Hyperthyroid Relpase

[cuteabce]

Hi Doctor,

I do need your advice on hyperthyroid. I am 40 yr old, male. I was diagnoised hyper and cured with Tapazole successfully in 2001-2003. Relapse maybe due to extreme stress in Aug 2010. Here is my number at relapse last year. TSH <0.03 mIU/L (normal range: 0.35-5.00), FT4:34 pmol/L (normal range: 10-20)

My numbers come back to normal range quikly and even went hypo after taking Tapazole,below was my progress.

Date           sTSH    FT3  FT4 Treatment
Nov/19/2011    1.06    4.3  17  no Tapazole for 13 weeks
Nov/11/ 2011   1.61    4.8  17  no Tapazole for 12 weeks
Sep/29/2011    1.7     4.4  16  no Tapazole for 6 weeks
Aug/16/2011    6.57    4.5  17  took 2.5mg Every Other Day fora month
July 20, 2011  3.11    4.7  15  5mg/d for one and half month
June 7, 2011   5.38    3.6  14  10mg/day for one month
May 3, 2011    1.3     3.6  17  After a month with no Tap.
Mar 21, 2011   5.14    4.6  16  Reduced to 10mg/d since late Dec, 2010
Dec 18, 2010   27.52        7   Continued on 20mg/day for almost 2 month
Oct 26, 2010   6.39         8   take Tap. 20mg/day since Aug
Aug 6, 2010    <0.03        34 Hyper relapsed

My questions are.
1. How come could the TSH drop to 1.06 from 1.61 just in one week? while the T3/T4 is till in normal range? could it relate to the bad cold?

2. In Aug 2011, I took very tiny amount of Tapazole (2.5mg ever other day), but I still become a bit hypo (TSH 6.57), so the doctor stoped the treatment for Hyper(totally one year on Tapazole), was that to say my thyroid was functioning normal enough?

3. I now feel hyper again (sweaty palms, palpitation, hungry, poor sleep, lightheadedness, weak) even though my numbers are still in normal range, can I take Tapazole again to get it controlled? In may case is it possible to cure the discease again with Tapazole like my first time in 2001-2003 with no relaps for almost 8 years?

Any suggestion is highly appreciated,
Thank you so much!

[Mark Lupo, M.D.]

1 - TSH can fluctuate like this in one day (much less a week).
2 - yes - the testing suggests normal function at that time
3 - would recheck levels soon to see if you are going hyper again - options would be low dose tapazole for longer term, but you became hypo on a low dose (but were decreased from 5/day to 2.5 alt days only 3 weeks prior).

[cuteabce]

Thanks Dr Lupo!

I am 40, and first time diagnosed hyper back in 2002 and relpased last year, do you think I might need ultrasound to screen thyroid cancer? My endo used a stethoscope to exam my thyroid gland and palpated my neck area and said no need of ultrasound as it is in normal size, but someone told me that I should take an ultrasound scan or RAIU.

Thanks again!