Drifting towards Hypo after Hyper?

http://labtestsonline.org/understanding/analytes/thyroid-panel/start/

How are you feeling on this amount of Carbimazole and Acetyl-L-Carnitine? Your T4 is right in the middle of the range right where you would want it to be and I will bet your T3 is also there. What I found for myself is that you have to be very careful and lower your dosages and adjust quite often. 1,500 mg of Acetyl is quite high which is good to start with because your values were so high and TSH so low but my experience was that even after I lowered my dose of Acetyl my TSH kept climbing and my T3 and T4 dropped to the lower part of the normal range on 5 mg of Tapazole. Others on the Board had similar results as you in one month but when you keep taking that high a dose, the Carbimazole is very sensitive to the Acetyl and even when I lowered my dose to 225 mg of Acetyl it was difficult to keep my results where I wanted them. So I would recommend that you lower your dose of Acetyl to 500 mg and when you see your Endo next week, ask him if you can lower your dose of Carbimazole and keep taking blood tests at least monthly and adjusting. If was difficult for me to find Acetyl in 225 mg capsules but I did. However, I would not go higher. Your TSH will continue to rise with the both combined even with a low dose of both Acetyl and Carbimazole. My T3 and T4 were in the middle of the range when I started and my TSH was 0.12. Eventhough I lowered my dose to 500 mg my TSH kept climbing and eventually the T3 and T4 lowered. So it is a balancing act for sure but you have to keep on top of it. If you have to, you can even stop the Acetyl or switch to regular L-Carnitine. The Regular L-Carnitine will not boost the TSH as much (like mine went from less than 0.01 to 0.05 and did not rise further even on a high dose of Regular). By keeping the Acetyl low and adjusting the other or even discontinuing the Carnitines altogether when your values are where you want them OR by switching to regular L-Carnitine I think you will find you will be where you want with your values. The fact that your T4 dropped from 64.8 to the middle of the normal range would not have happend if you were on Carbimazole alone. At least that is what I am seeing with others and your TSH would not have risen in the slightest. But you need to keep on top of it. I wish the docs would do clinical research with this but the FDA in America does not want them to as they would lose a substantial amount of money if they did. So we have to be our own guinea pigs and find out what works best for us. If at any time, you do not like how you feel on the Acetyl or you feel your results are going out of the range you want, you can safely stop it immediately. Thank you for the update and keep us in touch with what is happening with you. Your postings will help others. Oh and I have a feeling if you stay on this course, you will find your antibodies disappearing also.

I am in the US where Tapazole/Methimazole (generic) (MMI) is usually prescribed instead of Carbimazole (CBM).  The CBM is a precurser to MMI so CBM is slower acting and probably slower leaving the system, and MMI takes about 2 months to leave the body.

See what your Endo says.  I would think he would decrease the CBM to 40mg.  Do you take 5 mg tablets? 3 in the morning and 3 at night?

How is your resting heart rate?

The thing I notice about your lab reports is that it seems like they are measuring your total T4 instead of the free T4.  I have been to 4 different Endocrinologists so far and they all tested for FT4 and half tested the FT3 and half the TT3.  The T3 is present in such small amounts that lab reports for the free T3 are sometimes seen as being less accurate.  Also, always get a paper copy of the lab report if you can.  Actually, if the office has a patient portal where you can get the information online, it is even better.

My TSH was low for a long time when my FT4 and FT3 were in range. I hadn't heard about Carnitine until I had been off the MMI for a long time.  I was able to go off the MMI in December 2012, started thyroid supplements in June 2013 had a blood test with low TSH in November/December and had to go off the supplements earlier this year.

I felt awful on the MMI, awful until I was on T3 supplementation, awful going off, and I believe it is a combination of 3 or 4 things that helps me feel better now:

1- Acetyl-L-Carnitine

2- Methyl B12 and methyl folate

3- A Brazil nut or two every day or so (for selenium)

4- Wellbutrin prescription

One more thing about when I was on MMI, my TSH rose into the normal range at the next blood test after I was told I could LOWER my dose by 5mg one day per week. The next blood test showed my TSH at just above normal range, so I could lower my dose again.  After that, I did my own thing and informed the Endo at each appointment as to what I had done until I was off the MMI.  At that point, my FT3 was sometimes below the normal range and sometimes barely into the bottom of the range, but my Endo would not give me supplementation.  It took a convoluted turn of events before I could go to a general doctor and get the LT3, then another ordeal when I had to go off it.

Good luck on your journey through this problem.

My thryoid blood test from Monday this week has come back with: Serum TSH level 7.7 miu/L [0.2 - 4] - Above high reference limit and Serum free T4 level 12.5 pmol/L [10 - 20]. I'm still taking 500mg daily of acetyl-l-carnitine which I guess I should stop? However, I don't feel I have physical signs of my thryoid being underactive other than a low resting pulse rate (44 bpm).