Thyroid UK
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Thyroid testing post partial thyroidectomy

Hello All, I had a partial (just over half) thyroidectomy on June 1st 2018. I had stage 1 papillary carcinoma on my right lobe. I currently have a colloid (benign) nodule on my left remaining lobe. My ENT surgeon is not interested in thyroid function testing until I show symptoms of hypothyroidism, which I am not happy about. I am currently 8 weeks 3 days post op and awaiting a GP appointment to request blood tests. I will ask for TSH, FT4, TT4, FT3, vitD, folate, ferritin and B12. Is this correct and is there anything else I should request please? Thank you very much for reading this post. I appreciate any advice that can be offered.

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Definitely ask for all these, but sadly unlikely that they will do them all.

But Ask GP. Often lab refuses even when GP requests

private testing is available for any that aren't done

All thyroid tests should be done as early as possible in morning and fasting . This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

For full Thyroid evaluation you need TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies and also very important to test vitamin D, folate, ferritin and B12

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies

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.

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Thank you very much. Do I need antibodies testing if I have had them done previously (normal range) and my surgery was due to thyroid cancer not autoimmune disease please?

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I paid privately to have these tests done prior to surgery. How long since the first ones were done should I have them repeated do you think please? (Talking about vitD etc please).

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So how long ago were these tested.

What were the actual results and ranges and what supplements are you taking?

Vitamin D, folate, ferritin and B12 all need to be optimal

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Thank you I will check when exactly it was. May I think.

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Vitamin D should be at least 80nmol but 100nmol likely better

Folate and B12 need to be towards top of range

Ferritin at least half way in range

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Thank you. I edited and it seems to have made a new post.

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17th May. Will try and attach results

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You can edit post to add one photo

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Thank you. Was struggling with that.

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Supplements: raw b complex, Rosita Cod liver oil, liquid B-12.

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You don't need antibodies testing but it comes as part of the thyroid bundle of tests

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Thanks

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With thyroid cancer the standard treatment is usually to give thyroid meds until TSH is suppressed so that any remaining cancer cells are not stimulated to grow. Your ENT sounds incompetent.

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It was stage one, fully encapsulated with no vascular involvement. I am considered ‘cured’ so I wonder if this is why?

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If it was less than 1cm then the British guidelines only recommend lobectomy. In the US they want a TT and RAI and suppressed TSH. Probably overkill. But the not checking your levels until you present as hypothyroid...that's just nuts!

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It was 18mm

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So, your tumor was almost 2cm...

Here are the official guidlines:

onlinelibrary.wiley.com/doi...

For TSH suppression recommendations see page 50.

For no recommendation of RRA from page 38:

ALL CRITERIA BELOW SHOULD BE MET

• Tumour <1cm unifocal or multifocal

• Histology classical papillary or follicular variant of papillary

carcinoma, or follicular carcinoma

• Minimally invasive without angioinvasion

• No invasion of thyroid capsule (extra thyroidal extension)

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Even the no RRA group still needs TSH in the low range, which is going to be difficult if it isn't monitored!

From the guidelines for papillary thyroid cancer page 50:

Patients who have not received radioiodine remnant ablation

(RRA) because they fall in the ‘no indication for RRA’ group

(Chapter 9.1), do not require TSH suppression and the serum

TSH should be maintained in the low-normal range between

0.3 and 2.0 mU/l (4, D)

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Thank you very much. Will have a look. The consultant said my TSH needed to be below 2, but also said I didn’t need monitoring - which didn’t make sense. I’m starting to feel like I need to see another consultant.

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Well, not to freak you out, but that should give you some leverage to get testing and some thyroid hormone supplementation! Yeah, I think you are right about seeing another consultant.

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Looking at the info for my condition, it would appear that the there is no conclusive evidence for or against RRA in my case. I understand why the MDT made the decisions they did. However, I still think my dr hasn’t given me the info I require going forward (nor did he when I was going through the diagnosis etc). Thank you very much for your help.

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You are right. The chart is a bit convoluted, and you don't fall into the yes, no, or maybe categories :) But the not testing your levels is completely illogical. On several fronts.

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Yes, I feel that way too. I was told only 15% of people require levo after a hemithyroidectomy, therefore it wasn’t necessary to do as I’d most likely be ok. I’ve already noticed changes though and I feel even without changes it is negligent not to monitor.

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