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Please note that Thyroidologists who hold opinions that differ from the advice we have offered are welcome to send in responses, and we will publish these comments. Commentators should kindly include name, office address, and Email address.

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QUESTION-I will appreciate for help in another patient who is a neurosurgeon, had RAI for graves disease in 2009. He has been on levothyroxine since then but for last 6-8 months, he has been having episodes of dizziness and vertigo. He tend to have these symptoms when his TFT levels are in euthyroid range but feels extremely WELL when his TSH is high. His TFT are shown below. I checked his TSH with HAMA and it did not change. As you can see, in May 2014, when his TFT were normal, we had to admit him to hospital for his symptoms. His alpha subunit to TSH ratio is less than 1 when his TSH is 5.5 FT4 is 1.1 ad FT3 is 2.0 and alpha subunit is 0.5. MRI of pituitary has been done and is normal.

Is it pituitary resistance to TH that he AQUIRED in 2013?

Iftikhar A. Malik, M.D. TCP Endocrinology

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