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Forum Name: Endocrinology Topics

Question: from euthyroid to hypothyroid while on levothyroxine


 Maddiegirl - Fri Jun 11, 2010 5:50 am

Hi,

I'm 47 with a dx of Grave's Disease in '93, treated with RAI 131 and subsequently became hypothyroid 4 months later. I have had successful treatment for the most part with synthroid then levoxyl or levothyroxine keeping my TSH between 0.3 to 2.0 but clinically feeling best at <2.
Back in nov'09 I was dx with hyperparathyroidism, found to have 1 adenoma, had 1 and a half parathyroids removed. Follow-up labs showed all my levels to be mostly within range.(PTH, ionized CA, TSH)
TSH = 0.05 while on 200 mcg of levothyroxine. For the most part I felt pretty good but my doc felt best to decrease my medication to 175 mcg. That dose was started at the end of february '10.
Well I finally got rechecked and to all of our dismay my TSH was 19.0. no wonder I have been extremly constipated, brittle nails, losing tons of hair, very dry skin, extremly dry skin. My dose was just changed back to 200mcg.
Something else just started with me that I never experienced.... a firm large swelling/lump over or under the medial clavicle extends closely towards substernal notch on the left side. It is painful but feels almost like nerve pain not lump pain. Pain shoots towards shoulder, chest area and up neck into ear. Chest xray and lt clavicle xray are all normal.
Is there any correlation between the sudden large increase in TSH / this lump with anything else like ..... thyroid cancer?
Thanks I could really use some advise on this. I feel like the ER doctors are very quick to say "no fracture" nothings wrong. I don't think I mentioned that I have never had an injury to this area (shoulder, clavicle, neck) nor did I recently injure it. It just came out of no where.
 Dr.M.Aroon kamath - Thu Jun 24, 2010 7:56 am

User avatar Hi,
Your concern is indeed well founded.

Excluding thyroid neoplasms is important in patients with Graves' disease because reports have shown that differentiated thyroid cancer is probably more common in these patients and may also run a more aggressive course.

Most of the studies which show the above finding were surgical, and the patients were selected for surgery on the basis of suspicious nodules or large goiters. In patients with Graves' disease treated by radioactive iodine, no subsequent increase in the incidence of thyroid cancer has been reported.

Generally, diagnosing thyroid cancer in Graves' disease is not easy. If a malignant nodule is palpable, then it is far easier.Increasing use of ultrasonography and FNAC may help to increase detection rates.

Parathyroid adenomas have been reported in a small % of patients with thyroid cancer.Conversely, 3-10% of patients with parathyroid adenomas also have thyroid cancer . Exposure to ionizing radiation in the past may explain this association in some cases.

The swelling near the clavicle (? lymph node) that you had felt needs to be promptly assessed by a surgeon.In all probability, the rising TSH value following dose reduction of thyroxin is not indicative of an underlying throid cancer.
Best wishes!

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