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  • Extremely high Free T3 and Free T4...treatment

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    Old 05-25-2011, 08:24 AM   #1
    lolo2010
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    Extremely high Free T3 and Free T4...treatment

    Hello,

    I had a baby 9 months ago. I am extremely healthy and active. Or I should say WAS active. I was back to running about 2 weeks after giving birth and felt great for several months. In April, I started feeling extreme fatigue while running, but otherwise felt fine. I ran a marathon in early May, but felt awful the entire time. So I went to my doctor, who took blood tests and immediatly referred me to an Endo, based on results of those tests.

    My lab results as of yesterday:

    Free T4 - 5
    Free T3 - 12.85
    TSH - .01

    TSI - 3.9
    TSH receptor AB - 2.31


    Prior to getting these latest lab results, my Endo wanted me to do the Uptake Scan to determine whether this is Graves or Post Partum Thyroiditis, and it was actually scheduled for later this week. However, once she got these latest lab results, she said the scan would be too risky because my levels have risen so much and that I need to start on medication ASAP. So as of last night, I started on 10MG Methimazole twice a day and also 10 MG Propranolol every 6 hours.

    Does anyone have any insight regarding this treatment? Or regarding if I have Graves or Post Partum Thyroiditis? THANK YOU!!!!

     
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    Old 05-25-2011, 11:41 AM   #2
    sammy64
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    Re: Extremely high Free T3 and Free T4...treatment

    Congrats on the birth of your baby!

    I have lots of info to share with you but, we really need to see the reference ranges for your lab results - they vary from lab to lab and it's important to see how your results relate to the ranges.

    Glad you didn't get the scan - if those TSI/TSH receptor AB results are positive, you have Graves' disease (some doctors say they need the scan to confirm Graves' but, the antibody tests are much more accurate and don't expose the patient to unnecessary radiation).
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    Last edited by sammy64; 05-25-2011 at 11:44 AM.

     
    Old 05-25-2011, 11:47 AM   #3
    lolo2010
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    Re: Extremely high Free T3 and Free T4...treatment

    Ok, here are my results with ranges.....

    Free T4 - 5 (.89-1.76)
    Free T3 - 12.85 (2.3-4.2)
    TSH - .01 (.35-5.5)

    TSI - 3.9 (<=1.3)
    TSH receptor AB - 2.31 (<=1.75)

    Wow, as you can see I'm well out of every single range...yikes! Looking forward to any insight you have. And if it is Graves, will I be able to get running again soon if the meds work? Thanks.

     
    Old 05-25-2011, 12:04 PM   #4
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    Re: Extremely high Free T3 and Free T4...treatment

    OK....without a doubt, you have Graves' - the positive TSI and TSH Receptor antibody tests confirm this. You do not need a scan.

    You will be able to resume your normal levels of exercise once both your FreeT4 and FreeT3 levels get into range.

    Those are your thyroid hormone levels and the levels that should be used for dosing purposes. Since we have like 8x the amount of T4 vs. T3, dosing is based upon the FreeT4 level - not the TSH level.

    Your TSH level is being affected by the TSI antibodies which mimic the actions of TSH and stimulate the thyroid to produce hormone. You can expect your TSH level to be suppressed for a long time.

    A patient that is being medicated properly will take the lowest possible dose of methimazole that is needed to keep the FreeT4 level in the upper half of the range, regardless of TSH.

    You should start feeling better within a week and, within 6-8 wks., your FreeT4/T3 levels should be back in-range.

    At that point, you can expect a substantial dose reduction.

    You see, your starting dose is much higher to virtually suppress thyroid hormone production. This allows your body to use up all the hormones stored in your thyroid but not used by your body as you were developing hyperthyroidism.

    Once that happens, you need to take a dose to maintain that FreeT4 level in the upper half of the range.

    As you heal from Graves', you will require decreasingly lower doses until you are taking 1.25mg.....

    If proper FreeT4 levels are maintained and TSH starts to "show", that is a sign that remission is imminent.

    Hopefully, your doctor is planning on you getting labs in 6-8 wks. from when you started methimazole. Then, moving forward from there, you need labs every 4 wks. tops.

    Methimazole is a very effective med and you certainly don't want to risk going hypo by taking too high of a dose for too long.

    Many people achieve remission after 12-18 months on meds. Studies have shown that the longest remissions occur after being on meds for 4 years. By this time, there's a good chance that even the smallest dose of methimazole will make the patient hypo. If that happens, knowledgeable doctors will add some thyroid hormone replacement med to keep the FreeT4 level where it needs to be.

    That was a crash course - lol

    As you will note from my signature, I am in remission from Graves'. I did go hypo last year which can happen to 20% of Graves' patients after remission. I've been researching Graves'/thyroid disease and participating on several thyroid forums since my Dx in 2007 - if you have any questions, please feel free to ask.

    My former doctors weren't too informative and often overmedicated me. I will do whatever I can to help prevent that from happening to others.
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    Last edited by sammy64; 05-25-2011 at 12:06 PM.

     
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    Old 05-25-2011, 12:12 PM   #5
    lolo2010
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    Re: Extremely high Free T3 and Free T4...treatment

    Oh wow, THANK YOU! This is so helpful! I actually have a follow-up with my Endo. in two weeks, and will have blood drawn then. I guess we'll see if the numbers are moving in the right direction at least. One more question, I am 34 years old....my husband and I were planning to have another baby soon. I understand that should be put on hold....but how long do we have to wait?

     
    Old 05-25-2011, 12:19 PM   #6
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    Re: Extremely high Free T3 and Free T4...treatment

    Very happy to hear that you have a follow-up in two weeks.

    It's safe to conceive once you're stabilized on a low dose - 10 mg. or less.

    Since methimazole has been associated with birth defects, doctors often switch the patient over to PTU for the first trimester and will resume methimazole for the last two trimesters.

    Pregnant patients often find themselve needing much, much lower doses as they advance through pregnancy and some patients go into remission by the end of the pregnancy (although it's common to relapse after the birth, due to all the hormonal changes).

    In fact, there's a chance your previous pregnancy triggered Graves' - it's very common.

    Please know that, should you go into remission and then relapse, achieving a second remission is entirely possible and it usually occurs much faster than the first remission.

    I hope your doctor told you to avoid iodine (shellfish, iodized salt - including that in processed/fast foods) since it interferes with thyroid function. Another big thyroid "no-no" is soy.
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    Old 05-26-2011, 05:46 PM   #7
    brianna240
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    Re: Extremely high Free T3 and Free T4...treatment

    I can totally relate to your situation! I started having hyper symptoms when my baby was 10 1/2 months old. I was diagnosed shortly after that with Graves. I hope you get well soon I am on 30 mg a day of methimazole and 25 mg of atenolol 2 times daily, it helps alot!! THe first endo I saw dropped my anti-thyroid dose down before my levels were within range, so thats why I am back at square one with i high dose of methiamzole. I get my labs done June 15, hopefully by then they will be able to lower the dosages! Make sure you have a good endo and primary care dr. too
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    free t3, free t4, graves disease, hyperthyroid, post partum thyroiditis



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