The Wellness Q&A with Elaine Moore

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TSH falling
Last Post 14 Jun 2024 07:59 PM by Elaine Moore. 1 Replies.
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eakallUser is Offline New Member New Member Posts:
10 Jun 2024 05:11 PM
    Hi Elaine,

    Checking in with you and hoping you are well. I seem to recall you have started some new treatments? I hope life is treating you well. I was diagnosed with Graves about 4 years and mine is subclinical. My TSH at diagnosis was 0.35 but within range FT3 and FT3 and positive TRAB and almost normal TSI. I've been well managed on low dose mmi @ 5 mg per day with visits and labs every 3 months. 5mg MMI was my starting does in 2020 and has been my only dose- until now.

    Fast forward to a November '23 visit where my TRAB almost doubled, FT3 and FT4 stayed the same but TSH kept dropping. Then 3 months later TSH dropped, again then 3 months after that dropped to 0.35 but again with in range thyroid numbers. I know this is still subclinical but I do get symptoms when my TSH is this level ( palp, feeling warm and bathroom urgency)

    My endo upped by MMI to 7.5 three days a week and 5 on all other days.

    One month after this TSH rose to 0.52 from that 0.35. I am awaiting a current level.

    SINCE 2017 up until a few months ago

    TSH has been 1.5 -1.9 from 2017 until now ( range 0.4-4.5) while on 5 mg MMI
    FT4 1.1-1.3 ( range 0.8-1.8
    FT3. 3-3.4 ( range 2.3-4.2)

    I am just trying to understand what happened? I know TRAB can lower TSH and since my TRAB nearly doubled it makes sense it would drop but I was cruising on that 5mg dose for almost 4 years with stable numbers. Would you expect the increased MMI do raise the TSH and then back off or is this roller coaster the nature of Graves?

    I know TSH shouldn't be treated but. rather FT3 and FT4 but since I am subclinical and those numbers have been stable it's really my dropping TSH that causes my hyper symptoms.

    All the best to you.

    Elaine MooreUser is Offline Veteran Member Veteran Member Posts:4084
    14 Jun 2024 07:59 PM
    The recommended range for TSH for the last 20 years is 0.3-3.0 although the newest recommendation is 0.3-2.5. Many labs are still using the old ranges because it's expensive to run a large sample of patients to change them. The idea is that competent endocrinologists will know what the recommended ranges are. That said you may not have had subclinical hyperthyroidism.
    TSH doesn't cause symptoms since it's a pituitary, not a thyroid hormone. Thyroid hormones, FT4 and FT3, do cause symptoms when levels are high or low. Your FT4 is on the low side and may be too low for your body's needs. When that happens your gland tries to fix the problem by increasing its activity, including increased production of thyroid antibodies. Thiis may be what's causing your symptoms.
    Your lab results don't suggest hyperthyroidism and I'm surprised you're still on MMI because this goes against treatment guidelines. I would ask your doctor about lowering your MMI dose and eventually weaning off of it. Best, Elaine
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