[jax1122]

#1060539

My 24 yr old niece is scheduled for surgery to remove the thyroid next week but her tsh levels fluctuate between 75-150. they just added a medication to bring it down but told her that they cannot do the surgery if it does not come down..she is falling apart. she has a small goiter and there is no doubt that the thyroid has to be removed. Her t-3 and T-4 levels seem to be ok. Isn’t the point of removing the thyroid because the tsh is uncontrolled causing the Grave’s Disease. We cannot find any literature n this subject. Please help

[Kimberly]

#1183196

Hello and welcome! Usually, the issue with Graves’ and surgery is that the patient is too hypER (i.e. Free T4 and T3 are too high). The reason for this concern is that hyperthyroidism can increase the risk of a serious complication called thyroid storm when the surgery is done.

An extremely high TSH would indicate hypo. I’m not familiar with this being an issue for Graves’ patients, but hopefully, others who have had surgery will chime in here. If I had to guess, I’d say that maybe because hypothyroidism can potentially affect the heart, they want to get that under control prior to surgery?

Hopefully, your niece’s endocrinologist or surgeon can shed some additional light. She definitely deserves an explanation!

Wishing you and your family all the best!

[AzGravesGuy]

#1183197

The risk of having interoperative hypotension doubles with hypothyroidism.

http://www.ncbi.nlm.nih.gov/pubmed/6465175

That is disappointing that she might have to wait for surgery, but the delay is reasonable for her own safety.

Keep us posted!

[jax1122]

#1183198

Thank you so much for your thoughts. I have passed the information on to my niece and hopefully she will have a better understanding. As well as the right questions to ask her surgeon. Hopefully her next blood test will be much better and the surgery will move forward. I just don’t understand haw they could be sure if her tsh changes daily. Anyway, I will keep you informed. Be well!!! Thanks again

[snelsen]

#1183199

On the other hand, hypotension is EASILY managed by the anesthesia doc, intraop (during the surgery) and afterward. Worth asking this question of surgeon or some doc involved in her care. We do it all the time.
I hope her labs improve, so this is not a contraindication for the surgery.
Shirley.

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