Hello again Elaine

Sorry about all the questions lately. You have been my guiding light throughout my Graves' journey and I think I'm getting close to finetuning what needs to be done for me to consistently feel well while having Graves' disease.

As you may recall, 5 months after entering remission from Graves', I developed a significant number of hypo symptoms, my FT4 was1.2 (.82-1.77) and my doctor started me on 25mcg levothyroxine.

My levels were checked after 5 wks. on this dose - FT4 came in at 1.69 yet I wasn't feeling 100%.

Within a week later, though, all of my symptoms had resolved and I felt like a millian bucks.

My doctor checked my levels 5 weeks later - FT4 was 1.61 and I was still feeling great so she kept my dose at 25mcg and told me to lab/see her again in 8 wks.

Within 3 weeks of that appointment, though, I started to feel fatigue and, after 2 more weeks, my symptoms had increased in number and severity so much so that I went into see my doctor earlier than planned. FT4 had dropped to 1.45 so she increased my dose to 37.5mcg.

I have been on the new dose for only 2 weeks and am not surprised that I don't feel better yet since it took 6 weeks after first starting levo to feel better.

I would like to manage my thyroid health such that situations like this do not repeat themselves. I was thinking of asking my doctor to resume labbing every 4 weeks as she did when I first went off MMI.

I was also thinking of asking her to increase my dose a tiny bit if my FT4 shows a decrease and before symptoms develop - do you think this is a reasonable idea?

Somewhere along the line, I thought I read a statement from you saying that a .3 variation in FT4 is considered normal yet that is obviously not the case for me.

I've already told my doctor that I'd like to try to maintain my FT4 at 1.6 (and now I'm thinking that would be the absolute minimum)

I'm beginning to think that, when my FT4 dropped to 1.61, I should have asked for a tiny dose increase (like instead of taking 25mcg daily, alternate 25mcg with 37.5mcg).

Would you please provide some guidance as to what could be done to maintain my best FT4 level?

Thanks for everything!

All the best,

Carol