life threatening condition that can, also, be fatal...

[Totie]

You leave over an over active thyroid-hyperthyroidism-graves disease UNTREATED and you will have THYROID STORMS...

I had two of them...,NOT fun at all and can be fatal...

[Barb135]

I've read your question several times and I'm still trying to figure out why your doctor is giving you methimazole when you have hypothyroidism...

Your Free T4 is below the reference range and your Free T3 is almost on the floor of the range.  Additionally, all of your symptoms are those of being hypo, with the exception of the weight loss and there are even people who do lose weight when they are hypo...

Even if part of your thyroid is "overactive", it's not overactive enough to warrant an anti-thyroid medication like methimazole.

In answer to your question, I'm sure you will see a difference in the way you feel in a month(probably much sooner), because you're going to feel a whole lot worse than you do now.  Anti-thyroid med(s) prevent your thyroid from producing thyroid hormones; yours is already not producing enough, so it will soon be producing even less.  

The best advice I can give you is to find a different doctor very quickly because this one is going to make you a whole lot more ill than you already are.

As to people not taking your condition seriously; it's hard to come up with a response, because most people don't really understand thyroid conditions.  In most cases, it's a matter of taking a daily pill to get hormone levels where they need to be and people go their merry way.  We don't "look" sick, so we can't really "be" sick, right?  

And it's true - everyone "does" get tired; that's a normal part of life, but when your thyroid levels are where they need to be, you won't be so tired all the time, either.  Sleep will be restorative like it is for "normal" people.

For most people, it's a matter of whether you have something they can "see" or not... If you have a broken leg, you're going to have a cast and probably crutches or, at least, a limp, so everyone will race to open doors for you; if you have cancer, chances are, you will have lost your hair because of chemo, so people will know you've fought a tough fight, but many other illnesses don't leave outside marks... We "are" like everyone else, only we fight a fight that no one can see and if we persevere, we win...