Hi has anyone been refused surgery due to surpressed TSH ?My daughter is on Armour thyroid. Her TSH is surpressed, I know this is normal with NDT.
Her T4 and T3 are optimal.
She was due to have Gynae surgery in 2 weeks but it has been cancelled due to supressed TSH.
Any advice what to do ?
Thank you
Have they explained what they think the impact will be...if not ask.
No not explained, just said TSH abnormal. Communication has been via the nurses. Think we need to speak to the consultant.
Too vague!
Suggest you speak with consultant....
TSH when T3 is included is not a reliable marker!
bjanaesthesia.org.uk/articl....
There is some debate about whether or not surgery should be postponed in a mild or subclinical hypothyroid patient. It is logical to avoid premedication in overtly hypothyroid patients and to use regional anaesthesia wherever possible. T4 may be omitted on the morning of surgery but it is advisable to give the patient's usual morning dose of T3. The presence of a hypometabolic state necessitates careful perioperative cardiovascular monitoring and judicious use of anaesthetic drugs.
New paper
uptodate.com/contents/nonth...
Thank you. Where do I find the link ?
Click on the blue writing and the paper will appear on your search engine page eg Google
General anaesthetic in either overtly hypothyroid patients or overtly hyperthyroid patients poses big risks .. so the anesthetist will not usually agree to any non emergency operations with either very high TSH or very low TSH ( becasue they see the TSH as an infallible marker of hyper / hypo )
ncbi.nlm.nih.gov/pmc/articl... Perioperative Management of Thyroid Dysfunction
In order for the anaesthetist to agree to use General Anaesthetic for the operation with an out of range TSH, they will have to be reassured that the patient is not actually hyperthyroid ( or hypothyroid) based on their T4 / T3 results
So the person prescribing/ overseeing the thyroid meds needs to contact the anaestetist directly to explain why their TSH is supressed.
In order to clarify Tatty - I take it that a low TSH in range would mean at least 0.27? Even though I've halved my meds over the past couple of years I've still only increased from 0.01 to 0.05 and can't bear to think how I would feel on anything lower.
here 's not a fixed line .. it's up to the anaesthetist how low / high they are comfortable with /circumstances of the op etc .
I think i've had a GA with a very low (but stable) TSH while on levo .. eg about 0.05 but i'd have to check.. might have my dates wrong .
But this is not an 'argue the guidelines' situation .. GA takes you to the edge of death, without being dead and tries to balance you there with a bunch of humans twiddling the knobs that run everything instead of your body doing it by itself .. they're not messing about , it they are not happy with the risks they are taking , they won't agree to do it .. end of .
Would you mind sharing what procedure did you have the GA for? Also, what meds you were on then ? T4? T3 and T4 ? NDT???
For my sleep apnea, I was told that I would benefit from a upp done through GA and I haven't made up my mind if I should get it. I'm trying to learn as much as I can to make an informed decision.
Thanks for that. Whilst here can I also ask you to clarify something for me please as I've read up so much that my cotton wool brain boggles at times and that is. If one has had a thyroidectomy obviously the HPA axis is broken and am I right in thinking that is a good reason why endos shouldn't go by my TSH?
just checked what my TSh was before operation......even though it was usually lower , it was actually 0.18 [0.02 -6] at that time when the gp referred me for surgery , and fT4 was about 50%
so TSH was 'low' but not technically below range due to huge TSH range used in my area at that time (2009).
Re. your 'no thyroid therefore HPA axis broken ' argument .. bit complicated but i've tried to explain on this post : healthunlocked.com/thyroidu.... tsh-is-just-the-opinion-of-your-pituitary-about-your-dose-but-your-pituitarys-opinion-is-a-bit-warped-once-you-take-thyroid-hormone.
Imaaan op was sterilisation (clips on fallopian tubes ) ... taking levo.
Thanks for letting me know.
Sorry for delay in replying - message not showing up for some reason but thank you very much for all that you have told us - perhaps I should change my cotton wool for straw😁
Not exactly the same my surgery should have been on 6th June (Last Week) but it has been moved forward to June. This was because of my very Low FT4 and FT3 levels not be my supressed TSH. I have no thyroid and my TSH has been supressed for years now, no problem. This was due to the danger of the anaesthetic. I have had an operation before with my TSH suppressed no problem.
I should have said my operation has been moved to this September.
This is interesting. When I had my spinal surgery 2 years ago, I was very high risk due to my clotting disease and the nature of the surgery. At the time my T4 was well under range and my TSH 0.01 as usual. T3 was in range. Not one word was spoken to me about my thyroid by the surgeon or anaesthetist and I’ve never ever in the 20 years since diagnosis ever been asked at surgery about it.
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