Can having surgery and the inactivity due to th... - Thyroid UK

Thyroid UK

112,217 members130,521 posts

Can having surgery and the inactivity due to this impact test results?

Alfie141
Alfie141

Hi All, wondered if anyone can advise please? I was diagnosed underactive thyroid must be over 5 years ago now. Built up to 100mg levothyroxine to get within range. Having annual blood tests and all ok.

My TSH levels have increased gradually on annual monitoring but still within range just about (Jan 17 was 5.07 but no change in medication prescribed).

I had a pre assessment at the hospital in Feb 18 due to needing operation/s. TSH came back as 5.8 and T4 15. The Dr at the hospital advised me to get it checked with GP as I was outside of range.

I've now had the ops and have been physically inactive for about 2 months. I just had another blood test via the GP which has come back as TSH 1.69, T4 14. I was quite surprised TSH had reduced so much, especially due to current tiredness, and wasn't sure if I needed to make an appt to discuss with the GP.

Will have surgery/being inactive distort the results?

Any advice gratefully received, thanks.

Andrea

7 Replies
oldestnewest
SeasideSusie
SeasideSusieAdministrator

One wonders why your Levo dose wasn't increased as your TSH rose.

Have you had thyroid antibodies tested and were they raised?

Can you include reference ranges for test results, it's not possible to interpret them without the ranges from your own lab. TSH isn't really a problem but we haven't a clue about your FT4. With my lab's range that would be at the upper end as the range is 7-17, but it would be low with another common range we see here which is 12-22.

Thanks for your reply SeasideSusie.

I've always been told I was within range and no change to medication required? The ranges are TSH 0.1 - 5 and F4 8-19.

No I've never been tested for thyroid antibodies....

SeasideSusie
SeasideSusieAdministrator in reply to Alfie141

Alfie

I see you are new to our community so wont have seen many of the posts yet. The more you read the more you'll realise how you should be treated by probably aren't. GPs think anywhere within range is fine, unfortunately that isn't the case.

The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo, if that is where you feel well.

And from Dr Anthony Toft, leading endocrinologist and past president of the British Thyroid Association, the following article was published in Pulse Online magazine (the doctor's 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 article by emailing Dionne at tukadmin@thyroiduk.org It is Question 6 that the above quote is from. You may find this article useful in the future if you are symptomatic and would like an increase in your Levo.

With a TSH of 5.8 (range 0.1 - 5) then you are over range and should have received an increase in your Levo to bring you back into range.

FT4 of 15 with a range of 8-19 means that you are just over half way through range. There was plenty of room to bring your FT4 up to nearer the top of the range, which an increase in Levo would have achieved.

The fact that your TSH has changed from 5.8 to 1.69 does suggest that thyroid antibodies could be positive so it's important to get those tested. There are two types - Thyroid Peroxidase (TPO) and Thyroglobulin (TG). The NHS rarely does TPO and almost never does TG, often only when requested by an endo. We do have private labs that can do home fingerprick or venous blood draw tests if you can't get certain tests with your GP.

It's always recommended when booking thyroid tests to always book the very first appointment of the morning, fast overnight (water allowed) and leave off Levo for 24 hours. This gives the highest possible TSH which is needed when looking for an increase in dose or to avoid a reduction. TSH is highest early morning and lowers throughout the day. It also lowers after eating. (This is a patient to patient tip which we don't discuss with doctors or phlebotomists.) Doing this every time means that results can always be compared accurately.

Spot on SeasideSusie. I am new to community and although underactive for a while, I've felt well so not really got into the nitty gritty of the results etc.

I've felt more tired the last year or so to be honest but when my results keep coming back 'normal' I assumed it was just one of those things. Previous couple of years TSH was 3.57 then 5.07 so gradual increase.

The 5.8 (at hospital) result is what prompted me to ask for it to be checked by the GP but then it had dropped down to the 1.69. I'm not sure the 5.8 result had filtered through to the GP, so don't tjink they would have taken into account.

Thankyou so much for the thorough response. I need to digest it all and I will get a copy of that article too!

SlowDragon
SlowDragonAdministrator

Ask that GP tests vitamin D, folate, B12 and ferritin. All these need to be optimal for good thyroid

As you have had an operation low B12 can be as an after effect.

b12-vitamin.com/anesthesia/

Also essential to test TPO and TG thyroid antibodies, if never been tested. If high this gives diagnosis of autoimmune thyroid disease also called Hashimoto's. Variable TSH levels and low w vitamins are more common with Hashimoto's

You were under medicated to have TSH of 5 on Levothyroxine

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...

Alfie141
Alfie141 in reply to SlowDragon

Thanks SlowDragon.

I think when I've recovered from the ops I'll see my GP and ask for those additional tests.

It looks like the ranges differ across the country as I note my TSH range is a little higher (0.1 - 5). It makes sense that we should be at the lower end to feel well though.

In 2016 I was TSH 3.57 / T4 14, 2017 TSH 5.07, T4 14. It's only with the recent drop in TSH it seemed odd.

Its scary if official NHS guidelines say TSH should be between 0.2 and 2.0 when on Levothyroxine!

Thanks for including the attachment too.

SlowDragon
SlowDragonAdministrator in reply to Alfie141

Yes many GP's think a TSH anywhere in range on Levothyroxine is adequate, it isn't

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

You may also like...