Hyperthroidism after total thyroidectomy

[85aggie]

Am very confused after total thyroidectomy in June 2006 after two (2) FNA biopisies this year for follicular cancer.  Was put on .175 mg synthroid initially and lab results have been off the chart since.  Dose is now down to .100 mg but labs are still off.  The first round of blood tests after surgery while taking CYTOMEL showed my TSH to be 4.7 and Free T-4 to be 1.2.  When put on .175 synthroid TSH dropped to .471 and T-4 was 17.1 (H) and Total T-3 was 205.  The dose was lowered to .150 mg and TSH was .05(L) T-4 was 20.9(H) and Total T-3 was 245 (H).  Dose lowered to .125 mg and TSH was .01 (L)  T-4 was 4.0 (H) and Total T-3 was 375 (H).  The latest labs were repeated and the TSH is <.01 (L), Total T-3 is 412 (H), and Total T-4 is 22.2 (H).  I thought the lower the dose the T-3 and T-4  would begin to decrease and the TSH would increase.

I have been having a rapid heart beat, migraine headaches with blurry vision, diareha, and seem to have an intolerance to heat every since.  These symptoms are worse now on the lower dose.  Should I still be concerned at this point?

A

[lady di 2006]

I have hyperthyroidism and am currently on PTU and inderal.  It seems the medicine is not working like it should and they are wanting me to do the iodine radioactive or have it removen.  It is extremely high and I have all the tremors and feel run down and lifeless with very fast heartbeat.  What should I do.  Which has the best success and least side effects?

[Mark Lupo, M.D.]

The labs are a little abnormal in terms of trending TSH down with a decreae in dose -- assuming testing done at least 6 weeks after dose change.  Would continue to follow -- the average dose is 125mcg post-op.  No need for cytomel at this point.  Is the thyroid cancer gone?  There have been case reports of hyperthyroidism due to metastatic follicular cancer, but this is highly unlikely!