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

Answered by
Dr.
Dr. Rahul Tawde

General & Family Physician

Practicing since :1980

Answered : 1 Question

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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.
doctor
Answered by Dr. Rahul Tawde 2 hours later
Dear XXXXXXX,
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.
Shivaprasad
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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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 ?
doctor
Answered by Dr. Rahul Tawde 18 hours later
Dear XXXXXXX,
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.
Shivaprasad
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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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.

doctor
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.
Shivaprasad
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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