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Should I stop Methimazole over a high TSH?

I was diagnosed with Autoimmune Hyperthyroidism in Dec., 2006.  A relatively low dose of Methimazole was prescribed, along with Lisinopril, and Metoprolol.  I have been taking the same dosages for all those years, except my dosage for Methimazole was brought down to 1 and 1/2 pills (5 mg pills) about a year ago.

Throughout this time, I have experienced palpitations, leg spasms (only when sleeping), eczema, depression, and heat intolerance.  I have gone through many doctors and health professionals.

I am now 71.  2 days ago, I went to my latest health pro, a nurse practitioner, for prescription refills.  When I got there, my blood pressure was 175.  I was shocked at that, but our car had been hit from behind on the way to the clinic.  No damage to the car, but it really freaked me out.  The assistant took my BP again a few minutes later, but it was basically the same.  

When the nurse practitioner came in, she mentioned that the last time we did the lab work, my TSH was higher than usual.  Quite a bit.  She decided that we needed to do Thyroid Panel II, the quickie from LabCorp.  When it came back, the TSH was 5.600 (flagged HIGH)  uIU/mL   0.450 - 4.500.  She believes these results, along with the awful increase in my blood pressure were indicating that my Hyper had turned into Hypo.  She told me to stop taking Methimazole - cold turkey, and she wants to double my Lisinopril dosage, from 20 to 40 mg ...  

I know that you are supposed to get off of a drug like Methimazole slowly.  I didn't take my pill and a half of Methimazole this morning at 7 a.m.  Today, about an hour ago, I checked my BP, and it was 170. (It does fluctuate down to around 150, however)

Should I really double the Lisinopril?  Go cold turkey on the Methimazole?  I am seeing a new doctor next month.  I know you aren't doctors, but, I do not know what to do, and I do not want to end up at the ER on Christmas!  Please advise!
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649848 tn?1534633700
COMMUNITY LEADER
I've read of people getting off Methimazole all at once and doing okay, although many do have "withdrawal" symptoms (symptoms of being hyper) as their body purges the medication.  From what I've read, it can take a couple of weeks for those symptoms to go away.

Is TSH the only thyroid related test that was done?  What about Free T4 and Free T3?  Those are the actual thyroid hormones, with TSH being a pituitary hormone and not always indicative of what's actually going on.  If those tests (Free T4 and Free T3) were done, please post their results and corresponding reference ranges, since ranges vary from lab to lab and have to come from your own report.  That will let us see your actual status.

As you say, we aren't doctors, but I'm firm believer in not making too many changes at one time because if you run into trouble, you don't know which change is the culprit.   :-)  

You said your blood pressure was "175" and went to "150", but you didn't tell us the bottom numbers, which are as important as the top ones.  Do you monitor your blood pressure at home on a regular basis?  If so, does it ever go below 150?

I'm happy to hear you're getting a new doctor.  When, next month, is that appointment with the new doctor?  Do you have blood work scheduled prior to the appointment?  If so, do you know if thyroid blood work is included?  If so, be sure to insist they have Free T4 and Free T3 on the list of tests to be performed.

Without knowing actual hormone levels, it's like shooting in the dark.  
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Hi, Barb,

Yes, the entire thing is like shooting in the dark ...  The Nurse Practitioner   decided that we needed to do Thyroid Panel II, the quickie from LabCorp.  This test is "ancient", and it doesn't really reveal much.  That is why I didn't give all the results.  That is the reason for my question.  From this test alone, I need to go off Methimazole?  Because my TSH is so high, and my blood pressure is equally way too high?  And, all this just days before Christmas!

BTW, when I picked up my new prescription for Lisinopril, it was the same dosage. It's affecting me like it's a sugar pill instead of a medication.  My blood pressure is still way too high.

Anyway, here are the complete results of the thyroid test.

