Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
How low does my tsh need to be?
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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How low does my tsh need to be?


I have been having side effects of being hyperthyroid and I think they are keeping my tsh too suppressed at .04 My cancer history is as follows... I am 32 and found my cancerous nodule incidentally. after removing my thyroid the pathology came back with a .8mm papillary tumor tall cell variant with two positive nodes, clear margins and and no extrathyroidial extension. BRAF positive. I had 109 mci of RAI and a scan a week later that only showed uptake of remnant tissue in the neck. I know this is not the ideal type of papillary thyroid cancer, but was found very early. Based on this would you allow a patient to maintain a tsh of  at least .1? Are there any studies that prove that suppressing tsh impacts future recurrence. Also give my BRAF with tall cell variant are there any other things I should be doing such as looking into genetic modifying drugs?
Thanks!
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The key to this question is evidence of persistence/recurrence at this time.  If neck ultrasound and stimulated Tg (assuming negative Tg-antibodies) are negative, then TSH can be in the low normal range (0.3 - 0.8 (?)) although there are really no hard/fast rules on this.  We usually do the stimTg testing about 12 months after initial treatment.  Would not need to look into other meds at this point and we are not certain on the significance of BRAF with patients who had no extrathyroidal extension and small tumors although most tall cell are BRAF positive.  The key will be good ultrasound followup and watching the Tg levels.
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