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Thyroid Levels After Total Thyroidectomy
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Thyroid Levels After Total Thyroidectomy

I have been hypothyroid for several years (10+) and was initally placed on 25 mcg of Synthroid.  About a year ago my synthroid was increased to 50 mcg to see if I felt better at the lower end of "normal".  I subsequenlty had my thyroid removed 6 weeks ago due to a suspicious nodule.  The pathology came back benign.  During the first couple of weeks I felt just fine.  This past week or so I have been feeling absolutely exhausted after being up and about for about 4-5 hours.  Do I need to "tweak" my dosage to see if I feel better or how do I know what "normal" levels are now that I no longer have a thyroid?  What are considered normal ranges these days?
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Avatar_m_tn
Since your thyroid was removed, you are definitely going to need a higher dosage of meds to offset the loss of natural thyroid hormone.  Before talking to your doctor about tweaking your meds, I think you need to be tested beyond just the TSH test that sounds like what your doctor has been using to medicate you.  Using only TSH does not work.

Every time you go in for testing you should request to be tested for the biologically active thyroid hormones, Free T3 and Free T4 (not the same as Total T3 and Total T4).  FT3 is the most important because it largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate.   If the doctor resists testing for FT3 and FT4, along with TSH, then you should insist on it and don't take no for an answer.  

A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.   Symptom relief should be all important to you, not just test results.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he consults with from a distance.  The letter is sent to the PCp of the patient to help guide treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf

Since hypo patients are also frequently low in other areas as well, you should also request testing for Vitamin D, B12, iron/ferritin, zinc, and selenium.   When test results are available, please get a copy and post results and reference ranges and members will be glad to help interpret and advise further.
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Avatar_m_tn
I had a total thyroidectomy 3 years ago due to papillary with follicular variant carcinoma. I have been told I should keep my TSH levels below low normal to decrease chance of reoccurance. My doctor called to say that my TSH is high and he wants to change  my dose to 150mcg from 200 mcg.  I'm confused.... TSH level being high means that im not getting enough hormone in to suppress it right ? Shouldn't my dose be increased?
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Avatar_m_tn
I had a total thyroidectomy 3 years ago due to papillary with follicular variant carcinoma. I have been told I should keep my TSH levels below low normal to decrease chance of reoccurance. My doctor called to say that my TSH is high and he wants to change  my dose to 150mcg from 200 mcg.  I'm confused.... TSH level being high means that im not getting enough hormone in to suppress it right ? Shouldn't my dose be increased?
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Avatar_m_tn
Yes, TSH being high means that you are not getting enough thyroid hormone to suppress TSH.  I think something was misunderstood somewhere along the line.  Did you hear that straight from the doctor, or from a nurse?  Could you have misunderstood?  Anyway, you should call and ask for clarification.

Even though the 200 mcg is a fairly high dose, has it relieved your hypo symptoms?  If not, there is a possibility that your body is not adequately converting the T4 to enough T3.  This is a frequent occurrence when taking large doses of T4.  Since Free T3 largely regulates metabolism and many other body functions, it is important to be tested for both Free T3 and Free T4 each time you go for testing.  Many of our members say that symptom relief required Free T3 in the upper third of its range and Free T4 around the middle of its range.
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