TSH                                   5.600    uIU/mL    0.450 - 4.500
Thyroxine  (T4)              7.1            ug/dL            4.5 - 12.0
T3 Uptake                       28                  %                 24 - 39
Free Thyroxine Index  2.0                                   1.2 - 4.9
Triiodothyronine (T3) 94             ng/dL             71 - 180

I had stopped taking my blood pressure at home.  My blood pressure wasn't ever that much of a problem.  Just a little high.  I am doing so from now on.  It is now averaging 170/90, pulse 46-55.

I know about the latest tests, and, from now on, I will demand those tests.  I am going to have to meet my new doctor before any new testing.  I've been through too many "duds" (nicest way I could put it) in the past to hook up with another one.

Thank you, Barb, for any input ...
Well, nothing like wasting money for an antiquated panel is there?  :-)  

But yes, even those antique tests indicate that you have hypothyroidism.  Both your Total T4 and Total T3 are very low in the ranges - 34% and 21%, respectively. Considering that most of each of those will be bound by proteins and unavailable for use you won't have very much Free of either.  

Free T4 is considered a storage hormone that must be converted to Free T3 in order to be used by individual cells, but there isn't enough there - that's why your TSH is increasing... You pituitary is trying to tell your thyroid to produce more hormones, but the Methimazole (anti-thyroid med) is preventing your thyroid from working.

Most of us feel best with Free T4 at about the mid range point and Free T3 in the upper half to upper third of the range.  I doubt yours would be near that.

What if any, symptoms do you have other than the blood pressure issue?

Typically, if a dose is doubled, as with the Lisinopril, the pills may be the same dosage, but instructions will say to take 2/day instead of just one.  Please check your new bottle and see if that's how the script is written.  They may want you to take one in the morning and one at night. I used to take Lisinopril 2.5 and that was my instructions (one in am and one at bedtime).  

All of that said - do make sure your new doctor tests the FREE T4 and FREE T3 when they do blood work, not the old thyroid panel.
As far as symptoms go, I have been gassy (for no reason), fatigued more than usual, depressed, short tempered,  and I'm either too cold or too hot.  It seems to me that I still am feeling more hyper, with some new symptoms, the worst being the high blood pressure, and the "gassiness".

I checked the Lisinopril early this morning, and, no, the instructions are the same old ones.  Once a day.  I am afraid to take two a day without some authority figure telling me that it's okay ...

I told my husband just last week - It has been precisely 13 years since I was  diagnosed Hyperthyroid.  Hmmm ...  13 ... And, now Hypothyroid.   :  (  

Thanks so much, Barb.  I truly appreciate you interpreting the panel for me.  I am trying to read everything on the internet on "How To Lower Your High Blood Pressure Naturally".
What many people don't realize is that there are quite a few symptoms that can apply to either/both hyper and hypo.  Stomach/digestive issues (gassy feeling/bloating), depression and fatigue are certainly hypo symptoms, but many people who are hyper have them as well.  Being short tempered can go along with being fatigued and/or depressed or not feeling well in general.  Cold intolerance is a typical hypo symptom, but I've always had periods of heat intolerance as well and I've not been hyper in the past 12 yrs.  

On the flip side, all of those symptoms can be present in someone who is hyper, as well.  

Because of your blood work, I'd lean toward you being hypo and would agree that you don't need all the Methimazole; I'm just not sold on stopping it cold turkey or doubling the Lisinopril, both at once.  I have a pretty fair idea of what I'd do if I were in your position, but since I'm not a doctor I can't tell you what to do.  

You didn't say when, next month, the appointment with the new doctor is.  Is it early in the month or later?  
As I see it, you have a few options:  
1) you could consider decreasing the Methimazole by the half pill (vs stopping cold turkey), then waiting to make any other changes until you see the new doctor.  
2) If everything looks normal (instructions, number of pills, etc) on the label of the Lisinopril, you could  consider calling the pharmacy and have them verify that the script was filled as written.  Pharmacies do make mistakes.   If they didn't give twice as many pills as they normally do and you started doubling up on them, you'd run out before time to refill the script again.
3) You could consider calling the NP to clarify her intentions since it seems that she really didn't follow through with what she said.  
4)  Simply do nothing and wait for the appointment with the new doctor.   There are, definitely, ways to reduce blood pressure naturally.  One is getting more exercise, like walking, yoga, etc.  Eating less sugar and other simple carbs, eat less sodium, lose weight if needed, if you smoke - stop, reduce stress, etc will all help contribute to lowering blood pressure.  

