Surgery refused due to low TSH

[H0neybee]

I am due to have a laparoscopy next week but the hospital has just phoned to say that the anaesthetist is not happy to do the surgery as my TSH is too low. I explained that I have Hashimotos, I take Armour and it's normal for my TSH to be suppressed. All my other thyroid values are fine and symptomatically I'm doing well. I said I cannot magically make my TSH go into normal range but they seem to have tunnel vision when it comes to my bloods and are solely focussed on what the TSH is doing. So I basically have to choose between becoming unwell with thyroid symptoms in order to get my TSH to 'look pretty' for them, or I continue to live in pain because they won't do my surgery. Has anyone else come across this before? What did you do? Is there any peer-reviewed literature I can send to the anaesthetist?

[helvella Administrator Thyroid UK]

Anaesthetists have sometimes appeared to understand hypothyroidism better than many other doctors. It is a bit surprising that he/she is being quite so obstinate about TSH.

Afraid I can't think of anything useful/helpful to suggest.

[elderflower2016]

I had laparoscopy soon after I was diagnosed with hyperthyroidism many years ago. My tsh was still suppressed but my ft4/ft3 were in normal range. My gynaecologist only requested that I get a letter from my endocrinologist to say that it was safe to do the procedure. I appreciate this might be difficult to arrange at short notice - I had some flexibility because I was receiving private treatment.

[H0neybee in reply to elderflower2016]

Thanks. The surgery is private treatment. However I currently don't have an endo. I moved house to a new county and have been waiting for a referral to a new NHS endo since last summer. Plus my experience is that most NHS endos are so deadly against NDT that they will also disagree with a suppressed TSH However I do have my last year or two of blood results that show FT4/FT3 etc. so that is my plan - to send them those along with literature on how/why NDT suppresses TSH. Fingers crossed!

[elderflower2016 in reply to H0neybee]

A bit of a long shot, but you could ask your surgeon if there are other anaesthetists he/she works with and choose one who would have a better understanding of the thyroid?

[fiftyone]

If I may ask, why do doctors insist on higher TSH. What do they say the health risks are with a low TSH?

[Goatcheesesalad in reply to fiftyone]

i was just wondering the same!

[elderflower2016 in reply to Goatcheesesalad]

they think that with a low tsh, you are probably hyperthyroid and that you will be tachycardic and may have an adverse reaction to the general anaesthetic.

[H0neybee in reply to fiftyone]

As elderflower2016 stated, it's due to potential cardiovascular issues as well as potential thyroid storm and in very severe cases, coma. However my argument is that I am not hyperthyroid. I actually still have some hypo symptoms. It is just that my medication suppresses my TSH, so the blood result isn't a true reading of my status and symptoms. It's just getting the anaesthetist to understand that. I can understand their hesitance if I was hyper as it would be a risky anaesthetic, but I'm not hyper.

[fiftyone in reply to H0neybee]

if T4 and T3 are okay. seems odd.

[H0neybee in reply to fiftyone]

Many doctors struggle to look past the TSH. Most won't even include FT4 and FT3 routinely on a thyroid panel. I only know what mine are because I pay to have my bloods done privately. If I relied on my GP, I'd only ever have my TSH tested.

[Brightness14]

After I had my TT my GP and myself were given a letter from my surgeon, a professor at Poitiers Hospital in France. The letter states that my TSH should always be supressed.I have copies and take this everywhere with me.

Since my TT I have had my gallbladder removed in the UK and nothing was every said

about my low TSH which is around 0,005.

[H0neybee in reply to Brightness14]

That's interesting. Unfortunately my GP has said he doesn't know enough about thyroid diseases and NDT to advise or comment, and I don't currently have an endocrinologist (I'm waiting for a referral to come through). My TSH was 0.06, although I think it's come up over the last couple months as I lowered my med dose. It's always been below 0.1 since I've been on NDT. My FT3 and FT4 are in range.

[Batty1]

Absolutely ridiculous but it seems to be a common thing now with surgeries as my sister just got denied for knee replacement because she smokes 10 cigarettes a week even though she has lost weight and has no other health issues like breathing problems… But 10 Years earlier my mother had knee replacement and she smoked like a chimney and they proceeded with surgery and she had a slew of health issues….its Crazy.

[serenfach in reply to Batty1]

Tell your sister to lie - 2 cigarettes a day is not going to make any difference to anything! They seem to be looking for anything not to do any work now.

The silly thing is, H0neybee , if you needed emergency surgery, the TSH would be accepted!