[jg7]

#1019251

I saw a neurologist about shaking hands thinkng I had essential tremor. Bloodwork came back as low TSH, High T3 and sort of

High T4. (don’t have the exact numbers yet)
I’m male, 33, 178 lbs, avid athlete and I run sprint triathlons. I have always had mildly shaky hands since high school, but it

seems to have gotten worse in the last few months. I blew it off in college as too much Mountain Dew and late nights studying.

(I quit drinking that kind of stuff years ago) Now it is to the point where co-workers notice and I feed like an idiot. My

diet is excellent consisting of Kashi ceral for breakfast with Soy milk, sweet potatoes, lean beef, veggies, yogurt, nuts, and

lots of fruit and fruit juice.

Symptoms:
shaking hands
pounding heart but still only 60-80bpms, feels like a skip 1-3 times per month while sitting at my desk
feel adrenalized all the time and gets worse if I think about running a triathlon
wife says I’m irritable
Low TSH
High T3, T4

Haven’t checked TSI yet but plan to make the Endo check it when I see her on Thursday. I assume that will come back high which will confirm what I think I alredy know, GD.

Has anyone had low-dose RAI and recovered without needing hormone replacement drugs? It seems like everyone who goes thru this ends up Hypothyroid. What are common RAI levels given? From what I have read it should be less than 30mCi. Why not try something really low like 5mCi to partially ablate the thyroid and see what happens? You can always take it again since it is cumulative right? I would rather try that than overkill in the first dose.

Any info about the options RAI, surgery, anti-thyroid drugs, etc is appreciated. I’m leaning towards PTU or Methimazole right now since it is less permanent in case it doesn’t work.

Thanks for any info.

[James]

#1070360

I would ask my Dr. to assess (from the test results), the severity of the diagnosis. For example, when I became extremely hyper, my TSH level wasn’t just low, it was undetectable low (below 0 on the scale). Yet, while in remission my TSH level still remains in the lower quadrant of the range (this is normal for me). The TSI test wasn’t routinely requisitioned for back in the day when I was initially diagnosed, yet I feel it provides valuable information. It is good that you are having this test done. The thyroid uptake scan was and still is routinely used and will help your physician determine the amount of RAI required for Thyroid ablation should you decide on that option. It could also be a guideline to help determine how much ATD (antithyroid drug) you will need to take initially.

You are correct in saying that PTU/Methimazole is less permanent. Your other options are always still open to you at any time should you change your mind. I will add that it was more common in years past for a physician to administer lower doses of RAI in order to attempt a state of thyroid equilibrium. Some of the Facilitators here can comment on their experiences of the “lower dose” RAI treatment. I think the trend with most physicians is to move to a higher dose or RAI to fully ablate the thyroid the first time, rather than dealing with constant fluctuations to thyroid levels as the thyroid gradually dies off.

It’s good to see that you are actively involved in your treatment and looking for information. I am always encouraged when I see new the newly diagnosed taking an active interest in their health care.

Best to you,

James

[Ski]

#1070361

So true, James! ” title=”Very Happy” />

The low-dose RAI is largely abandoned at this point, because as long as thyroid tissue exists, it has the potential to react to antibodies. We will always have the antibodies, and they fluctuate for reasons we don’t fully understand, so "spikes" in activity have the potential to render you hyperthyroid at any time. At that point, you would think that the idea would be to control your levels with ATDs ~ oops, why start with a low-dose RAI if you’re left with managing on ATDs anyway? On another front, it is safer to do this all in one shot because any cell that is only partly destroyed has the potential to continue acting, but incorrectly. Better all there, or none there.

I actually intended to do a full ablation RAI (back in 1999), and my endo agreed with me, but the radiologist/oncologist who formulated the dose decided he would prefer to do a low-dose (never consulted with either me or the endo). I wasted a lot of time being ALMOST well, and I’m paying for that now. I wasn’t able to get back to exercising as soon as I’d have liked to, etc. etc.

You really sound like you have a good handle on where you stand right now, that is GREAT. For someone who’s hyperthyroid, it’s pretty amazing. ” title=”Wink” /> Oh one point ~ your heart rate may still be low precisely because you are so fit, and even a "high" heart rate for you reads more like "normal" for the rest of the world.

Anyway ~ get your test results and make sure this is your answer, then start asking the question of treatment. It’s a complicated decision to make, but it sounds like you’re well on your way already!

[Author]

Posts