Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
Post Thyroidectomy
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Post Thyroidectomy

Hi
I am new here and I will try and keep this short and to the point.  I had a total thyroidectomy on 12/23/05. I had Graves for 10 years untreatable(allergy to meds). Took beta blockers for A-Fib.That is better now, no more beta blockers. I went hypo within one week. Was prescribed 0.075mcg of Synthroid. No T3 supplement. I am in Canada Armour isn't available here. Had blood test done on Jan 6 at my request due to severe symptoms. Weight gain was 10lbs but the 6th. Extremely cold, insomnia,debilating headaches to the point of vomiting, fatigue, night terrors, depression, basal body temp of 93-94. First labs are TSH-0.05(ref0.30-4.70),FT412.7(9.1-23.8),FT33.3(2.5-5.7). My question is even though my TSH shows hyper, but not symptoms of hyper ALL HYPO should my dosage not be increase to bring my T's up to the higher range of normal due to the TSH suppression? Also with have an auto-immune disorder could me adrenals, and pituatary gland inhibiting the adbsorption or conversion of T4 to T3?  I am insisting upon a T3 supp, and tests for anti-bodies and adrenal functions?  Is there anything else I should be asking for. I also understand that only going by the TSH is not always a correct indicator of hyper especially if there is a reason for the suppression.  I would like to be in the range of 4.0 and higher ranges of T's I think that would help me emmensely. Everything that I read including Endocrinologists lectures, NE journal of medicine the importance of T3 supp.  There is desiccated thyroid and Cytomel here in Canada.
Thank you
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At first I would dose the T4 on weight (0.7mcg/pound) as you have had total thyroidectomy.  I would be interested in THE NEJM articles stressing importance of T3 - this is highly debated in academic medicine and the 1999 article is criticized greatly but did suggest that thyroidectomy patients may do better with t4/t3 - I do try it in some patients not doing well on T4 alone.  The TSH may take a few months to be able to interpret so would currently dose weight-based following symptoms and T4/T3. Avg post surgery dose I use is 125mcg.
9 Comments
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Avatar_n_tn
Thank you for your response but that recommendation dosage seems extremely high...I thought it was 1mcg per pd or weight.

The website that I found the NEJM article is on www.mercola.com. If you type in Armour in the search box you should find it there.

Thank you.
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Avatar_n_tn
Hi,
I had a thyroidectomy in 2003 and was put on Synthroid. I went hyper on it when they increased it to 125 and then to 112. I am now on Armour 3 grains and for the most part doing very good on it. I did have lots of stress lately (mother died) and had a set back but seem to be on an even keel now. Have you been to About.com?  Most people do better on Armour with the T3 T4 combo. Wish you well!!
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Avatar_n_tn
Icie,
After my thryroidectomy, I had symtoms (symptoms) of both hyper and hypo. Without getting into the details, I never felt "normal" after my surgery. Strenuous activity for more than 2-3 hours at a time would wear me out to the point I had never experienced before. My BP would go dangerously low (80/50, pulse ~100) and I felt extremely tired and light-headed. So much that I had to go lay down and take a nap for 3 hours. This never occured before my surgery.

I started to think maybe I'm having trouble converting T4 to T3 (I'm on Levothyroxine or T4). Reading some article on the Internet suggested that maybe Selenium may have kind of catalyst effect to converting T4 to T3. I went to the drugstore and bought Selenium Yeast tablets in 200 mcg. Within hours of taking my first one, I felt completely different.

Selenium has changed my life and I now feel better than I ever have before my surgery. I sleep great, feel stronger, back pains went away, headaches mostly gone, heartburn, dry skin, all gone. As long as I take the selenium every 4-6 hours, I can work in my yard (the strenuous activity) all day without any problems. If I forget to take it, my body reminds me within hours that I forgot.

I now take 50 mcg 4 times per day which I buy here:
http://www.puritan.com/pages/file.asp?xs=CE55E06F18104C838684363B85038B3B&PID=408

One last thing, my research about selenium shows that the selenium found in multi-vitamins (sodium selenite or sodium selenate) is NOT the same as that found in Selenium Yeast (selenomethionine) tablets. If you try it, get the more active form found in tablets that only contain selenium or selenium yeast.

