Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
Persistent TSH of zero and high TSIG
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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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Persistent TSH of zero and high TSIG

Hi Dr Lupo:  

I was diagnosed with Grave's 8/2010 and started on methimazole 11/2010.  I am 48 years old and started sudden menopause last December (LMP 12/12 -- verified I was menopausal and pituitary was functioning with FSH, LH, Prolactin spring 2012).  Since then I have had the following labs:

8/10 to 5/12:  TSH undetectable                    
5/12:             TSH  .040                        
6/12:             TSH  .050
8/12:             TSH  .019
9/12:             TSH  .019

8/2010          Thyrotropin Stimulating Immunoglobulin:  392 (<150)
8/2011          Thyrotropin Stimulating Immunoglobulin:  270 (<150)
9/2012          Thyrotropin Stimulating Immunoglobulin:  2,650 (<150)

1.  Any thoughts on what I should do with this continued severely suppressed TSH?  Any thoughts on why it would go down after slightly increasing:  My FT3 has been usually mid range of normal.  My FT3 has been low to mid range of normal (.8 to 1.2 usually and normal is .8 to 1.5).  
2.  Any thoughts on why my Thyrotropin Stim Immunog would increase so much after 2 years?  Does this put me at increased risk for TED or other autoimmune diseases or processes?  So far my eyes seem fine.
3.  I had a bone scan which showed Osteopenia (? d/t chronic hyperthyroidism) -- any advice on what I could do to help this?  I take Calcium (1200mg per day) and Vit D (5,000 u per day).  My PCP thought to put me on bisphosphonates but I am hesitant due to possible side effects.

I am so frustrated and unsure of what this all means that any help or thoughts would be greatly appreciated.

Thank you.

It appears you have subclinical (mild) hyperthyroidism due to Graves' disease).  The high TSI may increase the risk for TED (tobacco further increases this risk!).  The slight bone loss may be a reason to consider treatment, but otherwise at this age and without cardiovasculary symptoms, treatment is not mandatory.
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