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Thyroid Cancer, Nodules & Hyperthyroidism (Expert Forum)
Remission?
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.
Remission?
by ar1281a, Nov 14, 2005 12:00AM
Hi Dr Mark,
Well, this is my second question within 3 months...I have two:
1) My TSH has always been around 0.7-1. Now, lab work done in August showed TSH at 1.7 and T3 and T4 normal, PTO ABs were undetectable (while they were very high when I was dx 5 years ago, as well as TSI suggesting Graves). Labwork done last week showed TSH at 1.9 and t4 & FT4 normal (don't know why my endo didn't order FT3 as well). Based on this, my endo feels that I may be going on remission and would like me to stop my meds for 2 weeks and retest (i'm on 5 mg/day og Tapazol (generic). What's your opinion on this? Are these signs of remission?
2) You may remember all of us "discussing" adrenal insuff. in the past. 3 weeks ago, my pm cortisol came back at 2.7 (normal above 3.2), so my GP and endo had an extensive conversation about what to do...they didn't agree so decided that I should wait to see if I improve (BP problems and OI, dizziness - improving very slowly) without needing to put me back on any steroids (high or low dosis) as they feel that my adrenal cortex is taking long time to wake up after been put on high dosis of prednisone due to an allergic reaction. In the menatime, I'm on florinef which has helped. So I wanted to know your opinion on this.
Thanks!
Well, this is my second question within 3 months...I have two:
1) My TSH has always been around 0.7-1. Now, lab work done in August showed TSH at 1.7 and T3 and T4 normal, PTO ABs were undetectable (while they were very high when I was dx 5 years ago, as well as TSI suggesting Graves). Labwork done last week showed TSH at 1.9 and t4 & FT4 normal (don't know why my endo didn't order FT3 as well). Based on this, my endo feels that I may be going on remission and would like me to stop my meds for 2 weeks and retest (i'm on 5 mg/day og Tapazol (generic). What's your opinion on this? Are these signs of remission?
2) You may remember all of us "discussing" adrenal insuff. in the past. 3 weeks ago, my pm cortisol came back at 2.7 (normal above 3.2), so my GP and endo had an extensive conversation about what to do...they didn't agree so decided that I should wait to see if I improve (BP problems and OI, dizziness - improving very slowly) without needing to put me back on any steroids (high or low dosis) as they feel that my adrenal cortex is taking long time to wake up after been put on high dosis of prednisone due to an allergic reaction. In the menatime, I'm on florinef which has helped. So I wanted to know your opinion on this.
Thanks!
Doctor's Answer
by Mark Lupo, M.D., Nov 15, 2005 12:00AM
, Nov 15, 2005 12:00AM
The labs are suggesting normal thyroid -- if you have been on tapazole for nearly 12 months, may be time to try to discontinue and see if remission has been achieved - if there is any concern about a quick rebound to hyper based on your history then it may be worth a try of 2.5mg for 2 months and if still normal stop the tapazole. The disappearance of TPO is probably a good sign - TSI is more specific for Graves however.
The adrenal question is more difficult. If you have been off steroids for three months then an ACTH stim test would answer the question of significant adrenal insufficiency. I share the reluctance to use steroids unless absolutely necessary. Okay to continue the florinef (if no fluid retention or low potassium) and try to taper the dose over time.
The adrenal question is more difficult. If you have been off steroids for three months then an ACTH stim test would answer the question of significant adrenal insufficiency. I share the reluctance to use steroids unless absolutely necessary. Okay to continue the florinef (if no fluid retention or low potassium) and try to taper the dose over time.
