History of Follicular thyroid cancer, Thyroid hormone problems

[cocomadam]

Hi Dr. Lupo,
You've helped me many times before.

I am a 25 year old female from Australia with a past history of follicular thyroid carcinoma & hurthle cell adenoma.  I've had a total thyroidectomy, RAI last July, and had my follow up ultrasound & Whole Body Scan in early February.  My ultrasound showed a hypoechoic lesion near my scar, but was most likely post operative change.  Whole body scan was negative.

I recommenced my Thyroxine, 100mcg, on the 3rd of February (TSH levels reach 100 while i was off thyroxine),  I had my first followup blood test yesterday.  I went to see my doctor for that reason, and also some bowel problems I've been having, diarrhea, soft stools, stomach cramps etc.  I've had 2 colonoscopies in the past, all negative for problems.

She rang me today and asked if I took my Thyroxine just before my blood test, I hadn't, I'd had it the night before, and had the test at 1:00pm the next day.  She said my TSH was 7.5, way too high obviously, yet my T4 was the upper normal range of 21.8 (sorry these are australian levels).  She is confused as too why, and so am I.  My vitamin D is also still low at 25.

Is this just mild hypothyroidism, due to not enough Thyroxine?  I thought that would mean my free T4 would be low,
Thanks for your help.

[Mark Lupo, M.D.]

Regarding the cancer followup, would ask what the thyroglobulin level was when TSH was >100 for the scan.
The high-ish T4 is less important than the TSH, would probably increase the thyroxine and recheck levels in 6 weeks.
Bowel problems are not likely related to thyroid history although abnormal thyroid levels can worsen bowel problems.

[cocomadam]

Sorry, I forgot to also mention I had a Coeliac serology blood test last July which came back normal.  
I also have been diagnosed recently with high eye pressure and very high risk of open angle glaucoma, I have a very small and hard to see optic nerve.  I am taking Xalatan, 1 drop a day in each eye.