I had a hemithyroidectomy in 2021 due to a large benign tumour on the left side of my thyroid, the right side was biopsied but left due to being non cancerous even though there is 3cm nodule on there. I didn’t get put on any medication post surgery as bloods were all ok. Lately I’ve been feeling super tired, struggling at the gym and noticing hair loss so I went to GP who did bloods for me. My results have come back as abnormal and are below:
TSH 0.10miu/l (0.35-4.94 normal range)
Serum free T4 11.3pmo/l (9-19 normal range)
Serum free triiodothyronine 4.7pmo/l (2.9-4.9 normal range)
I’m assuming the latter is T3? I can’t get a call back from my GP until the end of the week. Can you get hyperthyroidism with only half a thyroid? Any help understanding my results before I chat with my doctor would be really appreciated.
Many thanks in advance!
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KCH651
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Did the nodule affect thyroid function prior to surgery?
Do you have comparison of pre & post levels.
Over replacement can give low TSH high FT4 & FT3 but you have not been put on replacement? So not case here.
Serum free triiodothyronine is FT3
Have you ever had any thyroid antibodies tested?
Yes it’s possible for hyperthyroid to develop after partial thyroidectomy.
There are several reasons.
Hyper can transient before declining to under active levels (Hashimoto’s/ autoimmune thyroiditis)
Graves causes continuous hyper as the immune system stimulates thyroid levels can become very high. Typically 3x normal level. As you have less thyroid the level may not become as high.
Sometimes nodules develop which hyper function causing gradual elevation of levels.
Your FT4 & FT3 are not over range (FT3 is quite high) so you don’t need treatment to lower them (yet). Not based on low TSH. Doctors focus on TSH but there’s many reasons for low TSH. You need to monitor levels for now.
Also test folate, ferritin, B12 & vitamin D.
See if TPO & TG antibodies as well as TSI or TRAb antibodies can be tested if hyper Graves suspected.
My bloods were showing hyper before the surgery, I don’t know the exact levels from then. My online access only goes back to last year. I requested bloods last year and they only did TSH which was 0.35 and T4 which was 10.2.
To my knowledge I’ve never been tested for antibodies.
should I ask my Gp for a referral to and endocrinologist? Even when I had my surgery I only ever saw ENT and no endo.
If hyper you should be referred to endocrinologist.
ENT only look at physical issues (growth of thyroid causing compression or concern of malignancy - they don’t look at function). That’s what endocrinology does. The FT4 is quite low in range.
Your nodule on remaining thyroid may be hyper functioning, they often show with high FT3 & gradual increase.
Graves’ antibodies should still be tested along with nutrients.
That's great, thank you so much for the reply. When I speak to the GP i'll ask for that referral. I'll make a note of the other tests you've mentioned too. Thank you again 🙂
I wouldnt say you were hyperthyroid with a normal T4 and T3. Sometimes doctors just rely on a tsh result which would indicate hyper but I dont think TSH is that reliable. Have you had your ferritin, folate, B12 and vitamin D taken. Low ferritin might be the cause of your hair loss, struggle with exercise and tiredness.It can also make you breathless. Make sure you are thoroughly investigated.
Ferritin, folate and B12 were all checked and came back within the normal levels. I had B12 and D deficiency 2 years ago so take high strength tablets everyday for these anyway.
What was the cause of your B12 deficiency. Are you vegetarian? Or were you taking antacid medication? If not then the tablets might not be working for you even if bloods now OK. You might want to post on pernicious anaemia forum for more expert opinions.
I have never found out why I had the deficiency. I am not a vegetarian, i tend to eat a well balanced diet and am not taking any medications. It seems to have stabilised since I take the supplement daily. My latest result came back at 343ng/l (normal range 190-883). To be honest I never thought to investigate the B12 or D deficiency because I hadn't realised it could be linked to my thyroid. I will also as my doctor about this when I speak to them.
I'm currently taking a Vitamin B complex from Tesco which has 100% of B12 in it with other B vitamins, I did wonder if this was enough but Dr said it was fine.
Understand that doctors get no training in nutrition.
The Tesco B complex is a very low dose of cheap, inactive ingredients with a number of additives if you compare the numbers to the image. You would be far better off with something like the dose I have attached which is from Thorne Basic B.
There are a number of alternatives, see link to spreadsheet post.
it is likely that you might have pernicious anaemia if there was no other known cause and need injections. it is like thyroid not a condition well understood by the medical profession so it would be a good idea to read up before talking to your doctors. There is a Pernicious anaemia society that is very good and a PAS forum on health unlocked. The blood tests are very unreliable for B12 and can appear fine when you are deficient.
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