[JennaV]

#1017897

I had a total thyroidectomy about 2.5 weeks ago. I was on PTU up until the night before the surgery, and right after surgery, I started on 100 mcg of Synthroid. 2 weeks after the thyroidectomy, I noticed that I have been feeling colder and more tired every day for the last several days. I called my endo, and he said to go ahead and come in for labs. I had some old lab recs from pre-thyroidectomy, which included TSH, FT4, and FT3. My results were as follows:

TSH 5.48 (0.5-5.5)
FT4 1.1 (0.7-1.9)
FT3 <1.1 (1.5-3.5)

I talked to my endo about these labs, and while he agreed this looks hypothyroid, he wants to wait and see for at least a week or two more to see if this is the right dose of Synthroid. He said if I still feel hypo in 1-2 weeks, I can get labs again and see where the numbers are headed. If they are worse, they will up the dose, but if they are getting better, then they want to wait to see if this is the right dose. I am okay with the plan, although I am a little frustrated because I was euthyroid going into the surgery, and I feel I am going hypothyroid, more and more every day, so it seems to me that the dose is going to be too low.

Anyway, I have a question about a comment my endo made in the course of the conversation about this. I think I was actually talking to his student, and she said that FT3 is not a consideration post-thyroidectomy. We only consider TSH and sometimes FT4 in dosing, and FT3 does not matter and may not be normal because I don’t have a thyroid anymore. That comment confused me because I thought the body still converts T4 into T3, and I also thought that T3 was the active form of thyroid hormone, and the one that often determines whether we feel hypo or hyper. She seemed to suggest that having super low FT3 is okay and should not affect how I feel. That confused me. Any thoughts and/or experiences about this?

Thanks! I’d love to know how some others are doing post-thyroidectomy on their replacement doses, and how long it took to get the dose right.

Jenna

[Ski]

#1061530

Hi there,

I can’t speak to the post-thyroidectomy/replacement hormone curve (I did RAI), but I can tell you that T3, while it is the active form of thyroid hormone, is extremely volatile precisely because it is the active form of thyroid hormone ~ it is made when you need it, and levels may drop when you don’t. T4 is a more constant, reliable level, and after you’ve achieved normal and stable thyroid hormone levels, TSH is the gold standard for adjusting your dose of replacement hormone. That said, a CHRONICALLY low T3 level would be something to consider ~ in other words, one that simply does not come up, ever ~ but you are far too early on in the process of finding your dose to make that determination.

I completely understand the frustration of feeling badly and wanting to make adjustments rapidly. For now, though, your doctor is right, and it’s better to wait just a little while longer before making those adjustments. Your TSH level won’t accurately reflect the way your body is reacting to the current dose for at least 4-6 weeks after you’ve been taking it, and making adjustments more rapidly can lead to a longer period of time until you feel truly well.

I hope this helps! Also hoping more responses will come in, to give you a better idea of what’s ahead, or at least what the story has been for others in your shoes. Remember this: you are getting closer to normal every minute. ” title=”Very Happy” />

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