T3, T4 after thyroidectomy papillary

T3, T4 after thyroidectomy papillary

Hello to all

Please help-us in the understanding of my husband blood test results in the picture I attached.

He had a thyroidectomy on March 2015 due to papillary carcinoma.

My husband belives that the dosage of the euthyrox is not good enough for him, fiscally he is always very tired and anxious. He takes 950 mcg for week.

Sorry for my poor English, I am contacting you from Israel and I have yet to find a place on line that can give us a sufficient answear.

Thank you for your kind help


10 Replies

  • Welcome to the forum, Einav, and my compliments on your excellent English.

    Do you know whether your husband took Euthyrox before the blood test? If he did, Euthyrox will have been peaking in his blood stream for several hours and will give falsely high FT4 and FT3 results.

    The results indicate slight overmedication. TSH is suppressed <0.01 (in the UK thyCa patients' TSH is targeted <0.1). FT4 21.89 is slightly over the top of range 19.7 and FT3 6.10 is slightly over the top of range 6.05. Thyroglobulin, thyrogloblulin antibodies and thyroid peroxidase antibodies are very low, indicating there isn't thyroid activity and therefore little likelihood of cancer recurrence.

    It's highly unlikely your husband's FT4 and FT3 levels were so high prior to thyroidectomy and the high levels may be contributing to his anxiety and fatigue. If he took Euthyrox after the blood draw he is overmedicated and will probably feel slightly less anxious if he reduces dose from 950mcg to 775mcg week (-25mcg daily). Overmedication can also cause fatigue.

    Unfortunately doctors don't manage recovery expectations well. The trauma of a cancer diagnosis, experiencing major surgery and adjusting to the fact one has a chronic health condition is very difficult. The implication is everything will be fine 2-3 months after surgery, but the reality is that it will probably take up to a year, perhaps longer, to find an optimal dose of the right medication which resolves hypothyroid symptoms without inducing hyperthyroid symptoms.

    Nutritional deficiencies are common in hypothyroid patients. Ask your husband to have ferritin, vitamin D, B12 and folate tested. Low levels can cause symptoms similar to hypothyroid symptoms, including fatigue and anxiety.



  • Dear clutter,

    I have to say waowwww!! No one explained it to us like that, we didn't even knew what the range should be for T3,T4

    You are so helpfull

    Thank you so much!!


  • Einav, the ranges can change from lab to lab, they aren't universal.

    The lab your husband used is using:

    FT4 10.3 - 19.7 Result in the upper quadrant ie >17.35 - 19.7 is desirable.

    FT3 3.5 - 6.5 Result in the top third ie >5.48 - 6.5 is desirable.

    I misread the FT3 range last night. Your husband's FT3 is high in range, but 6.1 is within range not over. Tracking results with dose adjustments can be useful to determine which dose, and which result level, is optimal for feeling well.

    Thyroglobulin (Tg) and thyroglobulin (TgAb) antibodies are used as 'cancer markers' post thyroidectomy. Tg rising >6 may indicate recurrence. They're tested at 6 months intervals in the first year, and annually thereafter, in the UK. It's advisable to use the same lab each time to avoid variables in analysis and reporting methods. The five year survival rate for papillary thyroid cancer is 97%.

    It was more than a year before I was told that low Tg and TgAb meant I was in remission. I was relieved, but angry too. My doctors ought to have made sure I understood this immediately. I'm now in my 4th year of remission.

  • I can absolutely understand your anger. We are very confused, it seems that the doc. Are more concerned about the survival issue then the quality of life, every doctor we see want us to be thankful and see the half glass.... But!!! If he can't get out of bad and not feeling even remotely close to his old self then it's not OK, we don't even know what the range should be for T3,T4 after surgery, our lab uses the same range for everyone (healthy people or sick it doesn't matter), so we don't even know what to expect....

    In the Facebook forum I read that Endocrinologist Keeps the Patient "hyper" on porpoise for at least 2 years after surgery, but we don't even know what Hyper means (?!?!)

    Again sorry for any spelling mistake, hope you understood me ;-)

    Thank you again!! You are so very kind!!


  • Euthyroid : This means normal thyroid hormone output is found in blood tests. The patient (hopefully) feels well.

    Hyperthyroid : This means "overactive". The thyroid is producing too much thyroid hormone (or too much is being taken as a medicine/drug) for long-term good health, and people will feel ill.

    Hypothyroid : This means "underactive". The thyroid doesn't produce enough thyroid hormone for good health and/or the medicine or drugs being given are inadequate. The patient will feel ill in this condition too.

