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



## Alise (Dec 24, 2014)

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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## Andros (Aug 26, 2009)

Welcome to the board! You have a very wonderful doctor and I would take his/her advice as several things raise the suspicion of cancer such as the cold nodule and vascularity.

In addition; why continue to suffer hyperthyroid? The only true cure for that is to remove the thyroid. Staying hyper and taking anti-thyroid meds will only wreak havoc on your body inside and out over the long haul.

The above is my opinion based on personal experience w/hyperthyroid.

You will hear from others after we get through the holidays here.


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## Lovlkn (Dec 20, 2009)

> In addition; why continue to suffer hyperthyroid? The only true cure for that is to remove the thyroid. Staying hyper and taking anti-thyroid meds will only wreak havoc on your body inside and out over the long haul.


I agree - have your thyroid removed.

I wish I had removed mine sooner


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## joplin1975 (Jul 21, 2011)

I often say that having my thyroid removed gave me a good ten years back, in terms of how I feel. If someone is wiling to remove it, if that someone is trustworthy and experienced and if you have someone who will propely manage your meds post-op, do it!!!


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## Alise (Dec 24, 2014)

Dear All,

Thank you very much for your support and opinions.

I would like to ask: could you please suggest to me any forum (web-page) where I could get an opinion of a doctor?

Have a nice day!


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## jenny v (May 6, 2012)

I don't know of any web forum where doctors post advice, they want you to come in for consults so they can see you in person. Posting on a web forum would probably open them up to lawsuits, too.


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## webster2 (May 19, 2011)

I agree, your thyroid needs to come out. I had part of mine removed in 1991. Looking back, I wish it had all been removed then. I had no idea I was not feeling great for 20 years. I feel wonderful now. I think a lot of your symptoms would go away with the removal of your thyroid. I am not a professional but someone who was at the mercy of an unreliable thyroid for over 20 years.


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