# What should labs be 2 weeks after thyroidectomy?



## Jaimee

My surgeon went ahead and checked my tsh and fT4 at 2 weeks post TT due to some weakness and shakiness I was having. I don't know what the fT4 was but the TSH was 2.9 I don't know why, but I figured it would be higher than that. Is that pretty typical for this time frame? I started on synthroid 112mcg the day after the surgery. I'm feeling better every day. I think once I'm all the way healed, I will have way more energy than before the surgery


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## Andros

Jaimee said:


> My surgeon went ahead and checked my tsh and fT4 at 2 weeks post TT due to some weakness and shakiness I was having. I don't know what the fT4 was but the TSH was 2.9 I don't know why, but I figured it would be higher than that. Is that pretty typical for this time frame? I started on synthroid 112mcg the day after the surgery. I'm feeling better every day. I think once I'm all the way healed, I will have way more energy than before the surgery


I don't think there would be a set guideline in that this probably varies from individual to individual depending on the circumstances.


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## McKenna

Were you on synthroid before surgery? Or were you hyper?

My labs at one week post TT were:
TSH 10.61 (.450 - 4.50)
Free T4 .86 (.82 - 1.77)
Free T3 3.3 (2.0 - 4.4)

I did not have labs for quite a while before, so I can't compare to my post TT labs, but you can see I'm quite hypo.

I'm certainly not an expert, but I wonder if you just had a good amount of stored hormone? If you were put on synthroid for the first time after your surgery it shouldn't have an effect since it takes a long time to build. ???


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## Jaimee

I was not on anything prior to the surgery. My last tsh a few months prior had been 1.47, a few months before that 2.33. I had hashimoto's and my labs bounced around quite a bit. Perhaps I just dumped a bunch during the surgery then?


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## McKenna

I guess it's possible that you dumped during surgery. It would be very interesting to see what your frees are. Can you get a copy of the labs? Did they run a free T3?


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## lavender

TSH looks like you are more hypo than you were before surgery, but it's hard to know. It takes 4-6 weeks for TSH to stabilize after a med change (or something major like surgery) Free T3 and Free T4 will be much more indicative of what your actual thyroid levels are. 
Also, it is generally very hard for a body to tolerate drastic thyroid level changes that would come with something like surgery or starting meds. Shakiness could just be a result of your body going through the changes. 
Are you on a replacement hormone?


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## Jaimee

I am on 112mcg synthroid from 1 day past surgery.

She didn't check fT3. I didn't even think to ask about the fT4. I'm sure if I called the office I could have the results mailed to me.

My calcium was 8.3

I don't know what the parathyroid hormone was but the nurse said everything except the calcium (being mildly low) was "in range."


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## lavender

Ah, yes, low calcium can cause shakiness. I feel better when mine is mid-range, even though the docs told me I should be fine at 8.3, I was not.

I had a lot of trouble with parathyroids after surgery, and it took a while for me to figure out how to cope with it. They said mine were "stunned" after surgery, and 1 was removed according to the pathology report. I felt pretty terrible for a while, and my docs were not a whole lot of help.

I now take 3 Citracal a day along with 1 vitamin D and 2 magnesium daily, and don't notice low calcium symptoms at all. I do buy more pricey supplements that my chiropractor recommended because they work and are worth how much better I feel.

Latest lab report shows that my parathyroids are improving at 3 months post surgery, which is good news. Most improve with time.


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## Lovlkn

Jaimee said:


> I am on 112mcg synthroid from 1 day past surgery.
> 
> She didn't check fT3. I didn't even think to ask about the fT4. I'm sure if I called the office I could have the results mailed to me.
> 
> My calcium was 8.3
> 
> I don't know what the parathyroid hormone was but the nurse said everything except the calcium (being mildly low) was "in range."


"In Range" - Do yourself a favor and get in the habit of asking for hard copies of labs and keeping a tracking of symptoms, doses and labs with ranges as ranges can change frequently.

I cannot tell you how often the nurses have told me everything was "in range" and it was but bottom range might as well be hypo for the majority of us on replacement.


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## Jaimee

So is it normal to continue taking the 1200-1500mg of calcium until the 3month appt? I already take 325mg of ionic magnesium and I have some vitamin D, though I should check... it seems like there is some vit D in my calcium supp. I really really felt like the shakiness was from the calcium. I know that until I took my first supp today at lunch time the soles of my feet were threatening to cramp because I was getting on my toes to clean out my medicine cabinet. After supplement, I felt fine.


