Bloods Post Partial Thyroidectomy

[Void1234]

hi everyone,

I was in touch previously at the end of last year and had a goitre which i got removed through a partial thyroidectomy and thankfully all is benign. I’m now having a few challenges getting meds right and would ask the communities steer, as abit lost

After surgery I was placed on 100mcg of levothyroxine. However as normal life resumed i feel totally exhausted, I take a D3 vitamin spray, B12 vitamin spray and my selenium and asked for my folate to be checked to see those numbers also ( awaiting results) , however my GP came back today to say my thyroid bloods look normal ,

so my TSH is 6.06 ( range 0.27- 4.2mU\L

FT3 3.7 pmol (range 3.1- 6.8 pmol)

FT4 14.3 pmol ( range 12-22 pmol)

after 22 calls to get through to GP they said everything normal and I’m not in agreement... My surgeon is on a sabbatical so cant get in touch with them and due to see my private endo Feb, could anyone give a steer on these results.

appreciate any steer.

Many thanks

[Hidden]

TSH of 6.06 'looks normal'. What nonsense.

There is nothing normal about a TSH of 6.06! You need an immediate increase in levo.

[SlowDragon Administrator]

Insist on 25mcg dose increase in levothyroxine and bloods retested in 6-8 weeks

On levothyroxine TSH should always be under 2

Most people when adequately treated will have TSH around or under one

Most important results are always Ft3 followed by Ft4

Aiming for Ft3 at least 50-60% through range

Always test thyroid levels early morning around 9am and last dose levothyroxine 24 hours before test

Approx how much do you weigh in kilo

Comprehensive list of references for needing LOW TSH on levothyroxine 

healthunlocked.com/thyroidu....

TSH should be under 2 as an absolute maximum when on levothyroxine 

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

[Void1234 in reply to SlowDragon]

Hi SlowDragon , thanks for response - I weight 76KG ,

[SlowDragon Administrator in reply to Void1234]

so guidelines of dose by weight suggests 121mcg per day

76 x 1.6= 121.6

get dose increase to 125mcg and retest in 6-8 weeks

Some people need slightly higher dose than guidelines

Always test thyroid levels early morning and last dose levothyroxine 24 hours before test

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine: 

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months. 

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range. 

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[Batty1]

Your thyroid levels are not normal and will only get worse.

[Void1234 in reply to Batty1]

thanks, spoke to GP this morning and they think 25mcg increase would be too high and 6 is normal TSH, i basically said its not normal for someone medicated already.. They said if i wanted to increase dose it was my choice! So now trying to get through to surgeons secretary!

[tattybogle in reply to Void1234]

if GP is adamant that TSH 6 IS in range ...... get hold of the range for that TSH test .. (ask the receptionist at GP's for a printout of your latest thyroid results ( results and lab ranges) , it will be shown on there .

There did used to be some TSH tests that had a lab range that went up to 6 ....ie my NHS lab used [0.02 -6] and then [0.05 -6] until 2015 , but in recent years most UK TSH test ranges have been pretty much standardised .. most are now in the region of [0.4 -4.5] and one is [0.5 -3.6]

If your NHS lab is still using equipment that measures using a reference range that goes up to 6 .. they are behind the times

And of they are not ,and the top of the range for your test is actually closer to 4/5 then it is your GP who is behind the times .

[helvella in reply to tattybogle]

In the original post it said:

TSH is 6.06 ( range 0.27- 4.2mU\L

It is so VERY obviously not within the reference interval!

Have a look here:

helvella.blogspot.com/p/the...

There are few who are on thyroid hormone who do well even at a TSH of 2. Many need slightly over 1 or lower.

[Void1234 in reply to helvella]

thats correct, thats the range. Ive to see my private endo in Feb, the surgeons secretary just going to voicemail.

[tattybogle in reply to helvella]

Ah ...thanks helvella .. forgot to go back up to the top and look .

in which case ....GP is a *insert expletive of choice*