Greetings to you Elaine,

My Endo is urging me to have a nuclear iodine thyroid scan, and I am requesting your recommendation on whether or not I should take the scan.

To give you some background information, I am 58 years old. Since 2003, my TSH has been totally suppressed, but my FT3 and FT4 have always been within normal ranges, so no anti thyroid Medes have ever been prescribed.

In 2016, I was going though a lot of stress and was experiencing hair loss, extreme heart palpitations, trouble sleeping and nonessential hypertension. In December 2016, I was diagnosed with Graves Disease (I suppose based o. My antibody test results) and was put on 10mg of MMI once/day and 25 mg of atenol once/day. Following are my lab results:

December 13, 2016 (initial prior to any meds)
TSH .01 (0.40-4.50)
Free FT3 not tested (2.3-4.2)
FT4 1.8 (0.8-1.8)
Thyroglobulin antibody 25(0-20)
Thyroid Peroxidase Autoantibody 75 (0-35)

January 13, 2017
TSH .01
Free FT3 3.3
Free FT4 1.2
MMI reduced (at my request) to 5 mg once/day

February 10, 2017
TSH .07
Free FT3 2.9
Free FT4 1.1

March 14, 2017
TSH .87
Free FT3 2.6
Free FT4 0.8
Thyroglobulin antibody less than 20
Thyroid Peroxidase Autoantibody 62

(I started reducing considerably my MMI dosage)

April 19, 2017
TSH 0.17
Free FT3 3.2
Free FT4 1.2

I wrote to you in late March of 2017. You advised that my initial lab results indicated sub clinical hyperthyroidism and suggested I may not need any MMI. I continued to reduce my MMI and have not taken any for about the past three months. I have also reduced my dosage of atenolol to about 12.5 mg every two or three days.

On August 4, 2017, I requested new blood tests from my GP since ceasing the MMI. Following are my results following three months without MMI:

TSH.01
Free FT3 4.6
Free FT4 1.5
(I requested antibody tests also, but the GP did not order them because she said the tests are very costly)

In February 2017, I had a thyroid ultrasound, which indicated multiple nodules, the most dominant nodule being 3.4 cm in the right lobe. In 2003, an ultrasound indicated the most dominant nodule in the right lobe measured 2.0. In 2003, I had a nuclear thyroid scan, which indicated the nodule was "hot" and that no needle aspiration was deemed necessary.

I have read that the nuclear iodine from the scans can make thyroid problems worse (as can the fine needle aspirations). Accordingly, I am vey hesitant to take the scan -- particularly since the 2003 scan showed the nodule was hot. Also, my mother and sister have had FNA, and their biopsies were non cancerous.

Do you recommend that I:

1. Request another ultrasound (particularly since the nodule is now palpably reduced)?

2. Have the nuclear thyroid scan?

3. Seek another endo?

4. Just see a GP in the future and not an Endo (since the Endo keeps pushing for the scan as well as radioactive iodine ablation, which is not an option I plan to take)?

Also, what does the Free FT3 test measure and what is your assessment of why my Free FT3 level is now 4.6 (2.3-4.2)?

Thank you SO much for your continued advice. I am very appreciative!!!

Hi,

Our major thyroid hormones are FT4 and FT3. We have about 10-20 times as much FT4 as FT3 so any treatment is based on the FT4 level. Your level is slightly elevated and this is seen in about 30% of people with multinodular goiter.
You don't have Graves' disease based on your lab results. The antibody tests you had just show mild thyroid autoimmunity and this is common in women older than 50 even in the absence of a thyroid disorder.
I don't see why you'd need another ultrasound at this time although your doctor may want to repeat this test in a year or two to make sure that none of your nodules are growing. I don't see why you'd need the nuclear scan. If your doctor really thinks you have Graves' disease, she should have ordered a test for TSI. TSI are the thyroid antibodies that cause hyperthyroidism in Graves' disease. I'd probably just have yoiur GP or Family Practice doctor manage your condition.
Since FT3 is slightly elevated but FT4 is fine, you might just want to make some dietary changes to help lower it. Like adding 1.0 cup of goitrogens to your diet (raw broccoli, cabbage, almonds, kohlrabi, peanuts, peaches, squash, etc) and reduce the amount of iodine in your diet by avoiding processed foods. Your TSH is low but in hyperthyroidism your condition would still be considered subclinical, and a low TSH on its own doesn't cause problems. Elevated thyroid hormone levels do. best, elaine