Just because lab results are within the so-called "normal" range does not mean they are optimal. Please post all your test results and reference ranges shown on the lab report.
Thanks, gimel. To answer, the most recent labs are:
T4 - 1.03 (reference range is 0.82-1.77)
TSH - 4.54 (range 0.45-4.50)
T3 - 96 (range 71-180)
The CMP was otherwise normal with slightly elevated bilirubin - 1.3 (range 0.0 - 1.2)
Again it feels like I alternate feelings of hypo and hyper. The day I did the bloodwork I was feeling more hypo. Cold. Tired. Slower. But then two days later I felt hyper again. No additional labs though. But my pulse was elevated, trouble sleeping, anxiety.
No idea when I should start synthroid. Both my endocrine and cardiologist say to hold off. My GP thinks my body still may be adjusting to the surgery. But it's been almost 4 months!
I have no direct knowledge about what happens with the thyroid system after a lobectomy. You have only half of your thyroid gland left, so my expectation would be that it would be unable to provide enough thyroid hormone to meet the needs of your body. I think the lack of thyroid hormone is shown by your test results. Even though TSH is a poor indicator of thyroid status, your TSH is increasing. Also, your Free T4 is much too low in the range, It is far better when at the middle of the range, at minimum. You were not tested for the other biologically active thyroid hormone, Free T3. Both Free T4 and Free T3 should be tested each time you are re-tested. If your Free T3 level is in the same relative position within its range as your Total T3 result, that would be strong evidence of hypothyroidism.
It is not as well known but the symptoms you identified as hyper can also sometimes be due to hypothyroidism. So all in all, it is likely you are experiencing different hypo symptoms for which your would need to start on thyroid medication to adequately raise your Free T4 to mid-range, and your Free T3 in the upper half of its range, as necessary to relieve symptoms. Note that when taking thyroid med adequate to relieve symptoms, the TSH frequently becomes suppressed below range. That does not mean hyperthyroidism, unless you are having hyper symptoms due to excessive levels of Free T4 and Free T3.
I may be really grasping for possible causes, but the only alternative I can imagine to hypothyroidism causing all symptoms, would be if your adrenals are over-reacting to the big change in your thyroid hormone levels. So before starting on thyroid med, it might be a worthwhile idea to test for cortisol levels. The best test for cortisol is the diurnal saliva cortisol test taken at 4 times during the day. It is difficult to get this done by doctors: they only want to test morning serum cortisol, but it is hard to interpret results since cortisol levels change so much over the day. If you wanted, you could use ZRT on line and for about $140 they send a kit for you to collect saliva 4 times during the day and then send for analysis. You could do these during the days when you experience the elevated pulse, trouble sleeping, and anxiety.
Also, before starting on thyroid med I would also get tested for Vitamin D, B12 and especially ferritin. Low levels can cause symptoms that mimic hypothyroidism. Low D or low ferritin can also adversely affect metabolism of thyroid hormone. D should be about 55-60. B12 in the upper end of its range, and ferritin should be 70 minimum. It is best to not start on thyroid med if ferritin is really low.
The best test for cortisol is the diurnal saliva cortisol test taken at 4 times during the day. It is difficult to get this done by doctors, they only want to test morning serum cortisol, but it is hard to interpret results since cortisol levels change so much over the day. If you wanted to consider this you could use ZRT on line and for about $140 they send a kit for you to collect saliva 4 times during the day and then send for analysis. You could do these during the time when you were experiencing the elevated pulse, trouble sleeping, and anxiety.
If you can get these tests done I think you will be better able to identify what is going on and what is required.