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Thyroid Cancer, Nodules & Hyperthyroidism (Expert Forum)
After RAI - Hypo
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
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.
After RAI - Hypo
by hyperfan, Oct 24, 2006 12:00AM
I'm 30 yrs old, female. I had Graves Disease for 9 years. I took RAI (14mc) in Aug 05. My lab results have been inconsistent ever since.
Dec 05 - turned HYPO, TSH 100.2 (0.35-5.5), was put on Levoxyl 75mcg
Feb 06 - hyper, TSH 0.05 (N:0.10-3.5), T4 28.4 (N:11-22), T3 6.95 (N: 2.85 - 5.5) Levoxyl 75mcg on alternate days
May 06 - hyper, TSH 0.05, T4 18.7 (N:11-22), T3 6.3 (N:2.85-5.5), stopped Levoxyl
July 06 - hyper, TSH 0.002 (N:0.47-4.64), T4 1.31 (N:0.71-1.85), T3 3.92 (N:1.45-3.48)started on 5mg NeoMercazole
Aug 06 - hyper, TSH 0.001 (N:0.47-4.64), T4 1.02 (N:0.71-1.85), T3 2.46 (N:1.45-3.48), increased to 10mg NeoMercazole
Oct 06 - HYPO, TSH 4.82 (N:0.10-3.5), T4 9.0 (N:11-22), T3 2.56 (2.85-5.5), decrease to 5 mg NeoMercazole
I gained about 5 lbs - now at 100 lbs, normal pulse, weak muscles, tired at times, dry skin and scalp. Neck appears normal does not seem to be growing, eyes remain the same.
My questions are:
- What are my lab results telling you?
- What is the possibility of me going back to hypo?
- Will I be back to hyper?
- Do I have to do RAI again?
Thanks in advance Dr.!
Dec 05 - turned HYPO, TSH 100.2 (0.35-5.5), was put on Levoxyl 75mcg
Feb 06 - hyper, TSH 0.05 (N:0.10-3.5), T4 28.4 (N:11-22), T3 6.95 (N: 2.85 - 5.5) Levoxyl 75mcg on alternate days
May 06 - hyper, TSH 0.05, T4 18.7 (N:11-22), T3 6.3 (N:2.85-5.5), stopped Levoxyl
July 06 - hyper, TSH 0.002 (N:0.47-4.64), T4 1.31 (N:0.71-1.85), T3 3.92 (N:1.45-3.48)started on 5mg NeoMercazole
Aug 06 - hyper, TSH 0.001 (N:0.47-4.64), T4 1.02 (N:0.71-1.85), T3 2.46 (N:1.45-3.48), increased to 10mg NeoMercazole
Oct 06 - HYPO, TSH 4.82 (N:0.10-3.5), T4 9.0 (N:11-22), T3 2.56 (2.85-5.5), decrease to 5 mg NeoMercazole
I gained about 5 lbs - now at 100 lbs, normal pulse, weak muscles, tired at times, dry skin and scalp. Neck appears normal does not seem to be growing, eyes remain the same.
My questions are:
- What are my lab results telling you?
- What is the possibility of me going back to hypo?
- Will I be back to hyper?
- Do I have to do RAI again?
Thanks in advance Dr.!
Doctor's Answer
by Mark Lupo, M.D., Oct 25, 2006 12:00AM
, Oct 25, 2006 12:00AM
looks like the RAI did not hold -- unusual given the degree of TSH rise in 12/05, but it seems you have persistent/recurrent hyperthyroid. In some cases the effect of RAI may take up to 12 months to be seen, but usually it's 6 months. In this case I would try to taper off the neomercazole (similar to the US tapazole) and if you are still hyper repeat the RAI at a higher dose -- but this time do T4/T3/TSH every 3-4 weeks to pick up hypo much sooner than last time.
What I see is you need to be tested more frequently to stop the rollercoaster. Every 6 weeks or maybe even 4 until you can stabilize.
I'm no expert on RAI, however going back and forth from hyper to hypo is not good medical treatment. Would you consider finding another doctor?