# TSH normal after RAI



## bdavis (Feb 26, 2016)

Hi all,

I had RAI on March 28th. I saw my endocrinologist on May 23rd after having bloodwork on May 16th. At that time, my TSH was elevated from zero before all this happened (well, 0.06) to normal but heading up. He expected that it would be high and I would be hypo in another month. I had bloodwork on June 14th and it is headed down again (but still normal). I never expected it to go down again after being zapped by the RAI. Is that a normal fluctuation? My doc so expected a high TSH that he gave me a prescription for Levothyroxine to fill when we got the new reports. I am not supposed to see him again until September.

These are my results: Feb. TSH .06 (range .4 to 4.5) (didn't get T4 then)

Had RAI in March

May TSH 3.51 (range .4 to 4.5) Free T4 .7 (range .8 to 1.8)

June TSH 2.23 (range .4 to 4.5) Free T4 .8 (range .8 to 1.8).

Can anyone tell me if this is normal in anyway after RAI? I'm very glad to be normal (I feel pretty good as well), but I am wondering if I am heading back to hyper territory.

Oh, and I had the RAI for a hot nodule.

Thanks!

Betsy


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## jenny v (May 6, 2012)

After RAI, you pretty much need to focus on the Free T4 result for dosing. And you need to insist they run a Free T3 lab every time, as well. Your FT4 is pretty darn hypo right now, as it is.

I never had to do RAI, but I've heard it doesn't always kill off the thyroid with one dose. I know a lady who had to do it three times before it totally worked. After the first two times, her thyroid kept popping back into life and began spitting out hormones again.


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## bdavis (Feb 26, 2016)

Thanks for that response! So, even if my FT4 reads normal, because it is so low-normal, that's hypo? He didn't ask for that on the first labs I had in this journey, so I don't know what it was when my TSH was basically zero. Can you explain about the Free T3 lab as well?

I think if my nodule keeps spitting out hormones (ugh) I might go the TT route next time. I really didn't like the RAI on any level, but my doc was all for it and it seemed easiest at the time. Then I just fretted about radiation for weeks.

My doctor is pretty good about explaining everything BUT he is gone for a month (which is why he left the prescription with every indication that I would be hypo by now). I do have moments of extreme fatigue, but mostly feel so much better than before RAI.

I wish I understood the FT4 and FT3 connection more.


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## jenny v (May 6, 2012)

Basically, FT3 and FT4 are the active hormones in your bloodstream that your cells use to do their thing. The thyroid produces T4 and the body converts it into T3, which the cells suck up and use. T3 is one of the biggies--it helps with energy, metabolism, etc. I'm betting if your FT4 is low (which it is at .8), your FT3 is low, too.

I would push to get a FT3 test done--it's also a good one to check after you start the levo. Some of us do fine on a T4 only medication (like levo) but others of us need some extra T3 in our meds (like Armour or Westhroid or Naturethroid).


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