Elaine -- confused, please comment

October 7, 2003

Hi Elaine,

I have a complicated question. I keep running into endos that insist on

medicating according to the TSH. I am on a very low dose of ATD (12.5mg PTU

per day), and my FT3 and FT4 are probably in the normal range (I just

adjusted down from 25mg PTU as FT4 was .8, with a low TSH). I feel

euthyroid (absence of symptoms other than cold hands), and will get labs

done in 2 weeks.

When I was on a high dose of PTU (200mg/day), my TSH did rise from .01 to

5.27, but then fell sharply as my dose was rapidly decreased. (I have a

mild case.)

I just e-mailed a doctor who treats most of his patients with ATDs to see

if he will treat me, given that my current endo goes by TSH. He replied

that he also only goes by TSH. I then asked him if he would medicate me

according to FT3 and FT4, as I was experiencing hypothyroid symptoms on a

higher dose of PTU. I said the TSH is suppressed due to the presence of

TSI. He wrote back: " Sounds to me like you are the MD and that you

don't need me. You are suggesting remaining hyperthyroid which is how you

feel best right now. But you have to adjust to normality. " What does this

mean? Am I crazy? My question is why does he say this to me -- is it that

we need to force the TSH up and then FT3 and FT4 will rise, or will I just

be kept hypO (with a constant low FT3 and FT4)? I never let myself stay

hypO long enough to find out if the FT3 and FT4 will rise. I am not eager

to lose more hair :-(

Also, will I be able to reach remission if I stay on 12.5mg per day? I am

under the assumption that GD remits spontaneously, tho the ATD can help to

suppress antibody production.

Thank you,

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