I have developed subclinical hypothyroid 3 months post hemi thyroidectomy, Not on medication at the moment, my Endo said blood test in another 3 months to see if treatment is needed.
My TSH is now 9.8 with free t4 being 14 (range 9-25),
My last blood test 3 weeks post surgery was -TSH 6.95 with free t4 of 15.
My TSH has risen further and my free t4 has dropped further, I have normal thyroid function prior to surgery, my ft3 was never checked .
I am worried that I would progress to overt hypothyroid, what are my chances of progress to overt hypothyroid or reverse back to euthyroid given I'm still subclinical hypothyroid 3 months post surgery ?
Thanks in advance
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Miraclesky
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Strongly recommend getting FULL Thyroid and vitamin testing
With such high a TSH likely to have very low vitamin levels
Keeping vitamin levels optimal can improve symptoms
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
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)
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
Thanks for the reply, yes, my Vit D is super low post surgery, I took Vit D supplement and go out to the sun but still can't get my Vit D level up, I didn't take Vit D before surgery but Vit D was still higher , don't know what to do, could that be metabolized problems or because of elevated TSH that suppress Vit D ?
TSH does not suppress vit D. It has no connection with Vit D. Are you taking the vit D cofactors: magnesium and vit K2-MK7? Vit D and magnesium work together. And vit K2-MK7 is necessary because taking vit D increases absorption of calcium from food, and the K2 makes sure it goes into the bones and teeth and doesn't build up in the soft tissues.
I was taking Vit D3 with Vit K2 before, but , when I asked my doctor, Endo, nurses etc., they have no idea about it and I thought that the K2 is only a recent thing and still under clinical trials, so I felt a bit sceptical about it, I don't take k2 at the moment , until there is more evidence to show that it does indeed remove calcium from arteries.
Oh, well. Up to you. But seems like a bit of an unnecessary risk to me. Does it hurt you to take that extra pill just one the off-chance that it might save you from a heart attack?
You really ought to know that doctors and nurses know absolutely zilch about nutrients - well, certainly no more that the average person on the street, and possibly less. They just don't learn about nutrition in med school.
Good grief! I know doctors are taught about nutrition but K2 is old hat. It's nearly 100 years AFAIK since vit K was discovered and 50 or more since K2 was first approved (in Japan). Mostly neglected up until the last 20 years or so when they started doing more studies into K2 and bone health. Perhaps he was confusing it with T2.
You poor thing - must feel dreadful. In many countries you would be treated once TSH gets to 3 - I have no idea which sadist decided to wait until it gets to 10 - more than double the top of the reference range, which makes something of a mockery of even having an upper limit to the range, You are already hypo and will get worse the longer you have to wait before being treated ...
Have you had your thyroid antibodies tested? If not, suggest you do so, and if they are high, go back to the GP as they will often start you on levo when TSH is over-range AND antibodies are high (ie Hashi's)
Please don't worry about being on levo: once you are on the right does, life can resume as normal. Don't think of it as taking a drug, it is just supplying hormones your body needs and now isn't producing properly
Thanks for the reply, my Endo said that once on thyroid meds, I will be on it for life, and the other half left will become lazy and starts losing its capacity, so I will give it time for the other half to kick in, I don't have much symptoms at the moment. No TPO test done yet, but will have another blood test with TPO in 3 months time.
my Endo said that once on thyroid meds, I will be on it for life, and the other half left will become lazy and starts losing its capacity
well yes, once you're on levo you're on it for life. I don't think you can say the remaining thyroid gets "lazy" - it's doing its darndest at the moment and isn't doing well enough - if the lab ranges are the same, your latest reading is a less-than-great 37.5% through range. You really need it DOUBLE that - and the only way to get there is to take levo [and if you DO have Hashi's, things will only get worse]
And you will feel sooooo much better than you do at the moment. And it's free. And you get all your other prescriptions (if any) for free too [if you live in England. I know they're free anyway eg in Scotland]. It's really not a big deal to take a tablet every day and feel tip-top again x
More rubbish, your half thyroid is already unable to make enough hormones for you even though it is trying really hard - that is why you are hypo. Yes, it's for life, because if you can't make enough thyroid hormones, you get dementia and heart disease and die.
My TSH at diagnosis would not now be classified as hypothyroid - maybe "subclinical hypothyroid".
But it kept going up every time it was tested, and I kept getting more and worse symptoms.
The reason, or reasons, I was going to the doctor was a number of symptoms! That were getting worse. If "my" subclinical hypothyroidism wasn't causing health problems, why did I have all those symptoms? Why had they worsened as my TSH rose? Of course, you could suggest that they were due to any of thousands of possible causes. Which is a completely fair point. But that suggestion is somewhat undermined when they all resolved as my levothyroxine dose increased and my TSH dropped.
Your thyroid might well have been working perfectly prior to your hemi-thyroidectomy. But you only have half of it now.
