how can you have a low TSH reading with no thryoid

[duedrop24]

My husband has been having trouble with his thyroid since last September. He takes thryoid supplements, but his levels keep fluctuating all the time. He was having mini-coma like episodes last year when his level dropped to 0.01 and passing out. It took 9 months to regulate him and now he is going back down again to 0.3. The local doctors are always switching him back and forth from 175 mcg to 150 mcg and he goes one way or the other.  They have alernated both to try and regulate him. Most the time he needs the 175 mcg doseage.  Can pain meds or bipolar medications interfere with these readings? He also has no appetite lately and is losing weight. He was in the hospital 4 days and was put through almost every test you can think of from colonoscopy to heart and blood work and they found no reason for his throid to fluctuate like it is. Is there another gland in the body that could cause this sort of fluctuation? His MRI showed no enlargement of any of his other glands. Do you have any idea what might possibly be causing such a fluctuation. He was diagnosed with Graves disease and had to have his thyroid removed years ago. The doctor said then that his thyroid gland was 3 times normal size. Could my husband possibly have cancer or something causing these fluctuations?

[Mark Lupo, M.D.]

TSH comes from the pituitary (in the brain) - it responds to the level of thyroid hormone in the blood.  The apparent only source of thyroid hormone should be the thyroid medication -- unless there is a small amount of thyroid remaining in the neck that could be producing thyroid hormone (would use ultrasound or even I-123 scan to determine if this may be the case).

Provided there is no functioning thyroid, then the issue is consistent absorption/metabolism of the medication and possible interference with other medications.  TSH goal for this situation is usually 0.3-2.5.  An endocrinologist should be involved to help sort this out.

[duedrop24]

Thank you for your insight. This problem only occurred once before shortly after the thyroidectomy. However it was quickly resolved. This has been going on for a long time now and he has every symptom of hypothyroidism with sleepiness, dry skin peeling on his hands except he has loss of appetite and weight loss more like hyperthyroidism. Of course his TSH levels indicated he was hyper at 0.3.  We demanded his local doctor repeat and do a T4 and T3. We thought that might give some insight if the pituatary or other glands were functioning properly.  I read somewhere that if the TSH is low but the T4 or T3 is high it indicates one sort of thyroid disease or problem and if it is low yet another.  He was diagnosed with graves disease prior having his thyroid removed. Is graves cured once the thyroid is removed?  I thought grave's disease was an autoimmune disorder that caused the thyroid to go bad and as well could affect other organs in the body. Is this so?  If the thyroid helps regulate so many other glands and your metabolism,then how could a metabolic problem cause the thyroid to go hyper? We are planning to follow up with an endocronologist if his T4 and T3 come back abnormal. We've already spent over $38K on all sorts of tests. They have not done the I-123 scan but have done all sorts of MRI's and Cat scans and numerous repeated blood works.  He is also bipolar and takes meds for that along with either vicodin, ibuprofen, aspirins, or darvoceet for back pain from a previous back surgery. He's  also been diagnosed with IBS before but the last colonoscopy done recently showed no inflammation which might indicate IBS. However, about 3 years ago, he did have a stomach bleed out from a malory tear and espohageal fissures. He has been reluctant to let the doctors repeat an EGD because he had so much neck pain after the treatment and emergency surgery, but the gastro doctor told him he had the worst stomach he'd seen in his whole practice.  Told him to stay on protonix daily the rest of his life or he'd have stomach cancer. The only area of the body the doctors didn't visually look at were her small intestine and inside his stomach with an EGD. The colonoscopy was clean and they did look into the cecum area and lower small intestine while there for Krohn's disease. We're just at a loss as to what to do and don't have the money to keep repeating tests. I do appreciate the info you've sent already, but if you have any further insight with what I've just told you, I'd appreciate it. TNX