Post partial throidectomy

[Mrslumpy]

Post partial thyroidectomy, has anyone any insight please? I've had rigours, fever, extreme lethargy, aching joints and hands have mild shakes. All bloods normal? I know something is not right. The multinodular goiter was size of an orange! Any thoughts welcome

[Nanaedake]

How long ago did you have partial thyroidectomy? Are you taking levothyroxine? When was you last blood test and what was the result? Did you lose any parathyroid glands and have you had vitamins B12, folate, ferritin and vitamin D tested? Sorry, so many questions but without knowing more it's hard to suggest what the problem might be.

When the doctor says bloods are normal you need to know what bloods they're talking about. It doesn't mean nothings wrong, it just means they can't see anything wrong in the items they've tested.

[Mrslumpy in reply to Nanaedake]

Thankyou for replying. Surgery was nearly 3 weeks ago. I dont take any medication. I have to go back for plasma parathyroid hormone blood test as this was not done, and I will ask on Monday if they can print out my results for me. Have you had similar?

I thought all symptoms would disappear when it was removed.

[Nanaedake in reply to Mrslumpy]

I had partial thyroidectomy for different reasons see profile.

I had no symptoms before thyroidectomy and was dreadfully unwell for years after.

I have discovered you need excellent vitamin levels, not just anywhere in range. Also, was probably calcium deficient. It doesn't always show up in blood tests as your body will rob calcium from your bones to maintain blood calcium levels. Good vitamin D levels are essential because then your body can absorb more calcium. The vitamin D Society recommends levels around 100nmol/L. I try to keep mine there. Also I find nutrition really important. I eat some healthy probiotic foods like natto and supplement 100mcg K2-MK7 daily and use a magnesium spray. Both are needed for good utilisation of vitamin D and therefore better calcium absorption from foods. I have been prescribed a calcium supplement due to loss of bone density. Hopefully you will get better help than I did. It was this forum that helped me sort it out as doctors did nothing useful for 7 years. Just prescribed beta blockers that made matters worse.

I have a good doctor now who helped me sort out the calcium problem. I'm fine now and working full time with good quality of life. You will get back to better health too. Sorting out vitamins takes a few months though, it's not a quick fix.

When you have results of blood tests post them here and people will help. Vitamin D result especially critical.

[Mrslumpy in reply to Nanaedake]

Thankyou, I am hoping my goitre is benign, results in couple of weeks with surgeon.

I most certainly will check that blood vitamin levels get checked. Thankyou for support, and I'm pleased you have control of your health.

Regards Mrslumpy

[SlowDragon Administrator]

Do you have any actual test results from BEFORE operation?

And please add the actual results and results just done

Bloods should be retested 6-8 weeks after operation

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

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...

[Mrslumpy in reply to SlowDragon]

Hello

I only had TSH and asked for T3 and T4. Prior to surgery= Normal range.

Thankyou for the links as family have suggested private route. No mention of not eating before tests either or early in morning, TBH I struggle to get a slot, and take what is offered. As soon as I get my results I shall post.

Many thanks

[SlowDragon Administrator in reply to Mrslumpy]

Just testing TSH is completely inadequate

[Mrslumpy in reply to SlowDragon]

Good morning

I have my results from my GP

CRP 1

TSH 1.74

TOTAL BILIRUBIN 8

ALK PHOS 114

ALT 19

TOTAL PROTEIN 69

ALBUMIN 46

GFR CREAT>90

Na 142

K 4.1

Cr 59

Calcium 2.27

Adjusted calcium 2.38

In. Phosphate 1.29

Hb 154

WCC 8.38

PLATELET 300

RBC 4.93

Hematocrit 4.93

MCV 90.1

MCH 31.3

RBC distribut width 13.3

Neutrophils 5.26

Lymphocyte 2.56

Monocyte 0.45

Eosonophil 0.07

Basophil 0.04

Nucleated RBC 0

ESR 2

Plasma parathyroid hormone level PENDING

I shall be telephoning tomorrow to discuss my symptoms and any further tests that I could have, I note your recommendations :

TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Is there anything I may have missed. So very grateful for your help.

Mrslumpy

[SlowDragon Administrator in reply to Mrslumpy]

Are these results from before partial thyroidectomy?

Bloods should be retested 6-8 weeks after operation

Ask GP to test vitamins now and separate thyroid test after 6 weeks

Can you add ranges (figures in brackets after each result) for MCV and MCH results

Yes you need

TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested, vitamin D, folate, ferritin and B12

Unlikely to get Ft3 tested...but no harm in asking

[Mrslumpy in reply to SlowDragon]

Yes this is post OP.

