Post hemithyroidectomy in June 20

[sam91]

Hi, after developing a cough, loss of voice and breathlessness I had a right hemithyroidectomy end of June, nodule of 7.5cm. Was told it was large and no cancer. Have made good recovery although now feeling so tired and gaining weight (unusual for me), TSH back at 6.3; T4 10. Wondering what your thoughts would be? Have a phone appt with GP booked. Thanks

[greygoose]

I think you're hypo and need thyroid hormone replacement. A euthyroid TSH is around 1, so yours is very high.

Can't comment on the FT4 because you haven't put a range. As ranges vary from lab to lab, we always need to know the ranges that went with your results.

[SlowDragon Administrator]

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Ask GP to test vitamin levels and thyroid antibodies

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

See both flow charts here

gp-update.co.uk/Latest-Upda...

Do you know the range on Ft4 result?

If Ft4 is BELOW RANGE - you have clinical hypothyroidism and levothyroxine must be started

If Ft4 is at bottom of range, but still within range ...technically called sub clinical ....ask for trial of levothyroxine

[sam91 in reply to SlowDragon]

Thank you both for treat advice. T4 range is 9.0-19.0 so I guess mine at 10 is ok but at lower end of normal. GP has suggested I wait a month and retest,

[SlowDragon Administrator in reply to sam91]

That’s standard practice after first abnormal result

Ft4 is very low

Suggest you get vitamin levels tested NOW and start supplements to improve to optimal levels...can significantly improve symptoms

Come back with new post once you get vitamin results. Members can advise on supplements

Retest thyroid as early as possible in morning before eating or drinking anything other than water

[sam91 in reply to SlowDragon]

Thanks for previous reply, since then TSH 7.6 and now started Levothyroxine 100. Was referred back to endocrine as have feeling of something stuck in throat all time especially after eating. Lots of throat clearing! Although my scar looks great he thought was stitched too tight; causing the issue. He recommended massaging it every day. Seems odd and not improving. Is this something that is common? Thanks

[SlowDragon Administrator in reply to sam91]

Feeling of something stuck in throat is extremely common when hypothyroid

Should hopefully improve once you get settled on levothyroxine

Bloods should be retested 6-8 weeks after any dose change or brand change in levothyroxine

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Ask GP to test vitamin levels now or certainly at next blood test

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/thyr...

Many people find Levothyroxine brands are not interchangeable.

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

Many patients do NOT get on well with Teva brand of Levothyroxine. Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

Are you currently taking Teva?

Teva, Aristo and Glenmark are the only lactose free tablets

healthunlocked.com/thyroidu...

Teva poll

healthunlocked.com/thyroidu...

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal