Re: Hyper friend needs help with monitoring

[Guest guest]

Fay,

I bet this doc looks at the TSH only, and wants to bring it up to " normal "

ranges. Even my slow-to-learn endo now says " if we tried to get your TSH up

to normal we'd make you miserably hypo " !

Terry

> From: cfyoung2@...

> Reply-To: graves_support

> Date: Mon, 30 Dec 2002 13:56:42 -0600

> To: graves_support

> Subject: Hyper friend needs help with monitoring

>

> I have a friend who has been monitored regularly for several years for

> subclinical hyperthyroidism and a multinodular goiter. Recently she

> started ATD's. Here are her numbers:

>

> 7.24.01 AND 7.1.02 (results were identical; DEXA in 2001)

> TSH <.05

> FT3 5.0 (1.1 - 4.7)

> FT4 2.1 (0.6 - 2.2)

> DEXA showing mild ostopenia

> (Endo would only recommend RAI which friend declined; becase of no hyper

> symptoms he was willing to let it ride with regular monitoring.)

>

> 8.12.02

> TSH 0.0

> FT3 not done

> FT4 1.44 (0.7 -1.48)

> serum Ca 9.5 (8.4-10.5 mg%)

> Letter to patient says: The gamma camera image revealed a rapid and

> irregular tracer uptake throughout a multinodular goiter that was

> approximately 1.5 times normal size. Antithyroglobulin antibodies and

> thyroid peroxidase antibodies were undetectable. A biochemical profile

> including postprandial glucose was perfectly normal. The

> blood count was normal with a hemoglobin at 14.3 grams.

>

> New endo in August. Good for her because her we share an ex; this new one

> was highly recommended. Here's where it starts to get bothersome: He

> recommends RAI but since she refuses will start her on Tap, 10 mg.

> 2x/day. He doesn't tell her to space it approx. 12 hours apart but to

> take with breakfast and dinner. He wants to recheck in two months. NOT

> one month like even our ex did to also measure liver and WBC.

>

> 10.14.02 (same ranges as Aug.)

> TSH 0.0

> FT4 0.96

> Apparently he didn't do a liver profile and WBC.

> Dr. says to stay at current dose and come back in 2 months.

>

> 12.17.02 (same ranges)

> TSH 0.1

> FT4 0.89

> Dr. wants her to increase the Tap to 15 in morning and 10 in evening.

> Yes, increase to 25. She is trying to contact him to find out why since

> logic dictates a reduction might be in order, to say 15 mg./day.

>

> When she contacts him about this should she also ask for further testing?

> She hasn't had a reaction so I suppose the liver panel is no longer

> necessary. Any other antibodies, etc?

> Also, her newer dr.is calling what she has mild toxic multinodular

> goiter. Is this Graves? Not that it terribly matters.

>

> Thanks and take care, Fay

>

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[Guest guest]

cfyoung2@... wrote:

>

> 12.17.02 (same ranges)

> TSH 0.1

> FT4 0.89

> Dr. wants her to increase the Tap to 15 in morning and 10 in evening.

> Yes, increase to 25. She is trying to contact him to find out why since

> logic dictates a reduction might be in order, to say 15 mg./day.

It doesn't sound too unreasonable from what you have said so far

(from 20mg daily to 25 mg daily), it seems likely she is still

hyperthyroid, unless there are contary symptoms.

> Also, her newer dr.is calling what she has mild toxic multinodular

> goiter. Is this Graves? Not that it terribly matters.

No it is not likely to be Graves' if the antibody tests are

negative, more likely to be an autonomous nodule.

I plead ignorance of non-autoimmune thyroid disease, but

diagnosis may affect treatment. RAI if used is normally used

more aggressively against toxic multinodular goiter, and is

presumably less likely to affect the eyes adversely, whereas if

cancer is a possible alternative diagnosis

subtotal-thyroidectomy can be used in place of a normal biopsy.

Also it is likely to affect long term antithyroid drug

treatment, I think Graves' goiter tends to diminish with

treatment, and lead to remission or quite low maintenance doses,

where as not all other causes of hyperthyroidism respond the

same.

Meanwhile monitoring fT3 may be desired as T3-toxicosis is

common in these complaints.

We can't claim TSH suppression is caused by antibodies, and then

see it is people without antibodies ;-) I think DeGroot is right

TSH suppression may have another or several causes. Oh how much

there is for man still to learn about thyroids, and there

disorders.