Hypo after RAI

[hyperfan]

I had a history of hyperthyroidism with Graves Disease for 8 years and took RAI in Aug 05.  Since then, I have have been going to the endo on a monthly basis to get blood work done, TSH 0.01 with normal T3 & T4.  After 3 months, I noticed hypo symptoms and my last week's visit to the doctor confirms it.  I'm now reducing my Methimazole from 20mg to 5mg Methimazole.  My endo needs to do another blood test on me next week, with the intention to start me on Synthroid. My questions are :

1)  What will the dosage prescribed for Synthroid
    for 'beginners'?
2)  How long will I have to be monitored once I'm on Synthroid,
    do I have to go to the doctor on a monthly basis?
3)  What's the difference between going to hypo or euthyroid?
4)  Will one ever get euthyroid after RAI?

Thanks

[Mark Lupo, M.D.]

achieving normal thyroid levels (euthyroid) is fairly easy after one becomes low (hypo) after RAI.  Three months after the RAI is a common time to become low - I doubt you need any methimazole at this point.  The TSH may remain low for up to 6-12 months so rely on the T4/T3 until the TSH begins a definite rise.

Synthroid starting dose for this situation could be 0.7mcg/pound (assuming roughly normal weight for height) -- unless you are above 65yo or have heart disease.  For young healthy patient - a full replacement dose can be used from the beginning.

Initially I monitor every 6 weeks while meds are "fine-tuned" then at least 1-2x a year.

[ancientmariner]

I had RAI in 2002 and I must say that although, as Dr. Mark says, " achieving normal thyroid levels (euthyroid) is fairly easy after one becomes low (hypo) after RAI.", that does NOT mean that you will FEEL like your normal self. My endo got my thyroid levels back into normal range within a year, but I am still trying to feel well. I am now on track - I have switched to Armour Thyroid and found a doctor who helps me adjust the dosage based on symptoms, not labs. I never felt well on Synthroid. Please, for your own health, become proactive in your treatment, research and learn as much as you can about thyroid. It can only help you.

[AK19]

I too had RAI in Aug and am now hypo.  TSH was 83 and endo pulled me off PTU, waited 2 weeks and started Synthroid at 50mcg. I was curious how long it will be before I start to feel good, get my energy back, etc.  I was also curious if it is normal to continue to have anxiety/panic attacks eventhough I am hypo now.  I can go 0 to 60 in 2 seconds and am taking the innopran every other day. Endo wants me to stop the innopran, but I'll wake up in the middle of the night with a weird anxiety or panic attack and blood pressure is sky high.  I'm starting to feel like a nut job and just wanted to make sure this was related to hyper and now being hypo.  Any advice or comments would be appreciated. My endo has absolutely no bedside manner and the "gate keeper" is fed up w/ me calling asking questions all the time.

[Mark Lupo, M.D.]

You are going through the rollercoaster of thyroid dysfunction - from hyper to hypo and now hopefully back to normal -- would go ahead and increase synthroid to 0.7mcg/pound (ie, full replacement dose) assuming you are young and otherwise healthy.  The anxiety can come with both hyper and hypo.  It should take 4-8 weeks to improve -- wish it were faster, but at least it is treatable.

[hyperfan]

Hi

Thanks for the reply and info sharing.

My blood test shows :

Nov 8 - TSH 34.65, Free T4 0.59, Free T3 1.47
My endo cut down Methimazole to 5mg daily.

Nov 16 - TSH 100, Free T3 1.31
It's amazing how the TSH jump within a week.  Based on this new result, my endo had just prescribed Synthroid, 50mcg daily, to be monitored for the next 10 days.  I'm petite, weigh 103.5 lbs, 5'ft tall.

AK19 - How are you feeling with your 50mcg now?  

rgds