Thyroid help!!

[Answerhunter]

\\\\AT A COMPLETE LOSS/// Diagnosed with hypothyroidism 3yrs ago with a TSH level at 90. It was decided by ICU Doctors to be caused by long-term use of Lithium Carbonate. Went on Levothyroxine 125mcg ( this maintained a +/- 1.06 TSH level) and after a few months things started to level out. Fast forward to 2.5 months ago, I ran out of Levo, relocated to new state and had to find a new GP. Now rather than writing a new script, GP decides to run full blood work - ok by me! At this point I had been of Levo for 4 weeks; blood work came back as 4.5 TSH and GP instructed to hold off on started Levo again as my TSH was technically within some kind of range. So off Levo, TSH was holding fine (Their opinion) but in the meantime my body was diminishing at an alarming rate with all the usual symptoms of hypothyroidism. 6 weeks go by and it was bad - hospital admittance time or back on meds, were the only things I was considering, I went back to GP for blood work and after waiting 2 weeks for its return the outcome was shocking: TSH- 2.68 and Free T4- 1.00! I was told by GP that I don't have hypothyroidism and to no take Levo anymore. To me this was unacceptable! I had already filled the Levo script and informed GP that I would restart anyway, as there is no info supporting her claim that hypothyroidism can go away on its own. So here we are, 3 weeks past this whole mess and back on Levo, all symptoms have either subsided or gone away despite the BW results of a level TSH. HOW, HOW, HOW??? I am unable to find any info or record of a "self- regenerating" thyroid. I have searched high and low, mostly through American studies or papers so now I am trying to expand into others experiences and knowledge. Please inform, teach or correct me! I NEED to understand this.......

*I do plan to order more blood work in about 3 weeks, just to see what TSH levels are at after being back on Levo for 6 weeks.

Thanks for reading and I appreciate any and all help offered.

[Clutter]

Answerhunter, if your hypothyroidism was Lithium induced it can recover when you stop taking Lithium.

Thyroid function tests usually return to normal if lithium is discontinued.

Monitor TSH levels and reduce or stop the dose of levothyroxine as appropriate.

The recommendations on how to manage lithium-induced hypothyroidism are discussed in a review of the literature and guidelines for treatment for lithium-induced subclinical hypothyroidism [Kleiner et al, 1999], and a review article [Bocchetta and Loviselli, 2006].

The full text below is from guidance to UK GPs treating patients with Amiodarone and Lithium induced hypothyroidism.

Scenario: Amiodarone or lithium treatment

Scenario: Amiodarone- or lithium-induced hypothyroidism

Age from 16 years onwards

Management

How should I manage someone with amiodarone- or lithium-induced hypothyroidism?

•If the person has amiodarone-induced hypothyroidism:

oRefer to endocrinology if a goitre or nodules are detected.

oThere is no need to stop amiodarone therapy.

oStart levothyroxine replacement therapy (see prescribing information).

Assess thyroid-stimulating hormone (TSH) levels after 4–6 weeks. Aim to achieve a normal concentration of TSH.

Aim to keep serum free thyroxine (FT4) concentrations in either the upper end of the normal range or slightly above the normal range (as seen in euthyroid people who receive amiodarone).

oThyroid function tests may return to normal if amiodarone is discontinued.

Monitor TSH levels and reduce or stop the dose of levothyroxine as appropriate.

•If the person has lithium-induced hypothyroidism:

oRefer to endocrinology if a goitre or nodules are detected.

oDo not stop lithium therapy.

oStart levothyroxine replacement therapy (see Prescribing information).

Aim to achieve normal concentrations of TSH.

Aim to keep FT4 concentrations in either the upper end of the normal range or slightly above the normal range.

oThyroid function tests usually return to normal if lithium is discontinued.

Monitor TSH levels and reduce or stop the dose of levothyroxine as appropriate.

Basis for recommendation

•These recommendations are based on expert opinion in a review article [Vanderpump et al, 1996]; a UK consensus guideline produced by the Association for Clinical Biochemistry, the British Thyroid Association, and the British Thyroid Foundation [BTA et al, 2006]; and the opinion of CKS expert reviewers.

oThe recommendations on how to manage amiodarone-induced hypothyroidism are discussed in two systematic reviews [Harjai and Licata, 1997; Basaria and Cooper, 2005].

oThe recommendations on how to manage lithium-induced hypothyroidism are discussed in a review of the literature and guidelines for treatment for lithium-induced subclinical hypothyroidism [Kleiner et al, 1999], and a review article [Bocchetta and Loviselli, 2006].