Is remission possible? - Question and Answer Forum - Elaine Moore Graves' Disease and Autoimmune Disease Education

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Tuesday, February 07, 2012

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Welcome to The Q&A with Elaine Moore. Registered members are invited to ask any question of Elaine Moore on autoimmune diseases, Graves' disease, other thyroid diseases and subconditions, laboratory work, traditional and complementary medicine, triggers and environmental influences, thyroid and immune disorders in pets and animals, and other relevant areas of inquiry.

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Questions are answered solely by Elaine Moore, a medical writer and clinical laboratory scientist, MT, CLS, with more than 30 years of experience in immunology. Moore has also authored and edited over a dozen books in the area of health sciences and is an editor for McFarland Publisher's Health Topics Series.

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Is remission possible?

9/2/2010 1:51 PM

SharieS

Joined: 9/2/2010

Posts: 2

Is remission possible?

Hi Elaine,

I have only posted once, when I was first diagnosed. I have done well on Methimazole for the past 18 months. My labs for FT4 and TSH were in the normal range for the past year on only 2.5 mg (down from the 30mg I started on).
I wanted to stay on a low dose forever, I felt good, but in the past 2 months I became very tired with a lot of hypo symptoms. My TSH is now 5.51 (range 0.30-5.50) and my Free T4 is 19 (range 11-22). I reduced my dose myself to 1.25mg until I could see my endo (have been on this dose for 3 weeks). My FT4 has always been in the upper range of normal.

I saw my endo yesterday, and he has taken me off my methimazole. He never mentioned remission to me, but mentioned block and replace therapy, or radioactive iodine if I should go hyper again. I told him that I didn't want to do either.
I am hoping for remission. My gp tested for antibodies for Hashimoto's and said that I didn't have that. I don't know what the numbers were or which antibodies they tested. From reading posts of others, is having the TSI and TRab numbers important if you are hoping for remission? My endo doesn't do labs other than the FT4 and TSH and Hematology panel.

Thank you for your help.

Sharie

9/7/2010 5:35 PM

Elaine

Joined: 8/1/2008

Posts: 3166

Re: Is remission possible?

Hi Sharie,

It looks like you're probably in remission based on your lab results done while you were on 2.5 mg of mmi. Usually, it's best to first get the dose down to 1.25 mg and then have labs. But if your TSH was 5.5 on a 2.5 mg dose it's likely that you'd still be secreting TSH normally on a 1.25 mg dose.

A TSI test can be helpful in cases where TSH is still low. In your case the elevated TSH suggests that you no longer have troublesome levels of TSI because TSI would be suppressing the TSH level if TSI were present. The only exception would be if the 2.5 mg dose was way too high for you and it was causing hypothyroidism. Since you mention FT4 not being too low, it doesn't sound like this is the case.

A study several years ago showed that the TSH level is a good indicator of remission because normally in Graves' disease TSI cause the suppression of TSH. With TSH being produced and secreted at a good rate with only a low ATD dose, presumably TSI production has dramatically stopped. If you were to relapse block and replace would be a good alternative but I think you're in true remission. best, elaine

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