low TSH basal after Thyroidectomy

[crenhov]

I had my thyroid removed in September 2018 due to a multinodular goiter. When my surgeon removed it, it was completely inflamed but the inflammation did not show up in bloodwork nor scans. I take Eltroxin 0,1 mg every day.

At my first six week check up my TSH basal was 1.22 mlU/l. Because I was so tired, I went up in dosage to 0,1 every other day and then a little bit more every other day.

At my second control my TSH basal was at 0.04 so my surgeon brought me back down to just the 0,1 mg Eltroxin every day.

At my third six week control it moved to 0.34. Today I had blood work done and it is back at 0.04 mlU/L (ft4 is 16.0 pmol/l and ft3 is 4.13 pmol/l).

Does anyone have any idea as to why it would go so low? I see my surgeon this Thursday.

[SilverAvocado]

Sounds like your surgeon is dosing completely based on TSH, and not looking at the complete thyroid panel. This kind of see sawing up and down is a common result

You were asking if there's something strange about this panel:

TSH: 0.04 mlU/L

FreeT4 is 16.0 pmol/l

FreeT3 is 4.13 pmol/l

Without the ranges this can't really be interpreted, but to give a very rough guide, my local ranges for these are freeT4 (12-22), and freeT3 (3.1-6.8).

This would make your freeT4 less than halfway up the range, freeT3 in the bottom quarter, and TSH suppressed.

This is a very sluggish TSH. But it has been 0.34 and 1.22 in the past few months, so it's not completely unresponsive. One suggestion would just be that you've been through a huge operation, your body has had a huge shock, and then you've been yanked around ever since by a typically cruel Endo, and your pituitary just isn't totally on the ball. It might be that if you stayed on a generous dose for a few months your TSH would come back online.

TSH is produced by the pituitary, it's independent from the thyroid itself. Just like the thyroid, the pituitary can to wrong in various ways. It can effectively be underactive or overactive (big simplification). You can have an MRI or other investigations to look into its functioning.

The first thing to try is just to dose thyroid hormone based on the freeT4 and freeT3, not in the TSH. In your case you're very clearly undermedicated, and will probably need the freeT4 near the top or even slightly over the top to feel well. Everyone is different, but for me that took quite a few increases of about 25mcg.

In your position (I've also has a thyroidectomy and had very poor treatment afterwards by a surgeon, so I was where you are 5 years ago), I would want to wait until there was a bit more evidence before I allowed these people to start messing with my pituitary - ie, see if it settles down once your thyroid replacement is good and you're feeling a bit more normal.

A big question is: How are your symptoms now? Are you coping okay, or still very ill?

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You should type in the ranges as well as the results they are most important for answers.