Continue to be Hyper a Year Later

Question

Doctor Mark -

It has been over a year since my TT for follicular w/hurthle cell changes.  I continue to show signs of being hyperthryoid despite not having a thyroid.

My latest labs as of 7-8-07 are TSH <.01 (.5 - 5.5) / Free T4 2.8 (H) (.9 - 1.8) and Free T3 1307 (H) (230-430).  I have tried taking Tapezole for the last 3 months but haven't seen any change.  If anything the numbers continue to go up.  

I am currently only take Atenoal for high blood pressure, Depokate for migraines, and BCP to prevent Ovarian Cysts.  I also take 2 Calcium pills daily.

My surgeon tells me that I should be hospitalized but wants my family doctor to be in charge.  My family doctor says that he doesn't hospitalize patients. Since the doctors are at different institutions, they don't seem to want to work together. 

I am totally frustrated at this point and any advise that you can provide would be greatly appreciated.

Thanks

MLupo,MD · Answer

Just to clarify -- this was not a cancer and you aren't on thyroid hormone replacement, right?

Assuming those things, there appears to be functioning thyroid  somewhere -- so likely the entire thyroid was not removed, or less likely there is ectopic thyroid (ie, normal thyroid byt not in the normal place).  Would see an endocrinologist to help with this, but I would start with a neck ultrasound to see how much thyroid remains in the neck.  Then would do an I-123 uptake and scan (must be off tapazole for about a week for this) but tell the technician to include the neck and chest (the most common place for ectopic tissue would be the upper chest).

This should identify the source.  

If all that seems negative, then I would do an empiric I-131 treatment and a post-treatment whole body I-131 scan.  The year-long hyperthyroid means that there should be thyroid that over-utilizes iodine, so should be treatable in this way.

You will need an endocrinologist/thyroidologist for this evaluation.

Good luck.

drmark · Answer

That additional info is helpful.

So it seems this was a cancer...?  The I-123/I-131 scans were negative...?

So this may be a case of functioning metastasis.  You need to find an endo who will work with you regardless of any other doctor you are seeing.

Another high dose I-131 treatment may be the best option.  PET scan could help localize where the activity is coming from and if it is surgically resectable, would be another option.

85aggie · Answer

Forgot to add that I had previously posted last year.  

I have had a I123 & I131 last year.  They have only continued to check lab values this year.

Do you recommend a PET Scan at this point.

It is very hard to find a Endocrinologist here where I live that will treat me since the sugeon isn't affiliated with them.

Thanks again

Continue to be Hyper a Year Later

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