Tsh and thyroidectomy

[Sweetart]

I have had a thyroidectomy due to a mutlinodular goitre, my Tsh has never stabilise, I have spoken to my dr who will monitor me more closely every 8 weeks ,

My latest tsh came back as 2.65 (0.3 -5.6)

I am sure I have read that I should be kept at 1 or just below ,if that's right is there any info I can print off and go and speak to the surgery about it,

I feel a bit hypo but nothing major, shall I just wait until next blood test or push the surgery for a dose increase?

Many thanks in advance 😊

[fibrolinda]

Dr Anthony Taft wrote an article about this if you email Louise at thyroid uk and ask for a copy you can show your GP TOFT not Taft, blooming auto correct got me again

[Sweetart in reply to fibrolinda]

Thanks that's fab I will email her now x

[shaws Administrator]

Email [e-mail] and ask for a copy of the Pulse Online article by Dr Toft (ex President of the BTA). This is an excerpt:=

6 What is the correct dose of thyroxine and is there any rationale for adding in tri-iodothyronine?

The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This ‘exogenous subclinical hyperthyroidism’ is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).

[shaws Administrator]

As you've had a thyroidectomy my personal opinion is that you should have T3 added to your T4. The doctor, of course, may want to see if you convert sufficient T3 from the T4 (T4 - levothyroxine - is inactive and converts to T3). T3 is covered in Dr Toft's article.

[SlowDragon Administrator]

Might be a good idea to check levels of vitamin D, folate, B12 and ferritin. We need these at good levels to help use thyroid hormones in cells. Always get printed copies of all results including ranges.

Just any where "in range" may not be good enough, they need to be optimal.

When you get results post on here and members can advise

Have you had antibodies checked to rule out also having Hashimoto's (autoimmune thyroid). If you do have Hashimoto's then food intolerances are common (usually gluten) as well as low vitamins.

I would agree with shaws you may well need addition of some T3. Ask for referral to endo, as GP's are unable to prescribe.

[Sweetart]

Thanks for advice ,I will get a copy of article and go to the surgery ,we apparently have a 'health buddy' that we can go and discuss treatments and conditions with .

Thank you Shaws I am thinking about t3 I will discuss it with them as my free t3 was 4.6 (4 -6.6) so just scraping around the bottom,I am having to sleep again in the afternoons.

Many thanks

[SlowDragon Administrator in reply to Sweetart]

Looking at your previous posts, I don't see any results for antibodies, vitamin D or ferritin.

Very important to check all three. If you have Hashimoto's, (raised antibodies) then looking at food intolerances is essential, most often gluten.

[Sweetart in reply to SlowDragon]

Thank you slowdragon for asking ,I had some tests done in April when I felt rock bottom ,(blue horizon )and since then I have been working through them buying supliments and then waiting to feel the benefit,my b12 in April was L 222 insufficient,so I supplemented these and the result was fantastic,I think I had been pretty low for a long time. ferritin was 57.7 (20-150)foliate was 12.84 (8.83-60.8) so not great ,I am supplementing selenium at the moment.

I do have food in tolerances and have to eat a clean fresh diet,how do the anti bodies work In my test in April I had

Anti-thyroidperoxidase 11.6 <34 and Anti thyroglobin abs 17 <115 can you still have hashimotos without a thyroid ?

Thanks in advance.🤗

[SlowDragon Administrator in reply to Sweetart]

Antibodies are low, so are fine.

Have you got a vitamin D result? Also is very important for helping Thyroid hormones work. Recommended we keep level above 70 nmol/L (UK units) and nearer 100 nmol/L probably better

[Sweetart in reply to SlowDragon]

I haven't had a vit d test but I have brought an oral spray,I am planning to get another test in a couple of months to see if everything is better,

I'll post new results.