If the capacity of your thyroid, anyone's thyroid, depends on the amount of thyroid gland/thyroid tissue, then there are two things that could happen. Either the remaining half-thyroid has to grow so as to be able to make sufficient thyroid hormone. Or it doesn't and you don't.
Maybe the amount of thyroid isn't perfectly related to amount of thyroid hormone it can produce, but I am convinced there is an association.
Thanks for the reply, I read somewhere that around 30% of people who had hemi thyroidectomy would progress to overt hypothyroid but the other 70% subclinical reverse back to normal in a 12 -18 months timeframe or so.
That's not really subclinical; it's hypo and is a result of having a partial thyroidectomy. Your GP should prescribe levo, not wait until TSH reaches 10
You need thyroid hormones now. A healthy person has a TSH around 1. Your is about double the top of the range. Unless your thyroid regrows, which is pretty unusual, you need replacement hormones.
“According to the current TSH reference interval, hypothyroidism was not diagnosed in about 50% of the cases in the afternoon.”
“Further analysis demonstrated inadequate compensation of hypothyroidism, which was defined in 45.5% of the morning samples and in 9% of the afternoon samples”
TSH levels showed a statistically significant decline postprandially in comparison to fasting values. This may have clinical implications in the diagnosis and management of hypothyroidism, especially SCH.
our thyroid controls our metabolism
As an example....if, when perfectly healthy, your own thyroid made the equivalent of 125mcg levothyroxine....and this metabolism is controlled by pituitary sending messages - TSH (Thyroid stimulating hormone)
Then as your thyroid starts to fail (usually due to autoimmune thyroid disease. But in your case due to loss of half your thyroid ) ....you might get diagnosed when your thyroid has reduced output to roughly equivalent of 75mcg levothyroxine
It’s true your half thyroid left, might manage to compensate.....but if it doesn’t.....then you will need levothyroxine
Once we start on levothyroxine dose almost always will need to increase to full replacement dose.....not because the thyroid frets “lazy” but because of the feed back mechanism
When hypothyroid Pituitary notices there’s a drop in thyroid hormones in the blood....(that’s Ft4 and, most importantly, the active hormone Ft3) ....so to try to make more thyroid hormone ...pituitary sends out stronger message to thyroid - TSH rises up.
When GP starts you on Levothyroxine this is typically at 50mcg ....initially you feel a bit better ....as you have equipment of 75mcg from your own thyroid and 50mcg levothyroxine
But (here’s the bit many GP’s don’t understand)....levothyroxine doesn’t “top up” your own thyroid output.....well it does very briefly....but the pituitary very soon “sees” the levothyroxine in the blood....and TSH starts to drop
So at the end of week 6 ....TSH has dropped a lot. Your thyroid takes a rest ....has a holiday.
So at this point you are now only mainly using the 50mcg levothyroxine....which is actually a dose reduction down from managing on 75mcg from your own thyroid before you started on levothyroxine
So you start to feel worse .....and are ready for next 25mcg dose increase in levothyroxine
Modern thinking ....and New NICE guidelines suggests it might actually be better to start on higher dose .....
but many medics just haven’t read guidelines ....
and many patients can’t tolerate starting on more than 50mcg and need to increase slowly.
Starting on 50mcg and stepping dose up in 25mcg steps, retesting 6-8 weeks after each increase. But we still very often need to increase up to full replacement dose
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.
RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.
Thanks for the info, very helpful. But I read comments that some people can get between hyper and hypo when on meds, and if overmedicated, can cause bone lost and/or fast heart rates etc etc.. I am frightened to be put on meds.
If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.
Having too much thyroid hormones cause health issues and having not enough causes health issues, this is why you do thyroid test to help prevent both.
Your labs indicate your hypo and need medication or you can ignore the numbers on the lab and wait and see what symptoms of hypo start to creep in because eventually they will.
The Thyroid gland is not considered to be regenerative gland. So, if its not producing enough thyroxine now, it will only get worse. You may have lost parathyroid glands which may impact calcium levels. Get a copy of the pathology report to check. Vitamin D is vitally important for good health. K2 is found in large quantity in Natto beans eaten regularly, 2 or 3 times a week, sometimes daily, in Japan. K2 is prescribed as treatment for better bone health in Japan. There's nothing experimental about it. The Western diet lacks enough vitamin K2 and the only food that contains a good enough amount is natto beans although other fermented foods contain some. K2-MK7 from natto beans contains natto kinase that improves cardiovascular health. You can find plenty of research papers on the Internet.
The Thyroid gland is not considered to be regenerative gland.
Quite right. We do, from time to time, see someone who has had their thyroid regrow after a total thyroidectomy. But the regrown thyroid is rarely, if ever, functional.
If you were diagnosed with diabetes would you take insulin to stay alive? There’s not much difference between that and hypothyroidism and taking thyroid hormones.
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