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## Jaimee

Lovlkn said:


> "In Range" - Do yourself a favor and get in the habit of asking for hard copies of labs and keeping a tracking of symptoms, doses and labs with ranges as ranges can change frequently.
> 
> I cannot tell you how often the nurses have told me everything was "in range" and it was but bottom range might as well be hypo for the majority of us on replacement.


Ah I know!!! Arg. I get such bad doctor anxiety that I forget to ask, even over the phone. And that leads to much questioning and under information after the fact. I guess I'm going to have to get used to doctors being a part of my life!


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## McKenna

This is interesting.....I've noticed that when I reduced my calcium last week that I got joint pain, heart palps, muscle cramps and a general shaky feeling. And I do feel better about an hour after taking more calcium. 
My calcium two weeks ago was 9.3, but that level was taken after I had taken a calclium supplement so I'm not sure my body is doing it on it's own. I upped my calcium back to the post TT dose a few days ago and I'm doing better. 
I was taking Caltrate but it really messed my stomach up so I switched to Spring Valley liquid filled calcium with D. Since it doesn't have the mag or zinc, I bought a seperate supplement with both of those. Sun Valley Magnesium with chelated zinc.


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## lavender

Jaimee said:


> So is it normal to continue taking the 1200-1500mg of calcium until the 3month appt? I already take 325mg of ionic magnesium and I have some vitamin D, though I should check... it seems like there is some vit D in my calcium supp. I really really felt like the shakiness was from the calcium. I know that until I took my first supp today at lunch time the soles of my feet were threatening to cramp because I was getting on my toes to clean out my medicine cabinet. After supplement, I felt fine.


Low calcium can cause muscle cramping and shakiness, and if the symptoms get better when you take your calcium, I would highly suspect that is the cause. 
http://www.mayoclinic.com/health/hypoparathyroidism/DS00952/DSECTION=symptoms

I found that it helped me to split my calcium doses throughout the day to keep a consistent level in my blood. Just make sure you are waiting 4 hours after you take your synthroid because calcium can interfere with absorption. I was also taking a much higher than standard dose for a while because I had to get IV calcium at one point, and the ER told me to take 4 calcium 4x a day with extra doses in between when my calcium dropped. I would not recommend that does unless your doc tells you to, but you may need more than a standard dose of calcium right now.

I also found that I was craving milk and dairy products when my calcium was low. Just drink all you need to right now. It will go away once your calcium is stabilized.

I found that the type of calcium makes a big difference. Generic calcium was not effective at all. Calcium Carbonate is the most common form of calcium, but it must be taken with food for absorption. My docs told me to take Citracal, which is calcium citrate and is most easily absorbed.

Vitamin D and magnesium are needed to help your body absorb calcium. Magnesium helps your parathyroids function correctly.

Calcium supplements do have vitamin D in them, but for me it was not enough. I was even put on a prescription vitamin D2-Calcitriol which did not help me, even though it appears to be the standard treatment. I am taking 5000 iu vitamin D in addition to the calcium, and it has helped a lot.

I take 235 mg reacted magnesium 2x a day with my calcium. Not sure about the ionic magnesium. Chiropractor told me the reacted magnesium was easily absorbed, and it is working for me. Citracal Plus with magnesium did not work for me. I guess it just depends on your body.

As far as how long you will have to do this, I can't really say. From what I read "parathyroid stunning" typically lasts 1-3 months. Parathyroid damage is rarely permanent. Since my mom has osteoporosis and I am on a normal supplemental dose of calcium, I may stay on it indefinitely.

In the meantime, I would get in touch with your doc if you are having low calcium symptoms. They may want to draw labs for calcium and PTH, which is Parathyroid hormone. My calcium was monitored pretty regularly (weekly then bi-weekly) for the first two months, and my PTH has been monitored monthly.


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## lavender

McKenna said:


> This is interesting.....I've noticed that when I reduced my calcium last week that I got joint pain, heart palps, muscle cramps and a general shaky feeling. And I do feel better about an hour after taking more calcium.
> My calcium two weeks ago was 9.3, but that level was taken after I had taken a calclium supplement so I'm not sure my body is doing it on it's own. I upped my calcium back to the post TT dose a few days ago and I'm doing better.
> I was taking Caltrate but it really messed my stomach up so I switched to Spring Valley liquid filled calcium with D. Since it doesn't have the mag or zinc, I bought a seperate supplement with both of those. Sun Valley Magnesium with chelated zinc.


Glad you found something that works for you. Parathyroid damage after TT is pretty common and usually temporary. I found that my surgeon did not warn me well enough. I ended up dealing with an on-call surgeon the weekend after my surgery who told me that everyone who has TT should take calcium after their surgery.


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