What supplement to take after thryoidectomy due to cancer

[alm0405]

Hi, I had total thyroidectomy 5 years ago, on levothyroxine 200 mcg daily, wondering whether i should take a t3 supplement that you can buy? my GP knows nothing about thyroid suppression therapy so i can't ask him. would t3 be safe for me to take do you think?

[SlowDragon Administrator]

Have you got you most recent blood test results for TSH, FT3 and FT4 plus vitamin D, folate, ferritin and B12

Presumably your endo wants TSH suppressed, but if they don't check FT3 you can still be under medicated or a poor converter

Low vitamins affect conversion rate

For full evaluation you ideally need TSH, FT4, FT3, TT4 plus vitamin D, folate, ferritin and B12 tested

See if you can get full thyroid and vitamin testing from GP. Unlikely to get FT3

Private tests are available

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"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)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

please email Dionne at

[e-mail]

Professor Toft recent article saying, T3 may be necessary for many. Note especially his comments on current inadequate treatment following thyroidectomy or RAI

rcpe.ac.uk/sites/default/fi...

[Clutter]

Alm0405,

Not everyone needs T3 post thyroidectomy. 200mcg Levothyroxine is usually enough to suppress TSH <0.1. If you post your recent TSH, FT4 and FT3 results and ranges members will advise.

[alm0405 in reply to Clutter]

Just had full results, let me know what you think, thank you

THYROID STIMULATING HORMONE *0.034 mIU/L 0.27 -4.20

FREE THYROXINE 16.4 pmol/L 12.00 -22.00

TOTAL THYROXINE(T4) 99.6 nmol/L 59.00 -154.00

FREE T3 4.07 pmol/L 3.10 -6.80

THYROGLOBULIN ANTIBODY <10 IU/mL 0.00 -115.00

THYROID PEROXIDASE ANTIBODIES <9.0 IU/mL 0.00 -34.00

[Clutter in reply to alm0405]

Alm0405,

TSH is suppressed, FT4 is a little under halfway through range and FT3 is low in range. Thyroid antibodies are negative as you'd hope post thyCa thyroidectomy.

If you feel symptomatic you might feel better with higher FT3 from adding a little T3 to 200mcg Levothyroxine. I would start with 6.25mcg (quarter of a 25mcg tablet) for a week or two to see how you tolerate it. If necessary you could add a second 6.25mcg dose at bedtime a couple of weeks later but hold at 12.5mcg for 6-8 weeks and retest to make sure FT3 remains within range before increasing further.

[alm0405 in reply to Clutter]

Thank you so much

Do you think the GP will be receptive to the suggestion to take T3 or should I buy it?

[Clutter in reply to alm0405]

Alm0405,

GPs usually require recommendation from a NHS endocrinologist before they will prescribe Liothyronine and the extortionate price charged in the UK means many CCGs and health authorities won't approve it.

I'd be inclined to buy your own and see how it suits and if you like it to see whether you can persuade your GP or endo to prescribe it.

[alm0405 in reply to Clutter]

Thanks

Any recommendations on where I buy it?

Really appreciate your help