Thyroid UK
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Any advice please

Hi all - just wondered if anyone had come across this scenario before. I am due to have an arthroscopy (knee surgery). My pre-op assessment included blood tests. My Thyroid results came back as TSH 0.02 (0.27-4.20) and my FT4 8.1 (11-25). They didn't test FT3 even though I take Liothyronine. I take 100mcg T4 and 20mcg T3. I know both results are very low but my endocrinologist has always been OK with that, however, the Anesthetist is refusing to be part of my operation due to the abnormal blood results and won't consider it until my TSH is in range. I feel better when my TSH is suppressed - any ideas?

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Is there a possibility, if your endocrinologist is supportive of you with these blood test results, he/she could write or speak with the anaesthetist ?

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Thanks for the reply LT - It's certainly a possibility and I'm sure the endo isn't worried at all. I can understand where the anesthetist is coming from as well though as if anything did happen to me (he didn't stress what!) he would be found partly liable as he knew my results were 'abnormal'. x

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I have had to had 3 surgeries all major in the last two years. My TSH is always supressed with the same reading as yours as I am on a ndt. The anesthetist told me they prefer to have the thyroid levels in the upper part of the range, especially ft3 as this aids recovery. My Endocrinologist liaised with the surgeon & anethatist, explaining , which really helped matters. I had no problems with the anaesthetic & all surgeries followed a normal recovery pattern.

In your shoes I would contact your Endocrinologist & ask if he/she could contact them to explain your health needs. Liothyronine can be injected whilst you are not able to take it orally.

I have learnt to keep a seperate supply of my thyroid meds as I found staff didn't seem to understand the timings. They fit all your meds into their routines of drug administration which may not be the best for you.

Hope this helps

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Hi WL - many thanks for the reply and sorry to hear that you have had to have 3 surgeries. I just take my meds first thing so I don't think that should be a problem :)

I think the best way forward is, as suggested, to get all the relevant people talking to each other.

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Terri

Is this for general anaesthetic? Just wondering if the same applies to the procedure being done with a local anaesthetic. My cousin has had both knee replacement and hip replacement done with local. She doesn't have a thyroid problem, but it's just something that popped into my mind.

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Thank you for the reply SSS, I'm too much of a coward to have local :( but it would solve all issues. x

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I hear you Terri :) Not something I'm sure I could contemplate either but I get why she did it - breathing problems and nearing 80 at the time. She didn't feel any pain but did know there was pushing and pulling etc - eek!!!

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I had three surgeries in 2 yrs at 2 different hospitals and within 2 specialties, with a TSH similar to yours - and no problems. One anaesthetist expressed interest in liothyronine (she couldn't spell it!) but only wanted to know why I took it in addition to levothyroxine, and simply found my explanation interesting. I explained that TSH is a pituitary hormone, not thyroid, and was largely irrelevant once taking exogenous hormones. I also explained that taking T3 meant that there was less need/demand for T4, so levels were generally lower which was fine so long as the T3 level was good. No one kicked up a fuss at all. I wonder if your anaesthetist would refuse to participate in lifesaving emergency surgery if you suddenly required it this afternoon? As others have suggested, he needs to better inform himself by talking to your Endo, because it's not his area of expertise.

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Thank you for the reply NMT3 - this is why I love this site, always common sense answers from everyone. I'm sure my endo will educate the Anesthetist. Sorry you've had to endure so many operations though. xx

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Just an update - and I don't know why I'm surprised ;o) - Endo has written to me to say 'stop taking T3, get your TSH back in 'range', re-test in 6 weeks, hopefully you'll be able to have the operation, then afterwards we'll start again from scratch with T3 and T4'. Wonder how ill I'll become in order to get my TSH to 1, 2 or above!

Thanks for all your replies though :) xx

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