General anesthesia and suppressed TSH, panicking!

[Laiah]

I'm having surgery on Saturday requiring general anesthesia (not thyroid related surgery) and just had a thought. The surgeon knows I'm taking levo and lio. But my gp doesn't yet know I take lio as I buy it myself and they have proved useless in my quest to feel better. I haven't told them because I'm worried if they knew my TSH level they would withdraw my levo prescription! I have had no NHS thyroid tests since starting the T3. My TSH is 0.01, is it safe to have a general anesthetic with a TSH that low? And secondly if they test my thyroid levels before the op, are they likely to cancel the op due to suppressed TSH? I had a pre op assessment but it was just questions over the phone. Should I tell them my levels? I'm assuming the anesthetist will want to know them? I obviously don't want to put myself at any risk and this has only just crossed my mind. If anybody has any experience of surgery while taking T3 or having suppressed TSH id be grateful to hear about it. Thank you!

[SlowDragon Administrator]

You need an honest discussion with anaesthetist

Have you got recent results including Ft4 and Ft3 results and ranges

Take these with you

Depends if anaesthetist is aware of liothyronine and it’s effect on TSH

[Laiah in reply to SlowDragon]

Yes I have results from 3 weeks ago, but I've upped T3 by 6.25mcg since then. So levels will likely be different now. Im really surprised they haven't done pre op bloods. Unless they will do them on the day? But that seems silly as if my levels are not acceptable to them then its a wasted surgery slot!

[SlowDragon Administrator in reply to Laiah]

Do you wear a Fitbit or equivalent

Any printable results showing resting heart rate and activity levels

[Laiah in reply to SlowDragon]

I do have a fit bit but haven't been wearing it lately. The surgeon asked me why I was taking 2 thyroid medications and after I explained he checked my pulse and said he was surprised how good it was considering the thyroid medication im taking. Also took blood pressure and said that was perfect. I did tell him that my TSH was suppressed and he didn't seem concerned. But whether that's been communicated to the anesthetist I don't know. It just crossed my mind tonight that I hadn't really though of the effect of my medication on the surgery and then I googled a bit and it all looked a bit scary. I will phone up tomorrow and make sure they are fully aware of what I'm taking and my levels. Thanks for replying

[SlowDragon Administrator in reply to Laiah]

Wear your Fitbit between now and hospital

[lisabax]

I have had a suppressed TSH for many years on imbibed therapy and had quite a few non-thyroi operations wit general anaesthetic, and no problems

[Laiah in reply to lisabax]

That's reassuring, thank you so much!

[csj113]

Just asked my OH (consultant anaesthetist) and he thinks it should be absolutely fine but you are right to always tell your anaesthetist exactly what you are taking. Btw I had a big op on Tuesday myself and my TSH is almost undetectable! I don’t even know if they tested it to be honest. All the very best for your surgery.

[Laiah in reply to csj113]

Oh thats brilliant, thank you for asking him! I will definitely make sure they are fully aware.

[Anthea55]

You might find this interesting - from ThyroidUK website - about the Myths of Hypothyroidism thyroiduk.org/further-readi...

And do make sure you tell hospital what you are taking. Otherwise for them it's a bit like doing a jigsaw with missing pieces. We've had discussions on here about that.

Best wishes for the surgery.

[Laiah in reply to Anthea55]

Thank you! I have told them what medication I'm taking, but they have none of thyroid blood results. I have some recent private ones I can print and take to show them though.

[Anthea55 in reply to Laiah]

My recent op, they included full thyroid testing in blood tests. I rang afterwards for the results so that I could put them into my spreadsheet.

[Laiah in reply to Anthea55]

OK thank you. Did you take your meds as normal on the day of the op?

[Anthea55 in reply to Laiah]

I think so - after all it's replacing the thyroid hormones your body can't make, so you need them. On the other hand they asked me to stop my supplements a few days before hand.

[Starfish123]

When I had an op back in 2014 I was told at the pre op that they preferred suppressed tsh.

[HashiFedUp]

I would be tempted to call the clinic and ask! It would be a nightmare if you turned up and they just sent you home. Its probably better they know. They will be used to dealing with thyroid patients during ops, but yes a low TSH might increase certain risks around respiratory depression (?) although I’m no a medic so don’t know!

[Batty1]

I had knee surgery in 2018 and also take T3/T4 combo at the time and I don’t think they even did blood test but they definitely knew what meds and how much I take and no I did not stop taking them prior to surgery, actually took them a few hours prior with a little bit of water.

[marvalrus]

As far as I know, it's only a concern if you are hypothyroid or hyperthyroid cuz they worry about how you'll wake up if you're hypo and worry about what type of med to use if you're hyper. Your TSH will clue-in the anesthesiologist and if there's a question about it being low, well your response would be that you do take thyroid medication so it's obviously going to be suppressed, and you feel fine, not hypo or hyper.

[Miffie]

My most recent experience was when I had a general anaesthetic in November 2019 when my TSH was suppressed. It was absolutely no problem. The op didn’t go to plan unfortunately and I was in theatre for far longer than planned and had significant blood loss. Absolutely none of that was caused by TSH or taking ndt. Tell the anaesthetist on the day when he speaks to you pre op if you are concerned. I would avoid contacting anyone other than your surgeon and theatre team for your op. as there may be personal differences of opinion and you don’t want to muddy the waters

In the sixty years I have had hypothyroidism I have needed general anaesthetist for six surgeries whilst o taking ndt so suppressed aTSH. I honestly don’t remember it ever being mentioned.

Try not to worry, I hope all goes well

[LAHs]

I had knee surgery about 7 months ago, my TSH was .001 (I'm on Armour). I took my thyroid meds before my surgery since I wanted my T3 to be on the high side. Absolutely no problem with the anesthetic.Now, a nurse tried to scare me that my TSH was too low and to reduce my dose immediately, I just said No. She told my GP who also made a big fuss and tried to put me on Levo. I argued and argued until he got bored and gave in. I told him that the only effect I might have was that I would die at 90 instead of 95 and it would be my fault and not his so stop interfering with success and reinstate my original prescription. It was a bit anxiety causing but I kept on and on and on emailing him till I got my point across.

But don't worry about your TSH being low for surgery, and it is good to have high T3 for surgery. It has been recorded that most people who die under surgery have low T3. Not that low T3 is the cause, just that they do not have the energy to fight off the real cause.

[m7-cola in reply to LAHs]

I completely agree with this.

[Laiah]

Thank you so much everyone for your reassurance. The anesthetist wasn't concerned at all and my surgery went smoothly. I am also having a very easy, non eventful recovery!