# iv sedation(wisdom teeth removal) with high tsh



## jakeas80 (Mar 15, 2011)

i need to get my wisdom teeth removed. is it safe for iv sedation with a tsh of 65(not .65). my tsh is high and the doctors can't seem to know why it's not going down. i have been on different doses. anyway, my FT3 and FT4 are normal. i read that it is not safe for iv sedation because i have a high tsh and even though i'm on levothyroxine(currently 88mcg), my tsh is still high. a source said there is a risk for myxedema coma. anybody's thoughts...


----------



## Andros (Aug 26, 2009)

jakeas80 said:


> i need to get my wisdom teeth removed. is it safe for iv sedation with a tsh of 65(not .65). my tsh is high and the doctors can't seem to know why it's not going down. i have been on different doses. anyway, my FT3 and FT4 are normal. i read that it is not safe for iv sedation because i have a high tsh and even though i'm on levothyroxine(currently 88mcg), my tsh is still high. a source said there is a risk for myxedema coma. anybody's thoughts...


Oh, boy.........................you do have a conundrum!! Yes to myxedema coma re the possibility of it.

You need to have it done but I would insist on out patient at your local hospital. I "really" would. You need a professional anesthetist and people on hand who know how to handle an emergency.

Why only 88 mcg? How long have you been on that? They can give you IV in the hospital with thyroxine to bring that TSH down much quicker.

I would love to see FT4 and FT3 with the ranges please?


----------



## jakeas80 (Mar 15, 2011)

my FT4 is 0.9. i don't remember what my FT3 is, but last i remember it was normal.


----------



## jakeas80 (Mar 15, 2011)

how much safer would it be if my TSH were in the normal range? i was first diagnosed with hypo and TSH was 220, and it dropped to 70 nine months ago and has been around 70 since. i also have hashimoto's and now my endo has me taking my levo at night.


----------



## jakeas80 (Mar 15, 2011)

or how about novicaine, one tooth at a time(3 teeth need taken out, all are impacted)


----------



## lainey (Aug 26, 2010)

Are you seeing an oral surgeon?

The type of sedation that they typically use for this is usually a 'twilight' sedation--you are not fully unconscious but you are relaxed and don't remember the procedure. It is very short acting, and can be reversed very quickly with medication if you go into distress. People generally recover very quickly (less than an hour) and are ambulatory and ready for normal activity within a few hours.

This is opposed to a full sedation (and there are levels of that) with the deepest being where you need breathing support (breathing tube).

You realize, they will likely numb the local area with novocaine anyway. This way you won't have much pain upon waking.

Have you talked to the dentist/oral surgeon about what type of sedation will be used and explained your thyroid status?

That said, your FT4 (without a range) seems low, as is your dose of levothyroxine (88 mcg). Why aren't you still increasing your medication? Has your pituitary been checked out to see if it is functioning properly?


----------



## Andros (Aug 26, 2009)

jakeas80 said:


> how much safer would it be if my TSH were in the normal range? i was first diagnosed with hypo and TSH was 220, and it dropped to 70 nine months ago and has been around 70 since. i also have hashimoto's and now my endo has me taking my levo at night.


Oh, my goodness!! You have been so so ill!!! I am so sorry for this!

I just don't know what to say here because I cannot put your life in my hands. I always opt for high level of care when giving advice or opinions.

Even if your TSH "suddenly" came into normal range; that could mean nothing unless we could see where the FT3 and FT4 are in the range. This is some tricky stuff here. You could have the TSH in range and the Frees could be way way out of kilter. I have seen this so many times and that is why doctors should not treat based on TSH alone.

You see; there are binding, blocking and stimulating antibodies and if they are active, they do skew the usual thyroid panel of TSH, FT3 and FT4.

That said, none of this helps your dilemma. Not one little bit.

Please do let us know what you decide and I will keep you in prayer for all of this. It would seem it always rains when it pours.


----------



## jakeas80 (Mar 15, 2011)

lainey, are you referring to hypothyroid patients for twilight sedation? is that still safe? and andros, i do know my endo isn't treating or only looking at tsh levels, i just don't remember what my FT3 is. my FT4 is 0.9.


----------



## jakeas80 (Mar 15, 2011)

here's another one. i wake up at night gasping for air because my lungs feel like they are suffocating. is this respiratory failure because my TSH has been high for so long that this is an early sign of myxedema coma? it feels as if i'm not getting oxygen to my lungs and i've told my doctor and they seem to not take it seriously. i did a sleep test, but with my luck, nothing happened.


----------



## Andros (Aug 26, 2009)

jakeas80 said:


> lainey, are you referring to hypothyroid patients for twilight sedation? is that still safe? and andros, i do know my endo isn't treating or only looking at tsh levels, i just don't remember what my FT3 is. my FT4 is 0.9.


