Doctor, My TSH is Low, but you tell me my Thyroid dose is correct. Then Why do I feel So BAD?

Patients need to be able to read the results of their tests, and know why they are taking thyroid hormone in the first place. The normal range for TSH is lower than before. It is 0.3-3.0.

There are three different dose levels depending on your disease

1. Hypothyroidism only without nodules, or goiter. The TSH should be between 0.5-2.0.

2. Suppression for nodules, or goiter in younger patients < 50 Y/O. The TSH should be between 0.1-0.5.

3. Active thyroid cancer needing maximum suppression to act as a hormonal chemotherapy.
The TSH needs to be lower than for hypothyroidism at < 0.1, and even <0.01 in active diease.

Do not let a physician change your dose without knowing what your reason for taking thyroid hormone is. The suppressed TSH is not correct for hypothyroidism, but is needed for cancer and nodule and goiter suppression. The most suppression is for cancer patients that still have active disease.

Good Luck,
Dr.G.

Traumatic Damage, with painful bloody cyst formation, due to a child's blunt blow to the mother's neck

After an incident where the mother received a blow to the neck by her child, she began to experience pain and tenderness and marked swelling of her neck. She did not realize the trauma caused the swelling and was fearful of cancer, because it was rapid in onset and very large. She noted that the swelling deceased in size but was still painful. She had a large visible mass from across the examining room. The ultrasound confirmed a 5 cm cystic mass. The rest of the thyroid confirmed a diffuse goiter was present. Thyroid tests were normal. The ultrasound guided FNA produced 5.6 cc of bloody fluid. The attempt to biopsy the mass was unable to confirm an underlying cancer. She returned in 1 week. The mass was not visible and was decreased in size due to the decompression and fluid removal. The repeat US revealed a reduction of 60% in the size of the cyst. There was no pain or tenderness now. She was placed on thyroid hormone to suppress the goiter. If the cyst recurs, she will be a candidate for percutaneous ethanol injection, or PEI. This has replaced surgery as the primary therapy for non-cancerous recurrent cysts. There is an average 80% reduction in size with PEI.

If you have a recurrent cyst, please consider a visit to my center instead of a major surgical intervention for a minor cyst.

The Return of a Pituitary Tumor Patient

Today, I saw the man I diagnosed with pituitary hypothyroidism 6 months ago. He had secondary hypothyroidism. That means his hypothyroidism was due to the failure of the pituitary to send enough TSH to sustain normal thyroid function. An MR of the head revealed a large tumor that was interfering the normal gland function. He had low testosterone for several years. A 3-4 cm mass was seen on the MR. The surgery was long and difficult. However he returned to see me after the surgery, with normal pituitary function. The clue to his diagnosis was a low Free T4, and a normal TSH. This was not the usual numbers for primary thyroid failure and suggested a central cause for his failure. His testosterone normalized, and he was markedly improved. He does not need replacement or stress steroids!

Great case,
Good result.

Until next time,
Dr.G.