Cancellation of Arthroscopy as low TSH

[sadiethedog1]

Good Evening Everyone

I thought I would share this with you. I am scheduled to have a private Arthroscopy on Thursday 12th Oct. I had a pre op appointment and had some bloods taken on 30th Sept. I got a telephone call today from a nurse to say that the Consultant Anaesthetist was cancelling the operation as he wasn't prepared to give me a general anaesthetic as my TSH was 0.01 (0.27-4.20). (The hospital only did Free T4 as well, which was 18.3 (12.0-22.0)).

I reiterated that self medicate with Thyroid S and I explained that I felt well with my TSH at this level. I was told that unless I increase it, there won't be an operation. I said that "this would take some time to do but that I wouldn't feel at all well in myself". Therefore, my options would be:- either I feel unwell but could have an Arthroscopy and be free of knee pain or I feel well but would continue to have continual knee pain.

I explained that my TSH had been this level for a few years and that my doctor was aware of it as we have annual blood tests. My doctor has expressed his disapproval but when I said that I would be prepared to work with him and give Levo another go if I could have some T3 alongside it, he refused.

I asked the nurse if I could speak to the Consultant Anaethetist but he had gone home. I explained that I had made a lot of arrangements to be looked after post operatively, with family travelling about 300 miles to do that. Also, that I had arranged for people to look after my horses and dogs. The nurse said she would ring the Consultant Anaesthetist and tell him all that I had said When she called back, she said the Consultant said that if my doctor was aware of my low TSH that I could continue with my plans to have the operation on Thursday, that he would speak to me then. I suggested that perhaps I have an epidural which was taken on board.

On Thursday, I would like to ask the Anaethetist why he didn't call me? Why had it been left to two days prior to the operation? Why didn't they look at my medical records or ring my doctor? Why did he not suggest an epidural rather thana complete cancellation? Hopefully it is alright now but I was upset when I got the call to cancel my procedure as I have been in a lot of pain.

Has anyone else had a similar scenario due to their low TSH?

Thank you for reading

Annie x

[SlowDragon Administrator]

We have had several members recently who’s anaesthetists were completely happy with suppressed TSH…..but patient had both tested Ft4 and Ft3

Other anaesthetists are not happy to proceed

If you have any recent private test results you have done yourself recently, suggest you take photocopies in to hospital with you……plus good supply of NDT

You may need to have a secret stash so you can self medicate….if nurses don’t bring NDT at correct times

They tend to insist thyroid medication taken with food and all other medications!!

[sadiethedog1 in reply to SlowDragon]

Thank you very much Slow Dragon, I will heed your kind advice.

I keep an eye on my heart rate and use that as my safe but optimum doseage. I just wondered if there is any danger in having a general anaesthetic with a suppressed TSH or perhaps that’s difficult one to answer without the other blood tests? I don’t really understand why it would be refused? I don’t have any other recent blood test results unfortunately. Thank you once again.

[SlowDragon Administrator in reply to sadiethedog1]

in a patient NOT on replacement thyroid hormones, a suppressed TSH would be due to being hyperthyroid

If a medic has no experience of someone with suppressed TSH on replacement thyroid hormone, they would assume you were hyperthyroid and therefore wouldn’t be suitable for operation

Taking NDT, which contains T3, will invariably result in suppressed TSH

Obviously if self medicating NDT it’s essential you get FULL thyroid and vitamin testing at least annually and after any dose change

[SlowDragon Administrator]

all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

On NDT or T3 - day before test split T3 as 2 or 3 smaller doses spread through the day with last dose 8-12 hours before test

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Tips on how to do DIY finger prick test

healthunlocked.com/thyroidu...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Just TSH, Ft4 and Ft3 test - £32

monitormyhealth.org.uk/thyr...

10% off code here

thyroiduk.org/getting-a-dia...

Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65

(Doesn’t include thyroid antibodies)

monitormyhealth.org.uk/full...

10% off code here

thyroiduk.org/getting-a-dia...

[Allergy]

Hi iv ha d 4 orthoscopy ies had them on both knees my tsh was always 0,01

But I do take t3 with thyroxine I had my last one last September on right knee I do need knee replacement I have the same anethatist since 2013 And consultant

Can you get previous blood results I wish you well x

[Sparklingsunshine]

I've had several operations with epidural and would always choose it over a GA if possible, the recovery time is much quicker and you avoid that horrible groggy feeling. A lot of hospitals offer a patients a choice these days. I know lots of people who've had knee and hip surgery this way.

[sadiethedog1]

Thank you to you all for your kind help and very useful and supportive advice. I am very grateful to each of you 😊xx

[Anthea55]

I agree with Sparklingsunshine. I avoid general anaesthetics whenever possible. I've had several ops under epidural.

[serenfach]

Just to reiterate what SlowDragon said, take your pills with you, hide them in your wash bag, they will take them from you to "give to you later" and you will never see them again. They may try to give you Levo so just pretend to take them. We should not have to play this game but we have to.

Good luck with the op and hope you are pain free very shortly.

[sadiethedog1]

thank you for the kind advice - I will definitely do as you suggest 😊