Hope it helps!
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Avatar_n_tn
Hi i'm new here so bear with me. I have hyperthyroidism. I have been told by my doctors and specialists that I have had this all my life and being pregnant with my last son had flared it up. I have had nothing but blood tests and meds as most of them make me violently sick... the one I'm on at the moment is Peopylthiouracil. And that seems to be working for me. Or so I thought. The meds are not working anymore and I'm contiuning to lose weight. I'm 6 foot and weigh an aneixic looking 52kg's. My blood test results have slightly improved but my t4 is still very very low. I had to take 3 tablets 3 times a day for 10 days then 3 tablets 2 times a day for 10 days and then 3 tablets once a day untill I had to go for a routine blood test and to see if I need operation. I was told yesterday by my doctor and my specialist to contiune on 3 tablets once a day for next 6 weeks then they will talk to me about the operation. The specialist did tell me not to be enive and not think that the meds would cure me, that cos my thyroids are that over active they need to come out whether that be 6 mths or 6yrs they will need to come out. I have been doing alot of reseach and talking to my mum's sisters etc... who have had an operation on their thyroids so that I am prepared. But even with all this information I still don't understand what's happening... and I think it's because I'm so scared. I have never had an operation ever. The only time I have been to a hospital is to have my two children... I can't stop crying and having panic attacks at the thought of having this operation. I haven't told my husband how scared I am in fact I haven't told anyone how scared I am...because I don't know if I'm over reacting. I'm just so scattered....I have to go for another blood test in 6 weeks to see what's happening but doctor said that no matter what the test show if I am still losing weight they will need to operate. I'm losing a kg a week... in 6 weeks... I won't weigh a thing... I'm not sure if I should go back to the doctor and speak to him... I also asked if they could... leave me some of my thyroid so that I don't have to go on meds for the rest of my life... specialist wants it all out. I don't take the pill cos I forget to take it everyday and he said that if I don't take meds everyday after op... I will die... then I just started crying and thinking about my two young boys and my husband I just can't deal with this
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Avatar_f_tn
I'm going to send you an e-mail for a graves website ok. Everyone on this site is very helpful & there is quite a few from the UK. Elaine Moore is one of the senior members. She has alot of info on the net re: hyperthyroidism. You'll be ok.
                            Jean
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Avatar_n_tn
hi just an update or should i say lack of an update. I ended up going back to the doctors and telling him everyone like how scared i am etc.... and he said the specialist and himself just want to give the meds a chance... HELLO??? i have been on them for over 4-5 months my TSH have not moved at all, i'm still losing weight. and by the way last time i looked i was the patient. what about what i want? he said that he wants to wait (again) to see what this next blood test says and i told him if he tells me that again once we get these results back i'm walking out and finding another doctor and another specialist both who are willing to help me. grrrrrrrr i asked him if they were waiting for thyroids levels to be stable heard something about thyroid storm and he said no. I don't know what more I can do. i have been there with my serious concerns and no one is willing to do anything. They have to come out...... so for god's sake take them out. Sorry for sounding so angry but i am.
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Avatar_n_tn
Thank you for your posting, I also had Thyroidectomy and have gone through hyper, hypo, panic attacks, arrythmias and on and on, one of my biggest challenges is retaining fluids, this is causing me lots of problems.  Because of my symptoms I am also thinking that perhaps my body is not converting T4 to T3 and read about Selenium a on Tuesday this week, I checked what foods were rich in selenium, and went out and bought Brazilian nuts, however since I saw your posting I am going to try the Selenium tomorrow and try it, I will let you know if this worked for me.  I am praying for a solution.

Thanks again
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Avatar_n_tn
This is the first time I have used a question forum like this but here it goes. I am 7 yrs post op total thyroidectomy, female,57 yrs old.   5/51/05 levothyroxine .137 TSH .11 dose lowered to .112 mcg,  7/13/05 TSH 2.65 no changes,  12/8/05 TSH 8.11 Levothyroxine raised to 0125 mcg, 2/13/05 feeling really awful, TSH 23.79 doctor doesn't believe test repeat 24.98 still doesn't believe test redone new lab 3/6/77 TSH 26.77.  Wow feeling worse all the time. Dr away for next week.  Trying to get to endochronologist can't get appt. til May 17th.  What should I do and what can be causing this?  I have not missed a dose but am on a lot of other medications.  Can someone help?

Desperately,

Ellypoo
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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
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