That is good to know; thanks for the heads up! I did not think your endo would treat by TSH alone!!


----------



## Andros (Aug 26, 2009)

jakeas80 said:


> here's another one. i wake up at night gasping for air because my lungs feel like they are suffocating. is this respiratory failure because my TSH has been high for so long that this is an early sign of myxedema coma? it feels as if i'm not getting oxygen to my lungs and i've told my doctor and they seem to not take it seriously. i did a sleep test, but with my luck, nothing happened.


It could be a form of myopathy; I had that. OMG!! I was so scared.

This is an excellent source for info on that.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1010480/

Re myxedema coma............you will read here that in poorly treated hypo (you are being treated, they mean if you are not yet euthyroid), surgery can trigger mxyedema coma.(also, trouble breathing)
http://www.drugs.com/cg/myxedema-coma.html

What has your endo had to say about your impending surgery?


----------



## jakeas80 (Mar 15, 2011)

my endo said that there is a risk with sedation, but he said being 30 years old and healthy(yeah right - high tsh, gasping for air at night, many hypo symptoms) that i should be OK with sedation. i am being treated, but with my tsh still high, wouldn't it be basically the same as not being treated? my FT3 and FT4 are normal, but with a high tsh, it's almost as if i'm not even taking medication at all. i don't know if i mentioned that i now take my levo at night.


----------



## Andros (Aug 26, 2009)

jakeas80 said:


> my endo said that there is a risk with sedation, but he said being 30 years old and healthy(yeah right - high tsh, gasping for air at night, many hypo symptoms) that i should be OK with sedation. i am being treated, but with my tsh still high, wouldn't it be basically the same as not being treated? my FT3 and FT4 are normal, but with a high tsh, it's almost as if i'm not even taking medication at all. i don't know if i mentioned that i now take my levo at night.


Yes; you are correct. It would be basically the same because you are not where you should be. Truer words were never spoken.

You might want to inquire at the hospital about all of this. You need "expert" opinion and care. You should not have to suffer at all and you should be able to have this surgery with the full knowledge that you are in competent hands.

If you see "red flags"; that means they are there and you need to heed that. There is only one you and that means bottom line here that you are the only one that cares the most about you.

You have to be very comfortable with your decision-making process.


----------



## lainey (Aug 26, 2010)

jakeas80 said:


> lainey, are you referring to hypothyroid patients for twilight sedation? is that still safe? and andros, i do know my endo isn't treating or only looking at tsh levels, i just don't remember what my FT3 is. my FT4 is 0.9.


My question remains, DO YOU KNOW what type of sedation the dentist/surgeon is going to use? Have you discussed your condition with them? "Twilight" sedation is typical, but I was guessing--you have to ask exactly what will be used.

The issue is that you will metabolize the sedative differently if you are hypo, and are more prone to depressed respirations and other complications.

You said previously that you have been on different doses, but that your frees are in range while your TSH remains elevated, and that other doses have made you feel unwell.

However, this is not as if you are untreated--you have been medicated for the better part of the last year...are you exhibiting continuing symptoms of overt hypothyroidism that would indicate you are still undermedicated??? How about some details for us about the doses you have tried that were higher than your current dose and the results?

MY question is, what reason does the endo give for the TSH remaining so high while the other values are "in range"? Has your pituitary been looked at as being the cause--after all, it is the gland that releases TSH, and it is obviously not responding properly to the medication!


----------



## jakeas80 (Mar 15, 2011)

he just said iv sedation. which sedation would be the safest? twilight? he knows about my condition and that my tsh is high. as far as doses, the highest i was on was 100, but i would get heart palpitations, or at least a harder heart beat almost all the time, so they put me back on 75 for not even six weeks and now i'm on 88. i had an mri and they said there were no tumors and that everything looked good. i'm thinking maybe my tsh has been high for so long(never tested for thyroid until a year ago, so my tsh may have been high for a long time) that it's just going to take a while for it to go down. maybe it's used to pumping out so much that it's saying i'm not ready to slow down yet. i don't know. your thoughts...


----------



## lainey (Aug 26, 2010)

I think you should ask for specifics--what drug will be used, what type of respiration support they anticipate, if any, recovery time, and what local anesthetics will be used.

As for your high TSH, keep in mind that TSH ranges are essentially a bell curve, and you can have people that function normally with numbers at the extremes of the scale (although these are very much the exception). While I agree that it could take more time for your TSH to come down, you could also be a person that has a TSH that falls naturally at the higher end of the scale. As long as your FT4 and FT3 are well in the range (but you should be getting those numbers with ranges from the doctor--don't just accept that they are "normal") you should be able to move forward.


----------

