subclinical hyperthyroid after hemithyroidectomy - Thyroid UK

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subclinical hyperthyroid after hemithyroidectomy

KCH651 profile image
KCH651
•16 Replies

evening all 🙂

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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16 Replies
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PurpleNails profile image
PurpleNailsAdministrator

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.

KCH651 profile image
KCH651• in reply toPurpleNails

Thank you for your detailed reply.

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.

PurpleNails profile image
PurpleNailsAdministrator• in reply toKCH651

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.

KCH651 profile image
KCH651• in reply toPurpleNails

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 🙂

greygoose profile image
greygoose

What time was the blood draw for this test?

KCH651 profile image
KCH651• in reply togreygoose

The blood test was approx 9am

Hectorsmum2 profile image
Hectorsmum2

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.

KCH651 profile image
KCH651• in reply toHectorsmum2

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.

Hectorsmum2 profile image
Hectorsmum2• in reply toKCH651

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.

KCH651 profile image
KCH651• in reply toHectorsmum2

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.

Jaydee1507 profile image
Jaydee1507Administrator• in reply toKCH651

A result of 343 for serum B12 is actually quite low. The range is too wide and cut off too low.

What are you tasking for B12? What brand and dose?

KCH651 profile image
KCH651• in reply toJaydee1507

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.

Jaydee1507 profile image
Jaydee1507Administrator• in reply toKCH651

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.

Slightly cheaper options with inactive B6:

amazon.co.uk/Liposomal-Soft...

Contains B6 as P5P an active form:

bigvits.co.uk/thorne-resear...

healf.com/products/basic-b-...

Explanation about the different forms of B6:

helvella.blogspot.com/p/hel...

B complex comparison spreadsheet:

healthunlocked.com/thyroidu...

Thorne basic b contents
KCH651 profile image
KCH651• in reply toJaydee1507

Thank you, I will look at the options available and change what i am taking.

Hectorsmum2 profile image
Hectorsmum2• in reply toKCH651

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.

SlowDragon profile image
SlowDragonAdministrator

suggest you get full thyroid and vitamin testing done

If GP unhelpful then , like thousands of other U.K. patients

Test privately

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels are extremely common with any thyroid issues

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test

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

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/testing/thyro...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

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

Link about Graves’ disease

thyroiduk.org/hyperthyroid-...

Graves Disease antibodies test via Medichecks

Has to be private blood draw

medichecks.com/products/tsh...

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