Decision on thyroidectomy

[daliav]

Hello everyone, this is my first time posting but I've been reading posts as a guest for some time. My story is similar to many: I was diagnosed with Hashimoto’s and a “discreet goiter” after my son’s birth twenty years ago (I’m 46 years old now). I was put on 100mcg of Levo and since then I’ve been struggling.

I have multiple nodules and now my doctor recommends I have a total thyroidectomy because they are becoming “suspicious”. I’ve had a centigram, but the result was “inconclusive”. I haven’t done a fine needle aspiration yet, because my doctor (with whom I have a good relationship and with whom I agree most of the time) doesn’t believe that disrupting nodules is the best approach.

I have to decide whether I have the thyroidectomy, but I don’t know what to do: If I postpone the surgery and the nodules become cancerous or if I have the surgery and my health and symptoms become worse than they already are.

I live in Portugal and the only prescribed treatment for thyroid issues is Levo. If I am already feeling sick with an underactive thyroid (I wonder if it is still active after all these years), what will happen after I have no thyroid and don’t get any kind of T3 from any source at all.

I have an appointment with another endo on the 25th to ask for a second opinion, because I can’t make up my mind.

My latest lab results (last February) are:

Thyroglobulin - 9.8 (≤35.0)

Free T3 – 3.25 (2.50 – 3.90)

Free T4 - 1.29 (0.61 – 1.12)

TSH 1.02 (0.38 – 5.33)

Thyroglobulin Antibody – 14.6 (≤4.0)

Anti-TPO Antibody – 1.0 (≤9.0)

Sodium – 136 (135 – 148)

Potassium – 4.3 (3.5 – 5.3)

Chloride – 105 (98 – 107)

Calcium – 9.0 (8.8 – 10.6)

Phosphorus – 2.9 (2.5 – 4.5)

Alkaline phosphatase – 55 (40 -100)

TGP/ALT – 16 (≤34)

My symptoms are: Severe ankle swelling, very lethargic, lack of restorative sleep, difficulty maintaining weight (I’m constantly overweight, but it’s getting worse), feeling of being bloated and body fat gain in the mid-section after being a “pear shape” all my life, breathlessness after walking small distances, etc.

Any help would be greatly appreciated, especially regarding decision on thyroidectomy.

Thanks Dalia

[Clutter]

Daliav,

In the UK it is protocol to fine needle aspirate and biopsy nodules >2-2.5cm and nodules >1 - 1.5cm with suspicious characteristics. I would want a FNA biopsy biopsy to confirm or rule out malignancy before agreeing to surgery unless the goitre is causing you trouble in other ways and needs removing anyway.

TSH is low-normal, FT4 is mildly over range and FT3 is mid-range which indicates you are adequately dosed on 100mcg. The T4 in Levothyroxine you take converts to T3. Currently your conversion is good. You may need a higher dose if you have a thyroidectomy but the principle is the same. Portuguese members have been prescribed Sanofi-Aventis Cynomel (T3) which is imported from France if their FT3 isn't good. Alternatively you can obtain T3 without prescription online and self medicate.

Thyroid peroxidase and thyroglobulin antibodies are positive for autoimmune thyroid disease (Hashimoto's). There is no cure for Hashimoto's which causes 90% of hypothyroidism. Levothyroxine treatment is for the low thyroid levels it causes. Many people have found that 100% gluten-free diet is helpful in reducing Hashi flares, symptoms and eventually antibodies.

chriskresser.com/the-gluten...

thyroiduk.org.uk/tuk/about_...

I had completion thyroidectomy after a nodule removed during hemilobectomy was found to be malignant. Radical thyroidectomy to remove as much thyroid material as possible meant so little thyroid cells remained that Hashimoto's burned out which was an unexpected bonus for me.

[daliav in reply to Clutter]

Thanks Clutter for prompt response and the links.

I'm already trying to come up with gluten free alternatives, but I'm having a hard time specially with breakfast.

I'll wait for the 2nd endo's opinion on the 25th but I'm not inclined to have surgery unless I really have to because I'm afraid my already debilitating symptoms will get worse.