Effect of removing half of your thyroid

[dorset92]

I have previously posted my girlfriends results and asked for advice on this forum and had some good answers. She has been suffering symptoms for around 20 years and has the following results from two blood tests:

TS4 - 11 on test 1 and 12 on test 2 (Range 10-22)

TSH - 1.6 on test 1 and 2.4 on test 2 (Range 0.3 - 5.5)

T3 - 4.6 (Range 3.1-6.8)

We think her T4 is low but know that without a raised TSH her doctor will say everything is 'normal'. However, she had half of her thyroid removed (due to a cyst) 20 years ago and we are wondering what the effect of this could be. Does the remaining half 'make up' for the lost half? Does the pituitary understand what has happened and regulate TSH or does it think things are normal when in fact they aren't?

Any comments, thoughts or experiences would be useful for us to build our case for a referral to an endocrinologist.

Thank you

[Clutter]

Dorset92, In theory one thyroid lobe will pick up the slack and produce sufficient thyroid hormone. Over 20 years thyroid function can deteriorate whether it is the full gland or half. Pituitary gland doesn't *know* whether the thyroid gland is present and functioning, or whether half or all of it has been removed.

In primary hypothyroidism the thyroid gland dysfunctions. When pituitary detects low circulating thyroid hormone it increases TSH to stimulate the thyroid gland to produce more hormone. When sufficient hormone is detected pituitary reduces TSH. If the thyroid gland doesn't respond, or there is no thyroid gland, TSH levels will continue to rise until sufficient thyroid hormone replacement is provided.

In secondary hypothyroidism (pituitary dysfunction) and tertiary hypothyroidism (hypothalmic dysfunction) the thyroid gland is usually healthy but pituitary/hypothalmus dysfunction means the thyroid gland isn't receiving enough TSH stimulation to produce thyroid hormone and thyroid hormone replacement is required. The pituitary/hypothalmus dysfunction should be investigated in endocrinolgy as other hormones may also be deficient.

Your partner's FT4 is bottom of range, and with low-normal TSH, suggests possible secondary hypothyroidism (tertiary hypothyroidism is very rare), or isolated TSH deficiency. Her FT3 4.6 is surprisingly good considering her low FT4. It's low T3 which causes hypo symptoms. I think she should test FT4 and FT3 every 6 months and when FT4 is below range her GP should refer her to endocrinology if TSH hasn't risen.

It's worth your partner requesting ferritin, vitamin D, B12 and folate blood tests. Low/deficient levels can cause musculoskeletal pain, fatigue and low mood similar to hypothyroid symptoms.

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I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

[dorset92 in reply to Clutter]

Thanks very much clutter for you comprehensive reply. We have results for ferritin which we will find out on Friday. We will request the others too. It's probably worth us highlighting too that the second test results may have been higher as she gave blood 8 days prior to her test so we would assume that her blood volume would be low and distort the results.