Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties

128 Doctors Online
Doctor Image
Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

Hyperthyroid. Variation in TSh level according to dose of methimazole. Diet plan and alternate medicine?

Answered by
Dr. Rahul Tawde

General & Family Physician

Practicing since :1980

Answered : 1 Question

Posted on Tue, 5 Feb 2013 in Thyroid Problem and Hormonal Problems
Question: My FT4 and other thyroid hormones is always under normal limits since i diagosed hyperthyroid , - only and only TSH is oscillating up and down depding upon the dose of methimazole i am taking.

When TSH is low i usually start methimzole and when it is above 7.0 I usually stop methimzole. And keep on. So it is oscillaing up and down.

But my symptoms are different altogeter like hypos all the time.

1.Pulse rate almost less than 70 ppm
2.Cold irtolerance ( feeling cold in temp less than 32 ° C)
3.Body Wight is almost stable not decresing so much

I observed few side effects of methimazole ( which is also reported everywhere) as follows.

1.Mild decrese in platelet counts
2.Significant decrese in Neutrophiles counts and thereby compensatory rise in Lemphocytes counts.
3.Increse in LDL and total cholesterol ( may be due to decresed metabolism with methimazole etc.)
4.Some times it may raise SGPT .
5.Anxiety and White coat hypertension

Can I really have Hyperthyroid [ Auto immune Graves Thyrotoxicosis ] if it is only variation in TSH and other hormones are normal.

Is It any other way to keep TSH stable because the methimzaole has much side effects as above and even through TSH is ocillating up and down based on dose.

What could be the diet plan for kind of conditions.

Is there any herbal or alternate medicins to minimize the dose of Methimzaole.

Plz. Advise.
Answered by Dr. Rahul Tawde 2 hours later
Thanks for writing in. Im afraid its not TSH but levels of Thyroid hormones T3 and T4 which matter more in deciding dose of methimez. I feel you are trying to treat the condition yourself which may not be a wise decision. Frankly its not that easy. Once TSH gets above normal its better to lower methimez dose than stop it all together. This abrupt cessation is responsible for fluctuating TSH & more importantly thyroid status from hypo to hyper and viceversa. Based on the available information it appears that you have autoimmune hyperthyroidisn or graves disease but more information regarding TSH receptor antibody and Tc 99m scan are reqd to confirm. There is nothing specific in diet and I wouldnt advocate herbal or alternate forms of treatment for this condition. My sincere advice is to XXXXXXX an endocrinologist and discuss deifinitive therapy for the condition like radioiodine or surgery. Hope this helps.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Rahul Tawde 23 minutes later
Dear Sir,

Thank you for your kind response.

I would like to inform you that I am under the supervision of an Endocrinologist, since I first diagnosed.

The dose of my methimazole do chang by him based on my FT4 and TSH reports done every two months. I am not deciding any dose myself.

I already had undergone " radio active iodine uptake test" which was normal in all respects. Is Tc99m scan is different than that.

Till now I have not undergone TSH receptor antibody that I will plan in my next lab visit.

I would like to ask that -

Is it what kind of sitution that where FT4 and other thyroid horemones are normal but TSH only is fluctuating or low ?
Answered by Dr. Rahul Tawde 18 hours later
Technitium 99m scan is different from radio iodine uptake test. It will provide information on the pattern of uptake. TSH can vary even when T3 T4 are normal in many situations. This is because TSH is a very sensitive marker of thyroid status and its in inverse log linear relation with T3 T4. This means a small change in T3 or T4 result in 10 fold higher changes in TSH. So we appreciate only changes in TSH. in patients with long standing graves disease TSH may remain suppressed for upto one year even after T3 T4 have come to normal and remained there. So we dont give much significance to TSH during follow up of graves disease patients.
Hope this helps.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Rahul Tawde 8 hours later
Dear Sir,

Thank you for your kind response and technical understanding on it.

The objective to connect in this forum is to clear the quaries related to treatment which gernrally not satisfied by my physian in OPD.

I am attaching my thyroid scan report ( hopefully - it is Tc99m mentioned on top) please review and provide your feed back on it.

As per your advise i am planning for TSH Receptor Ab. in my next lab visit.

as now, recent TSH is 10.83 and FT4 is 0.9 in latest report while on Rx methimz 5 mg od, my endocrane has just stopped it atlest for next 2 months till new lab reports.

Answered by Dr. Rahul Tawde 58 minutes later
Scan is similar to Tc 99m scan and is showing diffuse uptake thats consistent with graves. I would prefer the dose to be reduced to 2.5 mg/d and then repeat after 4 -6 weeks. If TSH then is above normal or in upper half of normal range I would stop it.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,   ,   ,  
Drug/Medication ,  
Medical Topics ,   ,  

Recent questions on  Thyroid disease

doctor1 MD

Hi, I have had a fluttery feeling in my throat off and on for a couple of weeks and /or palpitations.Also a sensation that there is something in there or in my upper chest. Heart rate is regular, no other symptoms. I am hypothyroid for many years. It is not severe, just bothers me and I worry what it is.

doctor1 MD

hi,i went through total thyroidectomy 3 months heart is beating hard and i feel like i will have a heart tsh level is normal..i take 125 mg of thyroxine daily..also i am 20 years old..why is my heart beating like i will get a heart attack?

doctor1 MD

My mother is 89 and on hospice care for advanced A.D. she has developed, over past year, an indentation on the top of her skull running left to right about three inches back from the front of the scalp. She has several large nodules on her thyroid, but her endocrinologist declined to pursue with needle biopsy or surgery due to her age and advanced disease, A.D. what do you think could be the cause of the changes in the top of her skull, indentation. She also has had significant loss in brain mass in past 12 years per MRI studies ren years apart.

doctor1 MD

My psychiatrist added 25 mcg of liothyronine, I started taking it Thursday 3-19, to be increased to 50 mcg after one week to augment my depression that has been resistent to other antidepressants. I don t have enough energy to leave the sofa. I also have panic disorder. I have gained about 35 lbs. in about nine months. I m nervous after reading some of the reviews. Should I be. How long can I safely take this medication. Will my thyroid stop producing the harmone naturally if I stay on this medication? When I come off will my thyroid be normal? I have very high hopes that this will increase my metabolism and give me the energy I m lacking and aid in my depression. Thank you

doctor1 MD

Hi. A few days ago I started experiencing heart palpitations. I feel my heart fluttering in my chest and throat. It doesn't happen when I am moving around. It starts when I sit down, upright on the couch or in a chair. It stops when I lie down or...

doctor1 MD

I recently got AMA - Anti Microsomal Antibody test done. The range was supposed to be 34 as Positive. My reading showed a Value of 91. The lab person said this is very high. Can you plz let me know If I need to get any further tests done to know...

doctor1 MD

Thank you. About three weeks ago, I noticed a slight redness of skin at throat area. It waned and is now back on all over the front of my neck. The skin seems puffed and is very red. No small or large bumps on skin. My throat is mildly sore.