hypo or hyper

[tbird0601]

dear dr. i had a total thyroidectomy in 1992 for pappillary carcinoma and was placed on.3mcg and thought i
was doing fine for 10 years until my cancer returned. 3 months ago i was diagnosed hyperthyroid while on
.2mcg which i was on for at least 2 years, my dose was lowered to .175mcg and now i cant perform daily
tasks, like walking, standing for any length of time, im always out of breath, my hair is dull, my skin is dry,
and im very sad all the time. i think id rather be hyper than hypo. what do you think???

                  p.s. what about dessicated thyroid, do you recommend it?
                                                                                                          sincerely,

                                                                                                           tbird

[Mark Lupo, M.D.]

The lymph nodes are not likely to cause other symptoms.  The thyroglobulin blood test after the thyrogen is also very important -- even if the scan is negative.  If the thyroglobulin is high, depending on lymph node size, FNA biopsy may be needed.
The thyroid levels may be too high - contributing to the symptoms as mentioned before.
Otherwise, from thyroid standpoint, the only other option would be a trial of adding some cytomel (ie 5mcg 2x/day) but still need to keep TSH within target (dictated by cancer risk).

[Mark Lupo, M.D.]

I do not recommend dessicated thyroid for cancer patients, especially now that it is not available consistently.  Would need to know the current cancer status to determine TSH goal in order to address the question of appropriate dose.  The 0.3mg dose was likley too high; many people get used to this (like excess caffeine, etc) and it is difficult to come down to a lower dose -- but it is often necessary to lower the dose to a more appropriate and safe level.

[tbird0601]

Dr., What bloodwork wo uld you recommend If I were your patient. And what would be the
normal ranges for them.      Thank You
P.S can you refer me to a Endo in Homestead or miami who might consider prescribing cytomel, my current Endo looks just at TSH.
I have an appt. this wed. with my family Dr. I can have him order whatever bloodwork you would deem important. I live in the fla Keys and dont have an Endo here.
A sincere thankyou for your time ! I will post my results for you by next Friday !

[tbird0601]

Thank you for responding so quickly, however my symptoms are what is troubling me!
I recently had an ultrasond done on my neck and they found two abnormal lymph nodes behind my jugglar vein. If this is my cancer returning, could this be the reason
for the symptoms ? I am being scheduled for a thyrogen body scan in the coming weeks.