Do TSH levels fluctuate after thyroidectomy

[cj245]

After 12 years of dealing with Hashimotos and multi-nodular goiter, I finally had my thyroid removed a couple of weeks ago.  I'd had a biopsy come back with some atypia cells and while they still didn't think it was likely to be cancer, after more than a decade of biopsies, my doctor and I agreed it was time to take it out.  Thank God!  After the surgery, the pathology confirmed that I had papillary carcinoma in 2 nodules.  One was 1 cm and the other 6 mm, so both very small and completely contained.

Since the surgery, I've been extremely fatigued and was not surprised in the least when my TSH came back at 24.  I am on a new dose of Synthroid, starting today.  I go back in a month, to test TSH, calcium and thyroglobulin.  Since my tumors were small and contained, we are waiting to see if thyroglobulin goes to 0  on its own before deciding on RAI.

I understand that right now my TSH levels are in transition and we are not yet sure what my final dose of medicine will be.  What I am wondering is, when it gets there, does TSH remain stable or does it still change from time to time, needing medication adjustments?

I'm thinking it shouldn't, but wasn't sure and just haven't asked my endo that question yet (because I had so many others following the diagnosis).

cj

[Totie]

My THS level was finally stable a yr after the TT.

That was 16yrs ago. I did start out with 200mcg (Levo) for the first 10yrs, than down to 150mcg, then down to 125mcg, down again to 100 mcg, then back to 125mcg & still on the 125mcg. I do get my TSH tested when ever I remember to have it done. My last TSH level was .67

[Barb135]

You're lucky.  Some people do well with having TSH adjusted; others (like me) have to go through he!! to find a doctor that doesn't panic at a low TSH (mine routinely runs at < 0.01). Best of luck to you........

[cj245]

Thanks Barb.  I will look over my medical reports and see what kind of testing they've been doing.  My doctors have never mentioned T3 before, so I suspect they haven't been testing for it.  Still, I do know that, as a rule, my thyroid issues have always responded well to TSH testing and adjustments in my thyroid medications to keep it under 2.  I have a great endocrinologist, who is on the younger side and completely open to discussing and explaining anything I need clarified.

I feel like my health care is a collaborative process....from things I've read on this and other forums, I feel very lucky.

cj

[Barb135]

TSH is a pituitary hormone, which varies greatly for a variety of reasons.  It should never be the sole basis for diagnosing/treating a thyroid condition.  

In order to provide optimal treatment, you also need to have your Free T3 (FT3) and Free T4 (FT4) tested every time TSH is tested.  These are the actual biologically active thyroid hormones, with Free T3 being the most important.  

Synthroid is a T4 medication and since the body can't use T4 directly, it must convert T4 to T3 in order to be used by the cells.  Testing for Free T4 will tell you how much is available for conversion to T3.  Testing for Free T3 will tell you how much is available for immediate use by the body.....testing for both of these will also tell you if you are properly converting the T4 to T3 (many of us don't)... Most patients tend to find that Free T3 correlates best with symptoms; for instance, my symptoms were not alleviated until I found a doctor who would allow me to adjust med(s) in order to get FT3 into the upper part of its range.  

Many doctors resist testing for FT3 and FT4; they believe that TSH is all they need to know; a doctor who does this, will keep you sick for a long time - the one I had kept me sick for nearly a year before I finally got the help I needed.  Do  make sure they test for FREE T3 and FREE T4, as tests for totals are considered obsolete and of little value.