One year follow-up RFA

[DearH]

Hello everyone, sorry to not have been more active here. So recently I had my last follow-up after RFA procedure on my right thyriod lob. The part they treated, a conglommeration of different nodules which was nearly 5 centimetres in diameter, has definitely shrunk, but of course has not disappeared totally. The nodule they treated shrunk from 23 mm to 14 mm. The feeling and appearance are better now. I am doing well, but my TSH has been up and down. Before RFA : 2,19, after 3 months: 6,2, after 6 months: 4,2 and now: 5,8. My FT4 level is 15,4. That's all I know. The results have been sent to my gp. I feel slightly down and a bit tired sometimes, maybe also because menopause is not far away. I need to keep an eye on my TSH level as a "TSH above 10 could cause my thyroid to grow again", as the endo said. So I will certainly have this followed up. Good news is that in the mean time RFA of thyroid nodules is available here in Belgium as well. If there is more news, I will keep you updated here!

[helvella Administrator Thyroid UK]

No apology needed!

And very good to read that the nodule has shrunk.

Most people need their TSH to be closer to 1 - much closer - to feel OK. Given the TSH above 10 point, it should be staggering that you are not receiving thyroid hormone treatment - or a dose increase. (I'm not 100% clear whether you are getting any thyroid hormone treatment.)

Many need TSH to be quite low within, or even below the bottom of, the TSH reference interval. 6.2, 4.2 and 5.8 would be over the top of a lot of TSH reference intervals!

No-one should be looking and saying "It hasn't reached 10 yet." as a reason not to treat you. It is plenty high enough to indicate treatment is needed. At the beginning of my journey, I was getting symptoms at a TSH of around 2. (Though I only got treated when it rose to the top of the local TSH reference interval.)

It would help if you could supply the reference interval (range) for the FT4? They vary a lot.

[DearH in reply to helvella]

I am not getting any thyroid hormone replacement at the moment. I will have my blood tested again soon by my gp to know the full picture.

[DearH in reply to helvella]

Reference FT4 is between 10 and 24 pmol/L

[helvella Administrator Thyroid UK in reply to DearH]

I just used one of the thyroid calculators and got this:

Free T4 (fT4) 15.4 pmol/L (10 - 24) 38.6%

healthunlocked.com/thyroidu...

Few feel well with an FT4 below 50%, indeed, many need 75% or higher.

[DearH in reply to helvella]

Thank you. Yes, I do feel rather tired at the moment.

[PurpleNails Administrator]

Thanks for update.

Do you have ranges for TSH & FT4. FT4 looks in range *by most ranges* but TSH is too high. Doctors that wait until it reaches 10 are waiting for overt hypothyroidism & you will be unwell long before that stage. Over range TSH usually means your thyroid is really struggling & you’ll have symptoms, but TSH is unreliable & FT4 & FT3 are what’s important.

TSH & FT4 isn’t a full picture either. In UK many use private blood testing companies to test additional FT3, thyroid antibodies, folate, ferritin, B12 & Vitamin D. Are there any options like that to you?

[DearH in reply to PurpleNails]

Indeed all I know is that right now, my TSH is 5,8 and FT4 15,4. These are the results that I got by phone from the Dutch endocrinologist. I am planning to have a new blood test done by my gp for full results of my thyroid activity.

[PurpleNails Administrator in reply to DearH]

That’s good to get full, current tests. Two above range TSH - 3 months apart should prompt consideration of replacement treatment.

FT4: 15.4 pmol/l (Range 10 - 24) 38.57%

FT4 lower in range / but FT3 tends to be prioritised & may be better. Must be tested to know.

[DearH in reply to PurpleNails]

Thank you for the info. Yes, I will get it tested.