Low level of Thyroid-stimulating hormone (TSH), indication for emergency surgery?

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Dear Professionals, 

I would like to ask for your competent opinion, because I am on the front of the surgery in order to remove my thyroid, but I am not sure in its necessity. 

I am a woman: 47 years old, height 164 cm., weight 57 kg.   

Endocrinologist diagnoses that I have: a nodular toxic goiter II, subclinical hyperthyroidism. TSH 0,005; Leukocytes: 3,21 - was prescribed "methyluracil" 1500mg a day to support level of leukocytes, I had taken them for 2 weeks. Leukocytes rose till 4,05. Then I started to take "propicil" 100mg a day, but after a week the level of leukocytes dropped from  4,05 to 3,33 (blood has been checked every week). Erythrocyte sedimentation rate (ESR) from 8 to 25 in a week. As a following the doctor canceled "propicil" because of very low TSH level and recommended to eliminate my thyroid, because there is a danger of leukopenia and agranulocytosis. 

 

My question is: is there a real need to remove a thyroid or there are other ways to solve a problem of low TSH? 

The medical history is the following: 

 Complaints appeared 3 months ago in September 2014. Dry eyes at mornings (can be result of lenses), pressing pain in the left side of the chest, high emotionalism, fatigability, rapid heartbeat. (ultrasonography showed: mitral valve prolapse 1 stage, with near valve regulation, dysfunction of 1st kind). Weight loss 3 kg in 2 months. 

2010.10.21 Ultrasonography: formation size of  1,5х1,0х1,6 cm, in the projection of the lower third of ovoid form with equal precise contours, hypoechoic rim, structure without acoustic effects with moderately inhomogeneous structure, with other type of ultrasonography internal vascularization is not registered, only bypass blood flow was registered. Fine-needle biopsy of thyroid showed: "Analysis corresponds mainly to nontoxic colloid goiter" 

 

Hormones:  

2010.10.21 TSH – 2,81 (norm 0,4-4,0), Т3 free. - 5,8 (2,6-5,7), Т4 free - 12,1 (9,0-22,0),  anti-thyroid peroxidase (anti-TPO) - 545 

2012.04.14 TSH – 1,44  

2013.09.23 TSH – 3,54, Leukocytes 4,16  

2014.03.26, Т3 free – 5,3, Т4 free - 17,6  

2014.10.31, Т3 free – 5,7, Т4 free - 16,5  

2014.11.12. TSH - 0,005; Т3 free - 2,87; Т4 free - 14,69; anti-TPO - 992,0; antibodies to  receptor of TSH - 20,04; Hemoglobin – 107; ESR (Westergren method) – 25; Leukocytes (WBC) - 3,33; Alanine transaminase (ALT) - 10,7; Aspartate transaminase (AST) - 12,7; Blood glucose – 6; Iron– 9,73 mmol/l 

 Scintigraphy showed: Thyroid located normally and has a shape of asymmetric butterfly. Dimensions of the left share - 1,2х4,0 cm; right one-  1,5х3,5 cm. Accumulation of the medication is relatively uniform. In projection to the palpated node (left part of the left share) accumulation of the medication decreased. Conclusion: "cold node" in lower pole of the left share of the thyroid. Ultrasonography: Contour is clear, relatively flat: right share 4,5х1,7х1,9 cm, left share 4,8х2,0х1,9 cm, isthmus 0,3 cm. Thyroid tissue has decreased echogenicity, expressed diffusely heterogeneous structure, because of existence of  hypogenous and echogenic areas and the set point and linear hyperechoic structuresю With this background there is visible oval formation with equal clear contours inhomogeneous echostructure of the following dimension: 1,6х1,1х1,5 sm with bloodstream around the node.  

 In the Doppler mode of ultrasonography  was shown: uniform significant increase in vascularization of thyroid tissue. Fine-needle biopsy: nodular toxic goiter II grade - material is taken from the area of the nodal colloid goiter with cystic hemorrhagic changes. Also in the analysis sample was highlighted a slight increase in the number of lymphoid elements (mature forms predominate over immature), histiocytic elements. There is might be a risk of Hashimoto's thyroiditis. 

 Here is all what I got.  

Dear experts could you please confirm that there is a need for surgery or there is a possibility of therapy?

Thank you very much for your attention 

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7 Replies

  • Posted

    The people who respond to you are not experts but merely giving an opinion from their own experience.

    Personally I'd have the surgery.  It will be easier to control your levels when you are on thyroxine. 

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    • Posted

      Thank you for your reply.

      Could you please suggest any forum where doctors are presented and can give an opinion?

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  • Posted

    Alise, you are not going to get a doctor's opinion without paying for it.  There is, however, a naturopath who himself has an authoimmune thyroid condition and has an Endocrine site.  He sees patients by Skype but charges for it but he has cured himself and other patients by natural means.  Google Osansky and his name should come up.  I have Graves disease, not Hashimoto's but I got my TSH to come up by taking the supplements Vitamin D and Acetyl-L-Carnitine.  Initially i used regular L-Carnitine but found the Acetyl-L-Carnitine worked better for me.  There is a Hashimoto's patient who posted to this Board and she tried both forms of the Carnitine and for her the regular L-Carnitine controlled her symptoms better.  I will email you privately a copy of her responses to emails she has sent me as she has given me permission to do this.  For myself, I saw a paper in an Endocrine journal about an Endocrinologist who did a study abou tthe benefits of L-Carnitine for hyperthyroid patients and tried this supplement based on that paper.  That said, you also seem to have other conditions besides thyroid and if it were me, I would seek out the opinion of a naturopath like Osansky.

     

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    • Posted

      Thank you for your valuable advice, I think that doctors in my country have never heard about the treatment by L-carnitine.
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    • Posted

      They also have not heard of it in America because they do not want to know.  They have an "accepted standard of care" which is antithyroid medication, radioiodine ablation and thyroid removal surgery.  Dr. Benvenga published his results in an accepted medical journal in 2001 and gave a lecture on it at an Endocrine conference in the States in 2004 and they still do not want to change.  Patients have to unite to change this.  That's why these Boards exist.  My Endocrinologist was shocked at my positive results but he doesn't recommend it to his other patients because he doesn't "know anything about it".
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  • Posted

    I have had my TSH very near zero at least 2 different times and there was no urgent need for surgery.  I refused surgery in any case, and now my thyroid is in the normal range.  I also take Acetyl-L-Carnitine.  I'm not sure, but I think since I have been on Wellbutrin for depression, it may have contributed to becoming more normal again.
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