TSH Renormalization

[Guest guest]

I had a meeting with my endo yesterday. During the last meeting she was pushing

for a second dose of radioiodine. I refused in light of my hormone trends,

which had peaked and where now dropping. At that time, she argued that it had

been nearly 6 months and I was still high (barely) in FT3 and high within normal

for FT4 (her " normal " being defined as the reference range). I argued that it

didn't matter, as my levels were trending down towards the reference range - no

matter how slowly. The meeting concluded with an uneasy wait and see agreement.

The next four test results (roughly monthly) have all my FT4 results in the

reference range, ending mid-range and my FT3 results dropping into the reference

range - though admittedly ending high in the range.

I expected these results to be very pleasing to my endo., even if imperfect.

But all she could focus on was the TSH which has only increased from

undetectable (<0.02) to 0.03 (reference range 0.34-5.6 ). She steadfastly

insisted that the TSH should be normal 8 months after RIA. She claimed since it

wasn't, it was an indication that my body wants my FT3 & FT4 levels to be lower

- even if they have to be suppressed well below the reference range in order to

get the TSH to rise - the means: more RIA (i.e. permanent). My first response

was that this was clearly crazy. She claimed that that leaving the TSH

repressed for much longer would lead to irreversible heart and bone damage. I

still refused - largely out of confusion. She said that if the TSH isn't up by

our next appointment, regardless of the FT3 and/or FT4 levels, she will refuse

to treat me any longer (which means refuse to prescribe any more blood tests).

So what do you all think? Is there some basis for being greatly concerned if

the TSH level fails to renormalizing soon after the free hormone levels reach

the reference range via RIA?

Hopefully the following " plots " will survive font changes and still look as

intended. The " I " s are the reference range bounds, the " O " s are test results

(with a bit of rounding to match increments). Right is increasing levels, and

down is increasing time. The time of RIA is indicated by a labeled dashed line.

Low Reference High

----I---------I-O----------

----I---------I-------O----

--- I - - - - I - - - - - - - RIA

----I---------I------O-----

----I---------I---------O--

----I---------I--O--------- F

----I-------O-I------------ T

----I-------O-I------------ 4

----I----O----I------------

----I-----O---I------------

Low Reference High

--- I - - - I - - - - - - - - - RIA

----I-------I----O-----------

----I-------I--------------O-

----I-------I----O-----------

----I-------IO--------------- F

----I-------O---------------- T

----I-------IO--------------- 3

----I-----O-I----------------

----I------OI----------------

Thanks, Devin