6 months post total thyroidectomy and my tsh still high (10), being treated on T4 only and my endo refusing to add T3 mainly coz he doesn't know what dose to prescribe and also is waiting for tsh to come to normal ranges.problem is I have severe depression and cognitive dysfunction since the TT and both psychiatrist and endo have suggested 10 mg(low dose) of prozac (ladose).I have been taking 5HTP for months with only slight improvement .I was always very against antidepressants but at this point i don't know what to do.my psychologist says I should wait till my tsh stabilizes ,as I had slight bipolar before TT but this could have been the hasimotos.I dont know if I can wait any longer ,I need to function to survive out there .Any advise or experience with this topic ?thank you
Prozac after thyroidectomy?: 6 months post total... - Thyroid UK
Prozac after thyroidectomy?
If the only problem your endo has with T3 is not knowing what dose to prescribe, suggest to him that he follows the rules for hormones : start low and increase slowly. Start with a quarter tablet, and increase by 1/4 every two weeks. His ignorance really shouldn't be allowed to hinder your recovery, and the TSH is not going to 'stabilise' (hate that word!) on its own.
Rather than prescribing prozac they should make sure your T3 is optimum. greygoose has shown the way and we need T3 for us to exist and have relief of clinical symptoms. I have my thyroid gland and levo was awful for me and T3 wonderful. So I should imagine you will find a benefit with T3 even added to T4.
Endocrinologists who treat us know little except to look at a TSH and T4. They know nothing about the reason our body produces thyroid hormones (before being hypo or having operations to remove gland). I think they are unaware that T4 is inactive and has to convert to T3. They rarely test Free T4 and Free T3 which you can get your own through one of our private labs. I shall give you a link and read about why we need these two:-
thyroiduk.org.uk/tuk/testin...
I remember when prozac was first introduced there were lots of negative publicity regarding this product. If psychiatrists can prescribe T3 for depressed patients, surely an Endocrinologist could prescribe it.
Thank you for your response.Yeah exactly my thoughts..I even said that to the psychiatrist about T3 he had never heard of it and he is supposed to be one of the best in my country .I will keep searching and hopefully I will find at some point a doctor to work with my symptoms .
I don't use Doctors I just use this site post questions include blood test results and then self medicate it's easy and very effective. Please do not take Prozac.
How much T4 are you taking?
They raised me from 100 to 125 a month ago when tsh was 17 a month later it got to 10 so it's working i guess,also tested ft3 and it was ok.endo said we should wait full two months with higher dose and see results and then might try to experiment with T3
Adding T3 that is
125mcg isn't a high dose for someone who has no thyroid. Your endo is being far too cautious and slow to raise. You should have been started on 100mcg per day, left for 6 weeks or so then tested, then had a raise of 25mcg, then left 6 weeks then tested again, and keep repeating this cycle until you feel better and your Free T4 was reasonably high in range.
If you still felt awful, then it was time to look into Free T3.
To have dragged out this process for 6 months is simply sadism.
I agree with humanbean and many of us find, and are astonished, that the professionals don't seem to know anything at all except to keep the TSH in range.
I changed endo after the first one neglected to check my calcium levels after TT and ended up in ER for few days ,I think what happened with the new endo was full focus on restoring my calcium which almost lost my life that's how low it was.It has been a torture and a nightmare all this experience and all I want is to feel better this is why I am considering the Prozac in hope something will help .I am starting to dearly regret having this operation ,I was given a cancer scare which thankfully it wasn't but never had health issues before meaning all my ranges where fine before TT.that's why only the scan showed the nodules and hashimotos.
I think I will have the second checkup sooner and force by endo to raise t4 as you suggested .
Thank you for your time in replying and this forum is the only place I feel I am understood and get valuable advise .
I have a different viewpoint and I am not medically qualified but have had a rough time too even though I have my thyroid gland.
T4 is an inactive thyroid hormone. It has to convert to T3 - the active hormone which is needed in our millions of T3 receptor cells - the brain and heart need the most.
They should test your Free T4 and Free T3 and I'll give you a link and read the reason these are preferable but doctors or endocrinologists don't seem to do them.
It is thyroid hormones you need.desperately but have to be increased very gradually.
