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Suggest treatment for abnormal TSH and elevated thyroglobulin

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Endocrinologist
Practicing since : 2001
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Need feedback from Endocrinologist. Female, white, age 57 prior 2006 dx with breast cancer at age 49 Stage 2, IDC, ER+, PR+, Her2neg. Treated lumpectomy, chemo 4 DD A/C, and 4 DD Taxol, 35 radiation treatments. Started Tamoxifen 4months - bad side effects so had oophorectomy age 50 to start Femara. Additional treatments for osteopenia with 6 infusions of Zometa. Past 2 years, elevated cholesterol levels and TSH between 4.5 to 5.8. Bloodwork done in February shows TSH 10.78, Thyroxine (T4) free direct 0.75, Thyroid Antibodies for 14, and below <.1.0 for TPO and Antibody. Thyroglobulin level elevated 95.9 for range1.5-38.5 ng/ml. Triiodothyronine free serum . Cortisol level 15.1 AM level. I recently started on prescription Armour Thyroid medication. I have concerns if I should be seeing an endocrinologist to further monitor me. No US done on neck.
Posted Fri, 28 Mar 2014 in Thyroid Problem and Hormonal Problems
 
 
Answered by Dr. Shehzad Topiwala 4 hours later
Brief Answer: Thyroid Detailed Answer: Yes it is strongly advised you see an endocrinologist for both thyroid as well as osteopenia. TSH of 10 is definitely abnormal and merits consideration of treatment options even though your thyroid antibodies are negative. Elevated thyroglobulin levels at this point are not so useful. I noted the direct free T4 levels earlier when the TSH was hovering around 4-5. Would you know the range for normal on that particular lab result ? Further, I did not see a free T4 level when you had the TSH of 10 most recently. Would you have had that done ? A low level ie below lower limit of normal would favor treatment. It is possible you may have a permanently underactive thyroid but before you commit yourself to lifelong replacement with thyroid medication one needs to rule out a temporary condition called thyroiditis in which the thyroid goes off for a free weeks and recovers fully in couple months. This differentiation is best made by an endocrinologist. Finally, armor is not at all recommended by thyroid experts. Levo thyroxine suffices
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for abnormal TSH and elevated thyroglobulin 12 hours later
Hello Dr. Topiwala - Thank you so much for your reply. My apologies for not providing enough information. I just figured out how to attach a PDF for my prior lab reports. Some were ordered by my GP who always was concerned for my elevated cholesterol levels (I did not want to take statins with side effects). I started to see a nutritionist in early 2012 and she orders more tests covering metabolic issues for thyroid. She identified I have MTHFR single mutation C677T and gave me a supplement for this condition. I was improving my diet for organic and healthy foods to help with cholesterol control and inflammatory issues for aching joints -- side effects of Femara. I was GUESSING that I went too far with eating TOO MUCH raw XXXXXXX salads and smoothies and recently learned they may suppress the thyroid functions. When I stopped eating raw XXXXXXX I took some iodine (Iodora tablets) for about 2 months Nov- Dec 2013. I had a yearly MRI with contrast in January to monitor a pancreatic cyst (no-changes.) The labs drawn this year are a mix of scripts from both doctors so I avoided 2 blood draws. I had much concern for taking synthetic thyroid medication due to all the side effects I read from patients and extreme issues with weight problems/loss. Last summer I was fit with daily walking at height 5'2" and weight 128-130#. Now I am up to 136# and was very tired over the winter - weather prevented walking with snow storms here. So I am struggling to maintain a healthy life style with diet / exercise and these lab results are a frustration in how tired I feel. I had the symptoms for some time with cold hands, feet, hair loss, difficult to loose some weight but easy to gain it. I was always quite petite when younger - - we have a small farm and I ride horses too, clean barn daily. I can easily lift 50# feed bags. So I'm not a lazy person --- just a tired person. Thank you for your feed back and I look forward to your reply with this added lab report information. Best Regards, Joann Long
 
 
Answered by Dr. Shehzad Topiwala 2 hours later
Brief Answer: Follow up Detailed Answer: After reviewing your lab results, I suggest you stop armor, and in 4 to 6 weeks check your TSH and free T4. Fasting is not necessary for this test. If the TSH is high, especially along with a low free T4, then you must see an endocrinologist to start levothyroxine treatment
Above answer was peer-reviewed by
 
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