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Thyroid Cancer, Nodules & Hyperthyroidism (Expert Forum)
Low dose synthroid?
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.
Low dose synthroid?
by running_man, Aug 26, 2007 09:48AM
Back in Februrary my ENT did labs and ultrasound of my thyroid.
US showed a couple of small thyroid nodules (6.5x7.2x9.1mm and 9.3x4.5x6.5mm).
My labs were slightly hypothyroid:
TSH - 6.52 High (norm .4 - 5.5 mIU/L)
T3, Free - 364 (within range)
Thyroxine, Free direct - 1.34 (within range .8 - 1.8 ng/dL)
Thyroglobulin ABS 39 H (norm < 20 IU/mL)
TBG - 11.9 low (range 12.7-25.1 mcg/mL)
So my ENT started me on 75mcg synthroid and referred me to an Endo. (I took the generic from Sandoz pharm.)
My endo tried but couldn't FNA the nodules. But after 8 weeks of the 75 mcg synthroid I swung the other way and I was having pronounced "hard" heartbeat sensastions, etc.:
TSH - .01 Low
T3, Free - 620 High (230-420 norm)
Thyroxine, Free direct - 2.81 high (.8-1.8 norm)
So my endo had me stop the synthroid. She also thought a lymph node was swollen so she ordered an MRI of my neck. and a recheck of labs. After about 8 weeks without synthroid, I redid labs and th e MRI.
Surprisingly, the MRI did not show the nodules seen on several US before, lymph nodes looked normal. My labs came back "normal" but with antibodies:
Thyrotropin-bind inhib. - 2 (within range)
Thyroglobulin ABS - 81 high (norm < 20)
TSH - 1.44 (.4 -5.5 range)
T3, Free - 299 (230-420 range)
Thyroxine Free direct 1.0 (range .8-1.8)
My endo wants me to follow up in 6 months. No synthroid at this point. Given my history, should I be on a lower dose of synthroid than before? She suspoects that the nodules may reappear.
US showed a couple of small thyroid nodules (6.5x7.2x9.1mm and 9.3x4.5x6.5mm).
My labs were slightly hypothyroid:
TSH - 6.52 High (norm .4 - 5.5 mIU/L)
T3, Free - 364 (within range)
Thyroxine, Free direct - 1.34 (within range .8 - 1.8 ng/dL)
Thyroglobulin ABS 39 H (norm < 20 IU/mL)
TBG - 11.9 low (range 12.7-25.1 mcg/mL)
So my ENT started me on 75mcg synthroid and referred me to an Endo. (I took the generic from Sandoz pharm.)
My endo tried but couldn't FNA the nodules. But after 8 weeks of the 75 mcg synthroid I swung the other way and I was having pronounced "hard" heartbeat sensastions, etc.:
TSH - .01 Low
T3, Free - 620 High (230-420 norm)
Thyroxine, Free direct - 2.81 high (.8-1.8 norm)
So my endo had me stop the synthroid. She also thought a lymph node was swollen so she ordered an MRI of my neck. and a recheck of labs. After about 8 weeks without synthroid, I redid labs and th e MRI.
Surprisingly, the MRI did not show the nodules seen on several US before, lymph nodes looked normal. My labs came back "normal" but with antibodies:
Thyrotropin-bind inhib. - 2 (within range)
Thyroglobulin ABS - 81 high (norm < 20)
TSH - 1.44 (.4 -5.5 range)
T3, Free - 299 (230-420 range)
Thyroxine Free direct 1.0 (range .8-1.8)
My endo wants me to follow up in 6 months. No synthroid at this point. Given my history, should I be on a lower dose of synthroid than before? She suspoects that the nodules may reappear.
Doctor's Answer
by Mark Lupo, M.D., Aug 27, 2007 06:08AM
, Aug 27, 2007 06:08AM
You likely have hashimoto's thyroiditis -- this can give the appearance of nodules on ultrasound due to the inflammation caused by the immune system attack (antibodies) on the thyroid ("pseudonodules"). There may also be small real nodules (you mentioned sizes <10mm) but usually these are observed with ultrasound and not FNA'd unless suspicious appearing. Hashimoto's can also cause some benign swelling of the lymph nodes.
The initial high TSH suggests a possible tendency towards hypothyroidism. With current TSH of 1.44 and the severe drop to 0.01 with a low/medium dose, would favor watching for now but test in 3 months rather than 6.
The initial high TSH suggests a possible tendency towards hypothyroidism. With current TSH of 1.44 and the severe drop to 0.01 with a low/medium dose, would favor watching for now but test in 3 months rather than 6.
