Hyperthyroid?Nodules? and Flucuating TSH and T3, Please help

[lyfroggy]

Wow, where to begin, I am a 26y/o female with long standing symtoms of hyperthyroid.  1996 tested while in Navy and had borderline TSH they never did T3 or T4 or anyothers.  So I went untreated and essetially undiagnosed.  Now in Aug of 05 lost 15lbs in one month, tremors increased and felt all around horrible, diarhea (diarrhea) 3 times a day,and couldn't work.  Hair loss, heat intolerance, palpitations, and vertigo, fell 2 times in one week.  Fianlly got seen, TSH was .16 finally referred to Endo, well 1 month later TSH was undetectable and T3 was high.  found goiter, and upon u/s nodule about 7mm left side.Then went on to scan and uptake only to find incereased uptake and another nodule on the right that is suspicious according to nuc med.  The left nodule is slightly overactive.  Just had another u/s where they mumbled that there was a dot in the center of the right nodules, not consistant with the left.  There are about 8 altogether small though.  Well the kicker is when my tsh was drawn in Nov, it came back .81 and all labs were normal??  the doc thinks that maybe the blood was mixed up? who knows but we re-drew all the labs again.  TSI has always been fine.  My question is What the heck could be going on? The Endo will say nothing, which is a little odd as I work in medicine.  He is just rubbing his head and has no idea.  Would there be any explination? I still feel like **** and have been experiencing palpitaions and then hypotensive episodes, I am on inderal BID but my bp was 92/54 resting done 3 times both arms, with pulse rate if 115. Please give any insight you can!Thanks

[Mark Lupo, M.D.]

The low TSH and increased uptake is c/w Graves (despite the normal TSI).  The nodules are seemingly small but there seems to be some discordance between the scan and ultrasound -- ultrasound is better for nodules than scan, so would rely on that more.  The 0.81 TSH is confusing - may be an error - would also need to follow free T4/T3 to complete eval.  

Also would check adrenal function (at least an am cortisol).  The low-ish BP and high HR make increasing the inderal tough.  Make sure you stay hydrated.  

If adrenal normal then may consider a trial of Tapazole if the the T4/T3 are borderline high despite the TSH.

Tough case.

[lyfroggy]

Thank you so much!!  My Endo also says this is tough, I guess I am just unique!! I have to say this forum is a great help in the chaos of thyroid disorders!!

[lookingtosolve]

A related discussion, same symtoms - no answer was started.