Help

[Shelly72]

I had a partial thyroidectomy about 11 years ago, i am always really tired , my levels have been checked t4 was 9.9 had it retested now its 11 remaining part of thyroid is slightly raised do i need medication

[Nanaedake]

You need to get a print out of the actual results, post them here and then people can help you. You also need to ask doctor to test vitamin D, B12, folate, ferritin and calcium levels. Get a print out of results that includes lab ranges and pist here for best help.

[SeasideSusie Remembering]

Shelly72

We can't say much without more information. We need to see full test results, including reference ranges (they vary from lab to lab so ranges are very important) to be able to comment.

Can you please post results for

TSH

FT4

FT3

and for a full picture it would be helpful to also test

Thyroid antibodies

Vit D

B12

Folate

Ferritin

Also, please tell us what thyroid hormone replacement you take and the dose.

Thyroid tests should be done no later than 9am, fast overnight from evening meal/supper the night before and delay breakfast until after the test, drink water only before the test, and take last dose of Levo 24 hours before the test, if you take T3 or NDT the last dose should be 8-12 hours before the test.

[Shelly72 in reply to SeasideSusie]

Hi have posted some of my results

[SeasideSusie Remembering in reply to Shelly72]

OK, so your FT4 is below range. What has your GP said about that?

You haven't said what thyroid hormone replacement you take.

[Shelly72 in reply to SeasideSusie]

Im on no medication doc dosnt seem bothered because its now normal

[SeasideSusie Remembering in reply to Shelly72]

A below range FT4 level is not normal, you are producing too little FT4 yourself from what remains of your thyroid gland after your partial thyroidectomy so you need to take thyroid hormone replacement. If your current GP won't do anything then see a different one and point out your FT4 result. Even your latest result of 11 is at the very bottom of the range which is not good enough.

A normal healthy person with no thyroid problem would have a TSH level of no higher than 2 with FT4 around mid-range or possibly a bit higher. You have had part of your thyroid gland removed, the remaining part is not coping well enough to give you the hormone level you need.

Ask for the full range of tests listed above, if GP wont do them then you can do a test with one of our recommended labs who offer fingerprick tests or venous blood draw at extra cost.

[jimh111]

As fT4 falls towards its lower limit TSH usually goes very high. This has not happened in your case indicating that there is subnormal TSH secretion. This can happen for various reasons, for example if there has been a period of high thyroid hormone levels. Possibly this happened in your case? It would depend on why you had the partial thyroidectomy.

A secondary effect of subnormal TSH secretion is that conversion of T4 to T3 is reduced leading to low normal fT3 levels. T3 is the active form, T4 must be converted to T3 for the hormone to work. If your doctor were to measure your fT3 it is likely to be below average. Your doctor should do a blood test measuring TSH, fT3 and fT4. This will confirm fT3 is low and so TSH is not responding correctly.

It is possible the remains of your thyroid are producing a lot of T3 and this is why your TSH is not elevated in spite of the low fT4. This can also lead to tiredness but on balance it is most likely your fT3 is low due to subnormal secretion. This is why it is essential to measure fT3 in your case. Your GP can request it but they must state very clearly it must be done otherwise the lab will skip it.

You need to be assertive with your doctor and make sure they help you. Perhaps take someone along with you for support. If the doctor is unhelpful ask for an appointment with an endocrinologist or better still contact the endocrinologist who handled your thyroidectomy (directly, not via your GP).

[Shelly72 in reply to jimh111]

Thanks for all your help i went to see a endocrinology doc he said to me why are you here your levels are normal

[jimh111 in reply to Shelly72]

Sadly there are quite a few useless endos. Many only understand diabetes and have little knowledge of thyroid disorders. Your levels are not normal and more importantly you are not well. Don't give up, make sure someone helps you. Either press your doctor hard for good care or if you can afford it get your TSH, fT3 and fT4 checked privately. ThyroidUK can give you a list of endocrinologists who are more helpful.

[Shelly72 in reply to jimh111]

Thanks for your advice hopefully will get it sorted

[Batty1 in reply to Shelly72]

What a rude doctor...just because your lab levels are ok doesn’t mean your not feeling unwell. ...why can’t these people treat the issues.

