Partial thyroidectomy

[asiatic]

A friend had a partial thyroidectomy 20 years ago and ever since been on 50mcg. Levo with annual TSH check. As she has some hypo symptoms I passed on what I have learned from this forum. Using thyroid uk she listed her symptoms. She didn't take her levo prior to blood draw and asked for fT4 to be included. The result was a call from GP to increase to 75 and retest in 8 weeks. I am now wondering if I should bring up ATD. She doesn't have my curiosity and I am not sure at this stage measuring TPO/TG would achieve anything. What do you think ?

[SlowDragon Administrator]

She needs FULL thyroid and vitamin testing 6-8 weeks after each dose increase

Levothyroxine doesn’t top up a failing thyroid.....it replaces it

guidelines on dose levothyroxine by weight

Even if we don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

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.

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

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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

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

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...

All you can do is give her the information

Up to her if she wants to do the testing

[jimh111 in reply to SlowDragon]

After a partial thyroidectomy levothyroxine is replacing the the hormone the removed half used to produce, so in a sense it is topping up the existing thyroid.

It may be this patient doesn't need a full replacement dose, I know of a lady who had half her thyroid removed and is fine on half a thyroid. If this patient does OK on e.g. 75 mcg levothyroxine I think this is preferable to having a full replacement dose as the healthy thyroid they have left can regulate her hormone levels far better than tablets.

[humanbean]

The result was a call from GP to increase to 75 and retest in 8 weeks. I am now wondering if I should bring up ATD.

ATD? Autoimmune thyroid disease?

[asiatic in reply to humanbean]

My friend doesn't know why she had the thyroidectomy. She just remembers a swelling in her throat. I was wondering if she could have Hashis as recently she had a few incidences of palpitations with no cause found.

[humanbean in reply to asiatic]

Palpitations could be caused by the wrong levels of thyroid hormones. They can also be caused by low iron, low B12, and other low levels of nutrients.

[Hidden]

Suggest she asks doctor to inform her of reason for subsequent prescribing of any levo at all.

A partial thyroidectomy is just that - the removal of part of the thyroid and should not affect the operation of the remainder. In my case, after removal of goitre which restricted breathing, the remaining tissues, when they eventually restarted, worked at 100% efficiency for 15 years until it became necessary to remove them when a multinodular goitre took over control and nearly killed me.

[asiatic in reply to Hidden]

Thanks to everyone who replied. I will show my friend the answers and like slowdragon said it is up to her how she wants to proceed.