High TSH levels, normal T4..should I retest?

[strangelittleisland]

Hi Some advice would be appreciated!

Recently had a left hemithyroidectomy for suspicious nodule, biopsy results in keeping with an autoimmune possibly variant of Hashimotos. 6 week bloods back show that I have a Serum TSH level 9.07 mU/L [0.35 - 5.5] and a Serum free T4 level 12.2 pmol/L [10.5 - 21.0]. Serum thyroid peroxidase antibody concentration 39 iu/ml [0.0 - 60.0] which I assume is okay?

I am symptomatic..feeling tired, constipated. My questions are 2 fold..1. Should I retest 4 to six weeks (or is this unlikely to happen with these results?)and hope right thyroid picks up production or look to medication? Question 2. If I decide to wait and see is there anyway I could help my thyroid gain strength and up production?

Thanks

[greygoose]

1. Should I retest 4 to six weeks (or is this unlikely to happen with these results?)and hope right thyroid picks up production or look to medication?

What did your doctor say you should do? Very often they like to get a new test six weeks later, to prove that the first lot of results wasn't a fluke. Also, a lot of doctors like to wait for the TSH to go over 10. But, if it were me, with a TSH that high - you're hypo when your TSH gets to 3 - I ouldn't want to wait any longer. And, your FT4 is only 16.19% through the range. It's in-range, but it no way 'normal'. Should be more like mid-range.

The remaining lobe of a thyroid often fails to compensate for the missing lobe, and it doesn't look like yours is going to. So, just my opinion - others might disagree - but I would want the thyroid hormone replacement now. Especially as you have symptoms.

2. If I decide to wait and see is there anyway I could help my thyroid gain strength and up production?

I really don't think there is, no.

Serum thyroid peroxidase antibody concentration 39 iu/ml [0.0 - 60.0] which I assume is okay?

You can't really make assumptions about antibodies. They fluctuate all the time. So, whilst they were low when you were tested, next month, or next week, they might be over-range. Plus, that's only one of the Hashi's antibodies. There's also Tg antibodies which could be high, indicating Hashi's. And, to top it off, 20% of Hashi's people never even have high antibodies. So, all in all, you could still have Hashi's, I'm afraid.

[strangelittleisland in reply to greygoose]

Thanks for above. GP is contacting my consultant regarding results but mentioned the options of retesting or starting treatment.

Why would you consider starting treatment now as opposed to later?

The more I read about the thyroid the more I think what a complex and sensitive gland it is and if it goes wrong (which it often seems to) there are far reaching consequences. Interesting to know about the antibodies. I'm still not sure what I had wrong with my left thyroid, it was all very odd and judging from the biopsy, they were not too sure either. With regards to Hashimotos, will become more evident with the passing of time?

[greygoose in reply to strangelittleisland]

I think I would want to start now, yes. Because you do know you've only got half a thyroid, and given those results... I doubt they're going to get better.

The thyroid is complicated, yes. That's why so many doctors make a mess of treating it.

Your Hashi's - if you do have Hashi's - will become obvious if your FT4/3 levels suddenly shoot up high without any change to your dose. And, then, they will come down again by themselves, leaving you hypo again. That can't be anything but Hashi's.

[strangelittleisland in reply to greygoose]

I just got a little jolt then because I think I'm in denial that I have half a thyroid!To be honest I was feeling pretty exhausted when I had a whole thyroid but definitely with more symptoms typical of hypothyroid now. Will be interesting to see what happens with my FT4/3 levels then as think I would prefer to know exactly what's wrong.

[greygoose in reply to strangelittleisland]

Did you have your thyroid hormone levels tested before the operation? Could be you were already hypo.

Will be interesting to see what happens with my FT4/3 levels then as think I would prefer to know exactly what's wrong.

Not sure what you mean there. What's wrong is you only have half a thyroid. I doubt you'll ever find out why half had to be removed, I mean why you had the nodules. Nodules are just things that happen. Most people have nodules on their thyroid even if they have no thyroid problems. And, sometimes the nodules grow for some reason. There are an awful lot of unanswered questions where thyroids are concerned.

So, do you mean you're going to wait and retest, to see what's going to happen? Don't leave to too long to retest, then.

[SlowDragon Administrator]

Important to test vitamin D , folate, ferritin and B12 too

Often these drop very low when hypothyroid

Important to test TG antibodies too...NHS won't (unless TPO are positive)

Do you have any gut symptoms?

React to gluten or dairy?

[strangelittleisland in reply to SlowDragon]

Thanks for this. No I have no gut symptoms bar constipation..not sure if that's a reaction to gluten or diary? How do hypothyroid manage issues of a slowed down metabolism..is there anything I can do or is it a case of getting my thyroid back on track with meds?

Are these vitamins are low before hypothyroidism or as a result of hypothyroidism?

[strangelittleisland in reply to strangelittleisland]

Just re read that and it's a bit muddled!! I'm having to go to bed at nine ish at the moment or my brain can't cope. It's way past my bedtime now!

[SlowDragon Administrator in reply to strangelittleisland]

Vitamin levels drop because of being hypothyroid

Low stomach acid is extremely common result of hypothyroidism