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What does this TSH level post thyroidectomy indicate?

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Endocrinologist
Practicing since : 2001
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Question
Hi doctor. I am one month post a full thyroidectomy. Prior to syrgery? My tsh level was .43. I am now on 150mcg of Eltroxine pist surgery & my tsh level is 4.3. Is this normal/ok? My free t3 is 3.5 & free t4 is 16. Thanks!
Posted Fri, 29 Aug 2014 in Thyroid Problem and Hormonal Problems
 
 
Answered by Dr. Shehzad Topiwala 2 hours later
Brief Answer:
Sounds good

Detailed Answer:
A TSH of 4.3 is fair but when I see someone like you in my practice I aim for a TSH of 0.4 to 2.5 as long as the individual does not have severe untreated osteoporosis, irregular heart rhythm problems or chest pains from heart disease.

I typically follow the TSH and free T4 levels over time. I would like to know the range of normal on your laboratory report for free T4. It is recommend to target the high normal range for this.

There is no guideline to monitor the free T3 or total T3 levels in a person with 'hypothyroidism' ie an underactive thyroid or someone like you whose entire thyroid has been removed.

The above targets are assuming you did not have thyroid cancer diagnosed either before or after surgery. If there is cancer then the strategy changes
Above answer was peer-reviewed by
 
Follow-up: What does this TSH level post thyroidectomy indicate? 18 hours later
Thanks Dr Topiwala. No I did not have thyroid cancer. I had a large multinodular goitre hence full tyroidectomy required. I have still not heard back from my specialist re my blood results so I am not sure if I am on the right levels or not. The laboratory ranges in New Zealand are as follows:

Free T4 - (10-24)
TSH - (0.40-4.00)
Free T3 - (2.5-6.00)
Also, why do you think my TSH level was 0.43 pre surgery and has now jumped up to 4.3 (that's a huge increase) but a good one I would think?
If I was under care, would you be happy with my results/change anything?
Thanks, XXXXXX
 
 
Answered by Dr. Shehzad Topiwala 2 days later
Brief Answer:
Follow up

Detailed Answer:
When someone comes to me in my practice with numbers like these I increase the Eltroxine dose by another 12.5 to 25 mcg, depending on my live interaction with the individual.
I also run a test for TSH and Free T4 6 weeks later to see if my dose change safely brought the TSH into the target range as described above
Above answer was peer-reviewed by
 
Follow-up: What does this TSH level post thyroidectomy indicate? 16 hours later
Hi, I am confused by what you are saying. My TH is within the target range.
TSH - range is 0.40-4.00. My level is 4.3. So it is actually on the high end. What I want to know is, is this reading acceptable?
I also want to know if you can explain, why do you think my TSH level was 0.43 BEFORE surgery and has now jumped up to 4.3 (that's a huge increase)? Thanks
 
 
Answered by Dr. Shehzad Topiwala 4 hours later
Brief Answer:
Second follow up

Detailed Answer:
The range for normal given by a lab is one thing and the target levels deemed by experts as desirable is another thing.
Most thyroid experts aim to keep the TSH in the range of 0.4 to 2.5, even though the normal range goes up to 4.2 or thereabouts. Studies tend to show this makes patients feel best when they are treated with eltroxin type medications while keeping the TSH closer to 1 or so.

Before surgery your TSH was in the normal range of 0.43 and it is normally expected to go up significantly after your thyroid is removed. If you were not started on Eltroxine, your TSH would eventually rise to 100 or more. So it is routine to start with a given dose but it has to be adjusted based on the individual's response to that dose of Eltroxine, and quickly adjusted to arrive at the right stable dose. Because there is no way to predict how much Eltroxine a given person will require after thyroid surgery. Person A may need 100 and person B may need 175 mcg, despite both undergoing the same surgery (ie thyroid removal). The simplest way to adjust is to go by the lab test results of TSH and free T4
Above answer was peer-reviewed by
 
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