Do I really need? - Question and Answer Forum - Elaine Moore Graves' Disease and Autoimmune Disease Education

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Wednesday, February 08, 2012

..:: Q & A ::..

THE Q & A

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.

Each thread represents one question with one answer and will only appear at the time it is answered. Once answered, further replies cannot be made to the same thread since each thread represents only one question. A new thread will need to be started for additional questions.

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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The Q & A with Elaine Moore

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7/22/2010 5:18 AM

Betty

Joined: 7/22/2010

Posts: 1

Do I really need?

Hello Elaine,

I was diagnosed with GD in May 2010. My doctor advised me to start Methimazole on 20 mg ( 10mg x 2 times/day).

After about 4 weeks the first blood test was done since starting medication, it showed some liver function problem.

My doctor suggested to stop medication. She says that liver function should be back within a week.

She now push me to have RAI asap.

Do I really need to rush to RAI? That is my only option? I don't have any options with lower dose of medication?

When I was diagnosed, I only had minor symptoms. Test result was TSH- 0.004 /Free T3-5.5 / Free T4-1.46

The lab test two days ago was TSH-0.003 / T3-2.3 / T4-0.77

Thank you for your site and your help.

Betty

7/22/2010 5:52 PM

Elaine

Joined: 8/1/2008

Posts: 3174

Re: Do I really need?

Hi Betty,

A dose, like yours, that's too high will cause abnormal liver function tests. Typically, unless the enzyme level is 5 times the high end of the reference range, the drug is continued. Lowering the dose will lower your enzyme levels. Your levels were only slightly elevated to start and a starting dose of 10 mg may have been more appropriate.

There's no need to have RAI. Based on your initial labs, your hyperthyroidism is mild and your liver enzyme levels should fall on a more appropriate dose of meds. You should be on the lowest dose needed to bring FT4 to at least mid-range. Many doctors wouldn't have started meds since only FT3 was elevated. Beta blockers are usually used in this case to reduce any symptoms and slow down the conversion of T4 into T3. ATDs, as you've seen, are too likely to move your FT4 into the hypothyroid range. Since we have roughly 8 times as much FT4 as FT3, our dose should always be based on the FT4 level. Best, Elaine

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