Hypothyroid to Hyperthyroid

[patcalt]

In 2001, I was diagnosed as having hypothyroidism caused by a pituitary problem.  TSH was less than .001 and Free T3 was high, T4 normal.  My endo had done another test at the time using a drug that is no longer available, which helped him determine it was a pituitary problem.  He put me on synthroid, slowly increasing the dosage, and keeping the TSH suppressed.  In 2003 I had gastric bypass surgery and lost 175 pounds.  By mid 2003, my numbers were about the same, but my endo decided I was hyperthyroid and maybe it wasn’t a pituitary problem.  My only symptoms were some palpitations and slight shakiness in my hands.  He also found that I had developed goiter and had multiple nodules (tested benign).  He put me on 10 mg tapazole, which I have been on since.  My T3 and T4 numbers have been in the normal range, and TSH has been low normal to below normal since.  He now says that possibly one of the nodules is the culprit and expects I will always have to take the tapazole.  I’m confused.  Is it possible to have had three different variations of a thyroid problem?  Could the weight loss have had anything to do with the change?  Are there questions I should be asking my endo?  I’ve also been anemic for over a year with no determinable cause (iron is good, no internal bleeding); could the thyroid, or the tapazole, cause anemia?

[Mark Lupo, M.D.]

My bet is that you have had hyperthyroidism all along and that the initial TRH stim test (the med no longer available) was mis-interpreted.  The question now is 1) why is it hyper (ie Graves vs toxic nodule(s)) 2) what's the best treatment (none, tapazole, I-131, surgery?).

If I were to see a patient with this history, I would do an ultrasound, then hold tapazole for 5 days and do an I-123 uptake/scan then discuss results.  Also check thyroid antibodies - TPO, Tg and TSI.  Also check prolactin as a screening test for pituitary issues.

The weight loss was unlikely to influence the thyroid but if you were hyperthyroid (sounds like you were) it may have made the weight loss easier.  

Not sure why you're anemic -- would need to evaluate a full iron panel and also "reticulocyte count", b-12 and look at menstrual cycles (common cause of anemia).  Tapazole can cause a low white count but not typicall a low red count (anemia).