TSH rising not dropping after complete thyroidectomy

[JamieAT]

Almost 4 weeks ago I had a complete thyroidectomy , every biopsy before that had come back benign , but the 4 nodules were massive in size the largest at 6cm.  I am not post opp almost 4 weeks and they found a tiny spot of cancer , clear edges , papillary .  Well I am awaiting a full body scan to start the thyroid meds , and they want my TSH to be over 30 ... well once a week blood draws have shown them rising and they got to 26 last Monday and I repeated the test on Friday and they called me this morning to tell me they had dropped to 18 !!!  How can this be ???  I just want to get this scan over with and on the thyroid meds ....  why would my levels drop ?

[Mark Lupo, M.D.]

This is a situation where the most important question is whether or not you really need radioactive iodine.  If there was only a small focus of cancer then you may not need it.  I would ask for your pathology report so the details could be made available to answer this question.  The fact that the TSH is only 18 now suggest that there may be some remnant thyroid tissue after surgery.  Typically that remnant tissue is the target of radioactive iodine therapy if this is indicated.

[JamieAT]

Typo above , " I am NOW post opp "