Posted 6/27/2014 7:56 AM (GMT -8)
How long have you been on methimazole?
From what I've seen, my personal experience and what I've learned over the years, is that there is a treatment protocol for ATDs. And that many doctors don't treat their patients optimally.
Methimazole should NOT be taken all at once. I started off on 30 mg. too. It's best to take at 2 or even 3 fairly evenly spaced intervals throughout the day. (PTU has a shorter half life so must be taken in 3 intervals.)
You should be tested after 4 weeks. Many patients should have their doses halved at this point. Don't go more than 6 weeks between testing. After that first dose reduction, dose reductions are likely to be smaller, like 2.5 mg. (Methimazole comes in 5 mg. pills for easy splitting.) A patient may stay on a dose for a few rounds of bloodwork. Sometimes patients will flirt with hypO but if a patient goes hypo, or stays hypo, that means it's likely the doctor is going by TSH, or keeping a patient on too high a dose for too long.
Doctors should NOT go by TSH alone. TSH stays suppressed well into treatment. Once the TSH is starting to move, the patient may be heading toward remission but should NOT stop meds, not until stable on a low dose. Some doctors say that any dose lower than 10 mg. is ineffective which is bad medicine. A patient can rebound if stopped at such a potent dose. This is where the gradual reductions and maintenance doses come in - it's good to stay at a low dose like 5 or 2.5, if the bloodwork is fairly stable at that point, and stop at one of the lower doses.
I hope I'm not violating the medical advice injunction, but it's really, really important that patients have a handle on how ATDs are best prescribed.