These are a couple of excerpts from the following link:-
In any event, I thought I would take the opportunity to catch up on the latest and greatest in T3 supplementation and safety issues, particularly since the very large STAR-D trial used T3 and found it equally efficacious in resistant depression to lithium use, and better than many other pharmaceutical tinctures. Fortunately there is an up to date review from the Green Journal, T3 Augmentation in Major Depressive Disorder: Safety Considerations. The article had a number of interesting points, particularly with regards to the standard endocrinology method of treating hypothyroidism with T4 monotherapy. I'll get to that in a bit.
and
In any event, I thought I would take the opportunity to catch up on the latest and greatest in T3 supplementation and safety issues, particularly since the very large STAR-D trial used T3 and found it equally efficacious in resistant depression to lithium use, and better than many other pharmaceutical tinctures. Fortunately there is an up to date review from the Green Journal, T3 Augmentation in Major Depressive Disorder: Safety Considerations. The article had a number of interesting points, particularly with regards to the standard endocrinology method of treating hypothyroidism with T4 monotherapy. I'll get to that in a bit.
I don't know much about calcium, apart from it is extremely important to keep it within range. If it is too low or too high then investigations must be done urgently.
However, I do think a doctor should be able to multi-task to the extent that he can read more than one number. Reading your calcium levels was obviously extremely important. But without a thyroid the levels of your thyroid hormones are extremely important too. It doesn't seem like too much to ask of your doctor that he checks both things!
It would be helpful if you could get hold of blood test results for thyroid, minerals and vitamins from before surgery (numbers and reference ranges), and also get hold of all results from tests done since your surgery.
It is important to keep copies of all these things and keep a history folder because you can then check :
a) which tests your doctor has actually done (which is often not the same as the ones he says he has done)
b) how your results are changing over time.
It is important as well, each time you have blood tests done that on the day the blood is taken you note down any symptoms and score how bad they are, as well as keep a list of which medications you are taking, which supplements you are taking, and which dose of these things you are taking.
A short list of thyroid symptoms can be found here :
thyroiduk.org/tuk/about_the...
A long list of thyroid symptoms can be found here :
hypothyroidmom.com/300-hypo...
Choose either or both lists, as you please.
Score your symptoms out of 10, with 10 being absolutely awful and life destroying or altering, 0 being non-existent.
If you have a test, and on that day your insomnia deserves a score of 7, then the next set of tests you score insomnia at 4, then you know it is improving.
You can then use these scores to show a doctor how your symptoms change with your dose and your test results.
This history will help you and your doctors. Be aware though that lack of motivation and poor memory can make this difficult to keep up for some people. Just do your best.
I had the same after my TT I was put on too high a dose of calcium and by the third week I was starting to fall over. After I explained to the pharmacy they told me to stop the calcium because my replanted parathyroids were already working again and I was overdosed. The only way I have been able to recover is my joining this site and now self medicate. You can do the same.
My parathyroids are still sluggish checking every month and even all these months after TT taking 3000mg calcium daily.
I am already taking all advise and articles here and looking for another endo.spoke to several already and unfortunately all have the same boxed views.
I am not based in uk but might be worth to take a trip there ,visit endos recommended here.
Thank you 
Suggest you find a more competent endocrinologist
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
tukadmin@thyroiduk.org
Also request the list of recommended thyroid specialists, some are T3 friendly
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...
Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine
(Many of us need TSH nearer 0.2 than 2.0 to feel well)
See box
Thyroxine replacement in primary hypothyroidism
pathology.leedsth.nhs.uk/pa...
I am already taking all advise and articles here and looking for another endo.spoke to several already and unfortunately all have the same boxed views.
I am not based in uk but might be worth to take a trip there ,visit endos recommended here.
Thank you
Sadly seems a global problem that a good thyroid endo is extremely difficult to find
I regret not having tried a holistic approach before caving into their cancer scare and urgency to operate .unfortunately from the moment you surrender to the "medical" industry we have today you become part of their game .I just feel like I.got duped .hoping for better days and will take my health into my own hands ,like the good people on this forum .
Just an update on this post ,happy to say I finally found and endo who is working with me ,he raised my dosage and as it was also suggested in this forum I was indeed undermedicated.new endo also added T3 without me asking for it! ..Most of my symptoms are going away and depression has lifted without me ever taking prozac and every day I am feeling better and better !thank you for all your valuable advise !!
Bad eyes after thyroidectomy
A predictable and unsuccessful GP consultantation. A rant
Iodine after Total Thyroidectomy
Hyper?
Desperatly seeking advice - is there someone who can tell me about TSH suppression and my blood results before my Endo visit next week?
