Has anyone else had an operation cancelled due to a slightly elevated FT4?

Hi, I was due to have an operation to repair a damaged ankle ligament at the Lister in Stevenage tomorrow, but my operation has been cancelled due to my FT4 level. I have suffered from hypothyroidism for 7 years and currently take 125 micrograms of thyroxine per day which just about keeps me feeling human. My GP has been happy with my annual blood tests, my last one was about six months ago. Anyway the hospital tested me and my results came back as TSH 0.28 and FT4 17.4. The hospital say that although my TSH is OK, their "normal" range for FT4 is between 7.8 and 14.4 and I am therefore too risky to operate on!!! I'm 46, reasonably fit, don't smoke and drink a small amount. I have been told I need to go back to my GP, get them to "sort out" my levels and then get referred back, all of which could take months!! All the info I have read puts a normal FT4 at between 10 and 25, so I'm completely baffled. I have now got to take less thyroxine which will make me feel grotty, so I'm ok to be operated on (go figure). Has this happened to anyone else and what do you think of their normal range?

22 Replies

  • I would not drop the dose and 'investigate' it, I think it's a load of cobbles (my 'hunch'), please look into it properly before you drop your meds as you're feeling ok-ish at this dose

  • Thanks for your reply. I've gone back to my own GP who works under a different NHS trust to the hospital and had more blood tests done to see what results the GP gets. When I told my GP the hospital results, they were surprised that the level of FT4 had caused a concern!! I have reduced my thyroxone dose slightly, as I need this operation and will have to "play the game" with the hospital, but I'm pretty miffed that I'm going to have to mess around with my dosage when everything seems OK on 125 a day!!

  • hi yes ice had a knee operation cancelled 5 times for same reason now have to wait untill august now to see if my levels have evened out . but i dont think i be getting op done this year

  • How frustrating for you! What I find weird is that supposedly 1 in 20 people (probably higher) can suffer from a thyroid complaint yet as far as I know, it is not normal for a hospital to do a thryroid function test as part of a pre op assessment unless you have an existing condition, so what happens to all the undiagnosed people who have operations! Potentially there could be loads of people operated on daily who are completely outside normal thyroid function ranges, yet I have successfully managed my hypothyroidism for 7 years but that's not good enough!!

  • Well I had my thyroidectomy with an FT 4 of 26. Don't know if that helps you as your operation is on your ankle. I was put on beta blockers during and after surgery - maybe they could consider that for you as a precaution?

  • Thanks for your reply, my surgeon is as frustrated as I am about this but it is the anaethetist who has refused to operate with my current level of FT4. Althought the operation on my ankle is essential to me, it is obviously not life threatening or making me ill, so the hospital doesn't want to take a risk. I therefore don't think that the beta blockers will be an option, but will bear it in mind for future discussions with the hospital!!!

  • Range here is 9 - 26 so at 14 you would be low in range. Clearly this is not an exact science.


  • I can't find anywhere else where the range is as low as my hospital. My GP who is in a different NHS trust told me that as long as my FT4 was less than 20 then they were happy!! I'm really concerned about this as altering my dose to fit the low range at the hospital will make me feel worse, so how can that be good when I am going to have to recover from an operation?

  • Can you be referred to another hospital for this surgery, or can you put it off for a while and see if you can manage without it in the end?


  • I can't manage without the surgery as it is too painful. I need to have ligament reconstruction. I have a fantastic consultant at the hospital who I have complete trust in, so I would not want anyone else to operate on me! My consultant is frustrated at the delay and is being very supportive in finding a way to get this sorted.

  • Further to my original question, I understand from other posts on this site that not taking levothyroxine the morning of a blood test is advised. I hadn't realised this, so I had taken my normal dose the morning I had my tests at the hospital. Would my FT4 have been lower if I hadn't taken my dose or would the difference be insignificant? I had another blood test yesterday for my GP and didn't take my normal dose until after the test, so I'm keeping my fingers crossed that if my FT4 is down then the hospital will accept this.

  • It would be standard practice to have your blood drawn as early as possible in the morning and to wait to take your levo until after the test. Personally, I’d try this as an initial tactic and then review your strategy if necessary.


  • 'actually', if you want the fT4 to show lower in your blood test you have to have the blood drawn AS LATE as possible in the afternoon as fT4 levels are highest early in the morning and lowest in the evening :)

    it's if you want your TSH to show the highest you have blood drawn as early as possible.

    so for the original poster a blood test as late as possible in the day is the answer with no thyroxine on that day until after the test :)

  • Thank you, I hadn't realised I should wait until late in the afternnoon. I had my blood taken about 11.30 am, but I hadn't eaten or taken my thyroxine. Will bear your comments in mind for future tests.

  • I stand corrected - thank you


  • You also might want to ask to see the anesthetist about this. My operation was cancelled a couple of weeks ago due to "unstable thyroid condition" and I was put in front of the anesthetist and what an eye opener that was. I have never come across a NHS worker that knew so much about thyroid issues and was so understanding, he took the time to explain and, joy of joys, listen to me.

    Apparently if your thyroid levels are not optimum then your recovery could be compromised but the best person to advise you of this would be the anesthetist.

    Moggie x

  • Thanks - the pre op assessment team have passed on the comments from the anaethetist and I get the impression that he is not prepared to discuss my case 1 to 1. I understand his concern but my FT4 level would be accepted as normal by plenty of other hospitals etc, so I can't understand the issue here and why this particular NHS trust has such a low normal range (7.8 to 14.4). I think there is far more risk to my well being in reducing my dose which will make me feel tired and groggy etc than in having a FT4 level of 17.4, which my GP is happy with!!

  • Isn't it amazing how, not just blood ranges, but attitudes of NHS staff can differ so widely from one trust to another. My anesthetist could not have been nicer or more helpful where as your's isn't interested other than to cancel your op.

    Your right about it being of greater risk to be under medicated - this is one thing that the anesthetist really hit hope about. It can cause trouble both in the recovery room plus in your overall recovery time.

    Good luck with it and let us know how you solved your problem.

    Moggie x

  • Thanks Moggie will keep you posted. Although the anaethetist is proving unhelpful, I can't fault the help and support from both the pre op assessment nurse and my consultant who are doing everything they can to sort this out for me.

  • That's good news - I am booked in AGAIN for next Friday and I am dreading it as my endo and GP have let me go drastically under medicated for about two months. I now have full blown thyroid symptoms and it looks like I will be having the op like this. Cant believe that an endo/GP can let this happen in this day and age.

    Moggie x

  • Hi,

    I had neurosurgery (brain) on 9th February. My T4 was >24 and my TSH below measurement. I didn't hear a squeak from the surgeon or anesthetist.

    Didn't have any problems with recovery whatsoever.

    Op was carried out at the National Hospital for Neurology and Neurosurgery in London.

    My Endo runs me high because much lower and I start to flag again. I'm currently taking 150mcgs, recently reduced form 175mcgs because T4 was still going up.


  • Glad to hear your op and recovery went well. My GP has retested my blood and I got the results today. My TSH is 0.2 (range 0.35 - 5.5) and my FT4 is 18.4 (range 9 - 22.7), so my GP is happy with my FT4 level and although my TSH is low, I am feeling fairly good on a dose of 125. I am due to speak to the hospital tomorrow and hope that they will take my GP's opinion into account regarding my dose and that I won't be forced to reduced to change it before they will operate!!

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