MCV 90.1 (80-100.00fl)

MCH 31.2 (27-32.00pg)

Is that what you're looking for, gosh I dont understand it.

I will try and politely suggest all others tomorrow.

Thankyou

[SlowDragon Administrator in reply to Mrslumpy]

So MCH is almost at top of range

Suggests B12 and/or folate may be low (common when hypothyroid)

medicalnewstoday.com/articl...

High MCH scores are commonly a sign of macrocytic anemia. This condition occurs when the blood cells are too big, which can be a result of not having enough vitamin B12 or folic acid in the body.

Any other results near top or bottom of range

[Mrslumpy in reply to SlowDragon]

Ok thanks I noticed ESR 2 and range 3-15mm/h

[Mrslumpy in reply to SlowDragon]

Good afternoon

I just wanted to thank you very much for pointing me in the right direction with blood tests.

I have been emailed some more which show very low Vit D and very high ferratin levels, which explain my muscle/joint pain and fatigue.

I await my GPs advice which will probably be on Monday now.

Again many thanks

Mrslumpy xx

[SlowDragon Administrator in reply to Mrslumpy]

How low was vitamin D

GP will often only prescribe to bring levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

But on levothyroxine improving to around 80nmol or 100nmol by self supplementing may be better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

It’s trial and error what dose we need,

Calculator for working out dose you may need to bring level to 40ng/ml = 100nmol

grassrootshealth.net/projec...

Government recommends everyone supplement October to April especially in current pandemic situation

gov.uk/government/news/phe-...

it's important to also supplement cofactors - magnesium and Vit K2-MK7?

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

Need B12 and folate tested if not been done

After anaesthetic B12 can drop significantly

b12-vitamin.com/anesthesia/

[Mrslumpy in reply to SlowDragon]

Vit D was 26 (50-200)

Ferratin was 224 ug/L (50-120)

Folate 7.7 (2.40-17.5)

B12 was 255 (197-771ng/L)

Thankyou

[SlowDragon Administrator in reply to Mrslumpy]

So has GP prescribed LOADING dose Vitamin D - 300,000iu over 6-8 weeks ?

B12 is extremely low. Likely due to low stomach acid when hypothyroid. GP should run test for Pernicious Anaemia before starting any B12 supplements or B12 injections. You may need to push them to do so....or they may simply refuse as B12 is “within range”

If you have PA you would definitely need B12 injections

If you only have low B12 due to being hypothyroid, then can start supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)

Or Thorne Basic B or jarrow B-right are other options that contain folate, but both are large capsules

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Low B12 symptoms

b12deficiency.info/signs-an...

With such low B12 result taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 sublingual lozenges

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/vitamins/vit...

Retest thyroid levels TSH, Ft4 and Ft3 6-8 weeks after starting B vitamins

[annnsandell]

So they have taken away part of your Thyroid so even if your levels were ok before the operation they are far less likely to be now and certainly don't sound like it. It will take a while for levels to settle down as well and you should be tested regularly until they do. I can only speak for years ago when you were put on temporary Thryroxine and then slower release later plus calcium until they are sure that your calcium is also ok. You must tell them all the symptoms you are getting and get your blood tests results. Surgeons are often only interested in TSH but as below, that is not enough.

[Mrslumpy in reply to annnsandell]

Thankyou

[Mrslumpy in reply to Mrslumpy]

It had to be removed as there was tracheal deviation, and difficult intubation, they couldn't see the larynx at first. I was on an urgent list. Cant help but think during pandemic how things are getting missed, and not just for me.

[Batty1]

You lost half of your thyroid and on no medication no wonder your feeling bad ... your hormones took a big hit!

[Mrslumpy in reply to Batty1]

My thermostat is broken! Trying to be positive though. Thankyou.

[endomad]

Thyroidectomy is major surgery, its not a quick job like removing a wisdom tooth. You had general anaesthetic and an important organ removed. Peoples recovery times vary, I was in hospital 5 days and 4 nights, heavily sedated for most of it. I had 14 huge blanket stitches at the base of my throat, I looked like Frankenstein's bride! Your whole body needs to get use to the fact half your engine has been removed. 3 weeks is early days but it does sound like you are low in hormones.

You need to get the fever checked out as that could be a sign of infection, you need to get that seen to asap. That was a huge goitre I hope you are feeling more comfortable. x

[Mrslumpy in reply to endomad]

Thankyou x