    The ranges used for people after thyroid surgery should be the same as for healthy people. If your body needs a certain amount of T4 and T3 before the surgery, then it still needs the same amount after surgery. If you can find out what levels your husband had before surgery, then the closer you can get to those with medication after surgery the more likely he is to feel well.

    Nutritional deficiencies are very common, as has been mentioned already. Since your husband has had surgery there is a very important issue that can arise with vitamin B12.

    If the anaesthetic used contained nitrous oxide (many of them do, it is very commonly used in surgery), it oxidises the B12 in the body and it becomes useless to the body. So the patient starts developing serious deficiency problems, even if the B12 level appears normal in blood tests. So, your husband needs to replace the damaged B12 as soon as possible because B12 deficiency is very serious.



    (Where there are references to cobalamin, this is another name used for vitamin B12.)

    Do some searches for "anesthetic B12 nitrous oxide" or "anesthesia B12 nitrous oxide".

    It would be a good idea to give your husband vitamin B12 supplements in quite high doses. The best one for quick absorption is methylcobalamin. If he takes more than he needs this is not a problem because the body just excretes any excess in urine. It would be good to take 1000mcg - 5000mcg per day - start with the lower dose, some people don't tolerate higher doses. Buy it as a tablet which can be stuck in the mouth somewhere it doesn't feel annoying, let it dissolve very slowly, don't suck, chew or swallow it whole - this helps to maximise the absorption. I buy one from a company called Jarrow Formulas, Solgar is also popular. I don't know what options you have available to you in your country.

    Please do your own research and double-check everything I've said. I'm not a doctor!

  • First off all thank you!!

    I checked he's blood test from February and found only T4 range which was 12..... Now it's 21(!!) so I can conclude that he is overdosed.... We have a doctors follow up on September 8th I will ask him how can we get him there!!

    By the way, my husband blood test, before the surgery, did not show any problem with his thyroid, it was only an ultrasound that found the Metastatic carcinoma, which lead to a full Dissection.

    Thank you for the good advise and knowledge it means the world to us, we really needed someone with experience to give us some *non* medical vaguely answers!!

    Wish you all good health:-)


  • Einav, Hyperthyroid means TSH is suppressed with FT4 and FT3 levels over range. 'Hyper' in the context applied to your husband means that your husband's TSH is suppressed <0.1 to prevent TSH stimulation of remnant thyroid cells left in the thyroid bed after thyroidectomy. Your husband's FT4 and FT3 should remain within normal range. His FT4 is slightly over which indicates over replacement.

    The problem with population ranges is that people with mildly abnormal levels aren't screened out which skews the ranges. If your husband can obtain his pre-thyroidectomy thyroid function test results he should be able to see at which levels he felt well and might target them as long as TSH remains suppressed.

    Doctors see their job done when the cancer is removed and thyroid levels within target ranges and can be unsympathetic, even hostile, when the patient doesn't respond.

    Low FT3 is often a problem in thyroidectomised patients but I think your husband's high FT3 and FT4 may, in part, be why he feels unwell. A 25mcg dose reduction should reduce his FT4 and FT3 levels with out raising TSH unduly. A 25mcg reduction raised my TSH from 0.01 to 0.03 well below the target <0.1. More recently dose reductions don't raise my TSH at all but do reduce FT4 and FT3 by several points.

    I was 90% bedbound for 15 months due to over replacement on 200mcg and because I was intolerant to Levothyroxine. I was also found to have severe vitamin D deficiency, folate deficiency and low B12 which undoubtedly contributed to the pain and symptoms I was experiencing. Correcting deficiencies and optimising levels played a great part in my recovery which is why I recommend ferritin, vitD, B12 and folate testing. Post the results in a new question and members will advise whether to supplement.

  • Hello Einav,

    Welcome to our forum and sorry to hear of your husbands health concerns.

    As Clutter has advised above your husbands results show him to be over medicated. This could account for anxiety.

    It can take many months for hormones to rebalance and your husband has also to recover from the trauma of surgery. Tiredness could be expected for several months.

    However, if he continued to feel tired a possible pathway to investigate could be the possibility of a convertion issue, when perhaps the euthyrox was not being used as it should within the body. Although these results show this NOT to be the case, perhaps a second test after 24 hour fasting might show a low T3 result.

    The antibodies levels are low showing no immune response in the body which is good.

    Nutrition is absolutely vital to help medication absorption and utilisation within the body. Good supplements to aid euthyrox absorption & usage would be Vit C, selenium, B complex and iron (only if low).

    Below is a link showing the importance of iron in connection to thyroid issues.

    I hope he makes a better recovery soon,



  • Dear flower,

    Thank you very much,

    I will check the issue of iron, and nutrition.

    No doc. Told us it is that important.

    Thanks again,


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