[LAHs in reply to Shelly72]

Hi Shelly, don't be shy about changing doctors. Many of us (me included) on this site have had multiple doctors until we have found an OK one - not necessarily great, but OK. I am on my 8th. It was very embarrassing asking a doc if they we're enthusiastic or curious about thyroid problems, but I kept on and on until I finally (and accidentally) came across one.

[Shelly72]

My t3 is 4.1

[Nanaedake in reply to Shelly72]

You need to give us all the information including the lab range for FT3 and the FT4 and TSH result with lab ranges taken at the same time as FT3 if you want good advice. If we get bits of information from you then we cannot give comprehensive advice.

Are you taking any medications or supplements and have you had vitamins tested? What was the reason for thyroidectomy?

[Shelly72 in reply to Nanaedake]

Lab ranges are t4 (10.0-20 )mine 11.8 t3( 3.1-6.8) mine 4.1 tsh (0.20-4.00) mine 3.8

[Shelly72 in reply to Shelly72]

I had a goiter

[jimh111 in reply to Shelly72]

This shows that you are undermedicated. I would expect your fT4 to be around 16 - 18 and your fT3 closer to 5.

[Nanaedake in reply to Shelly72]

Although your lab results are in range they are only just within the lab ranges which shows your remaining thyroid tissue is struggling to maintain thyroid levels. However you do need to test vitamin D, ferritin folate and B12 because if any of these are low then you are very likely to get symptoms similar to low thyroid hormone. Until you've corrected any deficiencies you won't know for sure what is causing symptoms.

If vitamin levels are low your symptoms may remain even if you start on levothyroxine and your body won't use the thyroid hormone very efficiently. So get them tested and if all are optimal then you might have the evidence to persuade doctor to give you a trial of levothyroxine. If they are not optimal then you may find once you've corrected deficiencies your thyroid hormone production will improve and symptoms will abate.

As your results are borderline it might be a case of sorting out vitamin levels and trialling levothyroxine to see if it helps.

Are you on other medications? These can affect thyroid hormone utilisation too so you might have to look at the overall picture to find solutions.

[SilverAvocado]

Shelly72, Doctors will often say it's possible to manage with only half a thyroid. I've heard experienced forum members say they don't believe anyone can manage.

Looking at your thyroid results, your freeT4 is below range. This is a very low result. FreeT4 tells us how much T4 hot one you've got in your blood. A healthy person will have a freeT4 around the centre of the range, and the further out to the edges it is the more likely thyroid function is inadequate. Often people will be very ill long before it gets below range, so yours is very low. I'd expect you to feel seriously rubbish with that result.

As others have mentioned, your TSH has responded quite sluggishly. This is your pituitary's response to the hormone levels in the blood, and should rise when hormone is low. There is quite a bit of individual difference in this response, but particularly if we've been sick a long time or as we get older it can be sluggish. Or it can indicate a pituitary problem.

The problem is, as many have mentioned, doctors are not very thorough and they will often rely on TSH only, and not care that your hormone level is low.

I've also had a thyroidectomy and ended up having to self medicate. I got to a point where doctors just said they wouldn't do anymore for me and I was still very sick.

[Shelly72 in reply to SilverAvocado]

Thank you so much for your help im going to go back to doctors with information you and everyone else has given me

[SilverAvocado in reply to Shelly72]

You're very welcome.

I hope you get a good result from your doctor. Often they are surprisingly hostile to thyroid illness

This forum is an amazing resource. No matter what response you get I recommend reading it regularly in your week and learn how to interpret your own thyroid blood tests. Double check everything you are told by doctors and make sure you're getting the right treatment.

[Wetsuiter in reply to SilverAvocado]

might depend in the definition of 'manage'

[jillyana]

I had a partial removal of my thyroid in 2006 & my T4 is 11 & TSH 4.7. No doctor will treat me, they all just say I'm within the band limits. Have you had your ferritin levels checked? Mine went so low that my hair fell out in clumps & I was so tired it was hard to live. My normal blood iron levels were OK, it is the ferritin (iron store) which could be the problem & could possibly be causing your tiredness too.