The Wellness Q&A with Elaine Moore

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Finally normal T3 & T4, but TSH dropped!
Last Post 07 Oct 2018 04:45 PM by Elaine Moore. 1 Replies.
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LowflyerUser is Offline New Member New Member Posts:
07 Oct 2018 09:49 AM
    Hi Elaine:

    I have posted before, but it’s been several years. Anyway, here is what’s going on. I’m not sure I like my endo’s recommendation, but I would like your opinion before decking what course of action to take.

    I was diagnosed with Graves in Jan of 2016. T levels were off the charts! I had the shakes, palpitations, sweats, weight loss, etc. I was properly diagnosed and put on methimazole 10mg and Atenolol. Slowly my levels subsided. I went off of Atenolol about a year later when my T levels and TSH finally returned to normal. I was at a daily dose of 5mg of Methimazole which was keeping my levels in check. In April of this year 2018, my endo wanted to ween me off of the methimazole. Therefore, I started alternating my doses on and off until I went cold turkey 30 days later. After I stopped, I didn’t have any old symptoms. I thought things were fine. My next labs a month later showed my T levels still normal, but TSH spiked sharply downward. Me endo wanted me to go back on 5mg of Methimazole. I said, “no” let’s wait longer to see how it goes since my T levels were fine. My latest labs from 9-21 show T levels still normal but TSH went further down. I feel fine, but I’m concerned about the TSH.

    Here is a summary of my last 4 labs:


    9-21. 1.39ng/dL (0.76-1.46)
    6-8. 1.13
    2-8. 1.02
    11-8. 1.00


    9-21. 129.58ng/dL (60.00-181.00)
    6-8. 118.58
    2-8. 115.94
    11-8. 94.87


    9-21. <0.005mcIU/ml (0.360-3.74)
    6-8. 0.048
    2-8. 0.672 normal
    11-9. 0.504 normal

    What would cause a TSH drop after finally returning to all normal levels on Methimazole? After almost 5 months my T levels are still normal, although slight increase. Should I get back on Methimazole? I responded well to it.

    Also, I did have very small module. No changes in size. My endo now wants an uptake scan. I feel that’s unnecessary and I’m not subjecting myself to any radiation.

    Thank you again for all your help with this condition! It’s unfortunate that endo’s aren’t as educated about this.

    Elaine MooreUser is Offline Veteran Member Veteran Member Posts:2937
    07 Oct 2018 04:45 PM
    Hi John,
    You don't want an uptake scan especially if there's no change in size. An ultrasound is a better option.

    You should never stop meds unless you're down to a dose of 1.25 mg MMI daily or every other day with normal labs after 8 weeks on this dose. Stopping from a 5 mg dose isn't a good idea. Doses as low as 0.5 mg daily are effective and the idea here is to gauge how your thyroid function is after 8 weeks on a minimal dose. If TSH has been low and remission is questionable, a TSI blood test would help.
    Sounds as though you weren't given this opportunity and are starting to relapse due to poor management of your medications. However, since you're not overtly hyperthyroid yet, you could wait to start meds or start with a lower dose like 2.5 mg daily. Best to you, elaine
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