Knock on effect of TSH

I was booked to have my 2nd hip replacement operation today, but have just received a phone call from the hospital saying it's been cancelled. They've been grappling with my thyroid blood results it seems; have consulted an endo who said I'm not fit to undergo a major operation. The results were Free T4 0.3, TSH 0.02. Can't remember the ranges she said, didn't write them down. But as I said to her, I only take T3 so the FT4 result isn't applicable and the TSH result shows I'm well as last. It seems they didn't bother to do the FT3 test, despite my records showing I only take T3. !!! So now, to get this 2nd hip sorted out, I will have to reduce my thyroid meds to manipulate the blood tests. Aaaarrrrggghhhhh ! Still smiling (just). The injustice, hypocrisy, the ignorance takes the biscuit

28 Replies

  • How did you get the first hip op?

  • I was undermedicated at the time, unknown to me.

  • I think i would ask to have a conversation direct with the endo .

  • My 1st hip replacement was 18 months ago and I really was not well at that time. Still came out alive!

  • Further in this sage today, I've discovered the hospital I was meant to have my operation today (a private one but the NHS pays to send patients there), were so confused by my thyroid pre-op blood test, they consulted an endo to get interpretation. Turns out that endo was Professor Wasim Hanif at Queen Elizabeth Hospital Birmingham, a teaching hospital, and presumably he lectures. Specialises in diabetes especially Asian, erectile dysfuntion. !! Still fuming! I'm pushing to get to speak to him to ask his take on my T4 result, taking into account I only takeT3

  • Marigold22,

    It's likely your suppressed TSH which has them in a tizz. If you can't talk them round you may need to reduce dose to let TSH rise until after your op.

  • thanks Clutter. How long do you think I would need to reduce my T3 dose for in order to get my TSH within their range? Sorry, haven't got their ranges at the mo. I've phoned the endo's secretary & she is emailing him, I want to talk to him but it will probably get me into trouble... seeing as he's a professor!

  • Marigold22,

    How much T3 do you take?

  • 40mcg a day prescribed by GP, plus around 12mcg extra which I get myself. The extra 12mcg is a new addition, since about the last 4 months.

  • Marigold22,

    Do you know what TSH was on 40mcg?

  • I've avoided thyroid blood tests from my GP but have found 3rd Feb 2015 - TSH 0.05 (0.40 - 4.00). I was def on 40mcg daily at that date. So it hasn't really changed.

  • Clutter, thanks. Also on 3rd Feb 2015, FT3 was 10.1 (3.20 - 5.90) & FT4 was 1.3 (10.60 - 21.00). This is actually making sense to me now my brain is not foggy at all!

  • Marigold22,

    TSH 0.05 may be acceptable to the anaesthetist if FT3 is within range. If you want to be certain you may need to reduce T3 dose to 30mcg for 3 or 4 weeks to enable TSH to rise.

    If you left 12-24 hours between last dose and blood draw you were very over medicated to have FT3 10.1, it should remain <5.90.


    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.

  • I took my 40mcg of T3 at 8am on the day I had that blood draw (at 11.45am) as it was for my operation and not for my GP. I stupidly didn't realise that my thyroid would be checked!

  • Sorry I'm being stupid... you were referring to my Feb 2015 results. Thanks for your help Clutter

  • Marigold22,

    Are you sure that only TSH was tested pre op? Taking T3 before the blood test will return an elevated FT3 level but won't affect TSH.

  • The hospital tested TSH and FT4 only, not the vital FT3. Sorry, I've lost your thread here. I've always found these thyroid tests confusing

  • Marigold22,

    I was just trying to narrow down whether high FT3 was part of the problem. Obviously not, as it wasn't tested.

  • Thanks for your help. I have thought there may be something else happening here as I don't feel well on 30mcg T3 a day, but my thyroid bloods have been a nightmare for everyone to interpret, including me! It seems my TSH is constantly extremely low, my FT4 low off the chart, and my FT3 very high.

  • Marigold22,

    FT4 is bound to be low when you are taking T3 only. Low/suppressed TSH is fine when FT3 is within range. I only suggest you drop to 30mcg which may not be enough for you to feel well in order to raise TSH so you can have your op.

    If you can discuss your thyroid levels with the anaesthetist and explain you are taking Liothyronine only he may be reassured and happy to proceed with suppressed TSH as long as FT3 is within range.

  • Thanks so much for your help. Ironically my surgeon gets it & can talk to his anaesthetist. It's the others who don't get it. x

  • Be careful. If you have been taking T3 for any length of time your TSH may remain suppressed even if you stop. I've been taking NDT, which contains T3, for 15 years and even when I stopped for eight weeks my TSH (don't ask!)stayed stubbornly at zero - but I was dying rapidly.

    You need a letter from whoever gave you T3, or failing that an appointment with the relevant endo to explain the situation.

  • Thanks Ruthi. It was Dr P who changed me from T4 to T3, so I'm up a creek as far as that goes! If your TSH stays suppressed even if you come off your NDT it must be frightening.

  • Well, its a concern, but since I am totally dependent upon it I don't have a lot of choice!

    Honestly, you need to see that endo.

  • Thanks. My surgeon has phoned me this evening to profusely apologise for what happened today. Apparently his anaethetist was the one who contacted the endo, but my surgeon admitted it was the worst thing that could have happened. He knows I should have had a FT3 blood test & has now booked me in for one on Wednesday. I have never seen that endo, he was only consulted by them to get his appraisal on my pre-op blood tests. In the meantime I have asked endo's secretary to get him to contact me. I'm a bit scared I will make him angry if & when he does contact me!

  • Don't take any T3 for 24 hours before the blood draw. You'll feel knackered, but you are much more likely to get a test result for Free T3 that your doctors/surgeons are happy with. It won't change your TSH though.

  • Its your body, and you are entitled to do what you like with it. You are the one that should be angry! How dare he be so lazy!

    With your T3 being fine there is no increased risk that you will contribute to his death rates, so there is really no argument against doing the op. And the surgeon clearly understands all that. What a shame he isn't an endo!

  • Sorry - who are you saying was lazy? The professor endo? i don't think he was being lazy - he knows no different.... a total waste of space being paid (no doubt) £200k+ per annum. In the past I have told my orthopaedic surgeon he should study endocrinology... his eyes rolled, but after this episode he understands why I said it.

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