I hope this helps a little bit.
Saturday evening, I took my blood pressure, and the systolic reading was over 200.  I don't remember the rest of the reading.  We went to the ER. They took blood work and X-rays, and this went on for over 4 hours.  The doctor told me to take a Metoprolol once in the morning, then, around lunch time, take the 20 mg  Lisinopril, then, at dinner time, take another Metoprolol.  Other than that, he said that they didn't find anything, such as pneumonia.  

I did pretty well yesterday (Sunday).  My BP was averaging 152/96, pulse around 58.  I took the Metoprolol at 6:30 am, and again around 6:30 pm.  I took the Lisinopril in between.  Then, around 7:00, I became aware that my heart had begun racing, and I took my BP again.  It was 175/152  pulse 155.   The palpitations lasted less than 10 minutes, but it was horrible.  Usually, when I do have palpitations, they have lasted over 2 hours.

So now, I'm afraid to leave the house, even if it is Christmas.  I don't want my husband to leave the house, either.  

I will wait to answer your latest questions until after you read this latest update.  I am going to try and contact my NP right now to update her, and to ask about my prescriptions.  I hope they are open today ...
Metroprolol is a beta blocker that slows the heart rate.  What was your heart rate when you were at the hospital on Saturday?  

So last night you took the Metroprolol at 6:30 pm and at 7;00 your blood pressure was 175/152 with a heart rate of 155?  Did you recheck your after the palpitations stopped to see what your blood pressure and heart rate came down to?  

So let's back up... Prior to this happening on Saturday, had you gone ahead and stopped the Methimazole per the NP's instructions?

It's also important to note that rapid heart rate/palpitations, high blood pressure can also be present with hypothyroidism.  I had them when I was hypo and had to be put on atenolol, which is also a beta blocker, for a while.

It's also important to note that anxiety can cause them.  We can have anxiety, even when we don't "feel" particularly, anxious.

I understand your fear and don't disagree with the idea of getting hold of the NP.   They should be open today, but may be closed tomorrow and of course, I'm sure will be closed on Christmas Day.  If, at any time, you feel like you're in medical distress, do not hesitate to go back to the ER or call an ambulance.  
When I was in the ER, they hooked me up to the BP cuff, and it stayed there, turning off and on the entire time.  The screen reading the results was behind me, and I was in a bed.  I occasionally would ask my husband what the readings were.  They were always very high.  Twice, I got worried because my hand and arm were deep red from the tightness of the cuff.  Seemed like it got stuck or something.

Last night, after the palpitations finally stopped, I was so worn out that I just turned over in the bed, and went to sleep.  Yes, I should have checked it.

I hadn't had any Methimazole since Wednesday morning (before I went to the clinic).  I showed my husband what you said about taking a half pill, and we decided that I should.

OMG ... I did not know palpitations came along with Hypo.

I have an appointment with my NP in the morning.  I hope this all gets straightened out soon ...  Right now, my BP is 158/98,  pulse - 45
Okay I didn't know you had completely stopped the Methimazole, but I think you misread what I wrote.

You said originally that you'd been taking one and half 5 mg pills, my suggestion was that you consider decreasing by the half pill, which means you would still have been taking a whole pill.  This could have been a first step toward weaning off the Methimazole completely vs going cold turkey.

As I said previously quite a few symptoms can apply to both/ either hyper or hypo. That's why it's so important to have the Free T 4 and Free T3 tests.

If you stopped the medication on Wednesday, you could be having the withdrawal symptoms I mentioned in my first post. From what I've read those typically last a couple weeks. That leaves getting your blood pressure under control. You can try a combination of medication and the natural things I posted previously.  

It would be a good idea to ask the NP for the proper thyroid tests while you're at it unless you're just going to wait until you see your new doctor.
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