# Robotic Transaxillary Thyroidectomy.



## Reporter (Mar 17, 2011)

I recently had a Total Thyroidectomy (near total) due to Nodular Graves and Hashimotos thyroiditis. Five days after the procedure which, by the way, left no visible neck scar, I was sent home on 50 mcg of Levothyroxine. I took that for about a week before my endocrinologist at Duke said that I had to bump it up to at least 100mcg for my weight, 150lbs. After having taking that dose for about 4 consecutive days, I awakened with the worst palpitations and muscle twitching, and muscle weakness of my life, all occuring simultaneously. I can't understand why at two weeks post-op a dose of 100 mcg would cause these symptoms if before surgery my Frees were already on the low end of normal.

One week before surgery:

Free T4 1.03 (0.82 - 1.77)

Free T3 2.7 (2.0 - 4.4)

TSH 0.065

TSI 242 (that's Aug labs after being on .5 MMI beginning May 2015. Earlier this year it was 329)

Day 5 post surgery my TSH was 4.5 and Day 7 it was 7.0

Prior to surgery I had a mild form of Graves eye disease that I took flaxseed oil, cod liver, fresh turmeric (curcumin) which I believe, helped. After surgery the eye pain, dry eyes, slight a.m. swelling completely resolved, not a symptom until beginning the Levo.

Right now I don't know if I'm hyper or hypo and have no idea which dose I should take as it is too soon still to do labs. My eyes have started bothering me again.

I'm calling the endo today but wanted to know if you guys have any advice? Thanks greatly.


----------



## jenny v (May 6, 2012)

Your doctor may have increased you too fast for your system to handle. Usually people go from 50 to 75 to 88 to 100, to give the body a chance to get used to the dosage increases.


----------



## joplin1975 (Jul 21, 2011)

I was started on 50mcgs, too. I took that for six weeks and then when my TSH came back as 121, my endo bumped me up to 100mcgs. The first two weeks were pretty rough. I had digestive issues, heart palps, the sweats, etc.

The hormonal swings are tough. You are talking about the possibility of your thyroid dumping hormones during and after surgery, then a few days of low-low dose of synthroid, followed by a doubling your dose. It's really tough and I appreciate your struggle...but I don't think you want to stay on 50mcgs.

You might see if your doctor can prescribe you 25mcgs. You could split that and take it with your 50mcgs so that for a few days, you are on something like 62.5mcgs. Do that for a week or two and then take the 50 and 25 to get to 75mcgs. Again, do that for a week and then bump up to 100.

I opted to ride out the symptoms and eventually ended up at 150mcgs, but there are ways to step things up more gradually.


----------



## Andros (Aug 26, 2009)

You may benefit by having your ophthalmologist rx prednisone for you to help your eyes. Also, radiation is available to the eyes but you have to do the pred. first. Also, Kenalog shots.

Most folks with Graves' have a thyroxine dump during the ensuing days in the aftermath of thyroid ablation. Starting you on the thyroxine replacement was much too soon.

Sorry for what you are going through and welcome to the board!


----------



## Reporter (Mar 17, 2011)

Thank you to everyone for your comments. Don't know what I'd do without this particular forum.

I want to update and say that the three or four days that I was not taking levo I felt great. Yesterday and today I took 50mcg per my endo's instruction. Hours after taking I feel horrible, just absolutely horrible: Anxious. Fidgety. Hyper. The front of my thighs ache and I may experience occasional muscles twitches in random locations.

Like joplin I, too, have heart palps, sweating, or maybe it's more accurately described as hot flush or "flash." I go from hot to cold, cold to hot. It's cyclical, everyday that I'm actually taking medicine. When I'm not, I have no symptoms.

It makes sense, yes, to start at a smaller dose, and maybe even I'll have to ride it out like Joplin, but I'm more convinced that I should not be on the levothyroxine right now. The surgeon did mention the 'dump.' *Perhaps three weeks later is still too soon to medicate. If that's the case, what is the average, a couple of months? *

One other question please: * because I was diagnosed with Hashimoto's as well as Graves will that make it more difficult to treat over the long run? * I thought I may have read that some years ago.


----------



## joplin1975 (Jul 21, 2011)

YOu very well may have to wait for things to "simmer down." My TSI was never that high pre-surgery, so it makes sense that I had an easier time dealing with the medication changes. Have you called your doctor?


----------



## jenny v (May 6, 2012)

I have Hashi's and Graves and it was dang near impossible to dose towards the end (10 years of ups and downs) before my surgery. I would feel hyper one day and hypo the next, there was no consistency.


----------



## Andros (Aug 26, 2009)

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test
(Copy and paste into your browser)

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/health-medicine/understanding-thyroid-why-you-should-check-your-free-t3
(Copy and paste into your browser)

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm
(Copy and paste into your browser)

It would make a lot of sense to give you a FREE T3 test. Additionally, it takes a while for the TSI to back down.


----------



## Reporter (Mar 17, 2011)

Good morning and thanks for the additional comments and links, Andros.

I'm one month status post TT. The surgeon says to do the labs today. I will ask for the Free T3, Free T4 and TSH.

I took 75 mcg of Levothyroxine the other day and like the 100mcg tablet, I got the same bothersome symptoms. It's only with the 50mcg that I'm without symptoms. Whether it's due to the hormone "dump" after surgery or because of the TSI, I don't know. I thought surgery would 'definitely' reduce the amount of TSI. Hopefully that will happen. Will having TSI or TPO make it difficult to stabilize on the medication? I cannot avoid being concerned about the effects of taking this low dose is having on my health right now and how it may affect my health over the long run. Without my thyroid I must take meds but if 50mcg is the most that I can tolerate, what happens? I'm very worried.


----------



## Reporter (Mar 17, 2011)

Would it be unusual to start on meds, say, 6 wks post op or do most begin 100 mcg immed following surgery?


----------



## joplin1975 (Jul 21, 2011)

Once your thyroid is gone, there really shouldn't be any antibodies left. They may still be there at a low level, but things should settle down.

I didn't start meds until six or seven weeks after surgery due to RAI.


----------



## Reporter (Mar 17, 2011)

Thank you Joplin. I'm always looking for and needing this information so I really appreciate you all...

I picked up my labs this evening Four weeks post-op they are as follow:

Free T4 0.7 [0.9 - 1.7]

Total T3 0.60 [0.80 - 1.80]

Total T4 4.4 [4.5 - 12.0]

TSH 21.99 [0.30 - 4.50]

I am due to follow-up with my endo in 2 -4 weeks, as I was originally asked to come in six to eight weeks after surgery. The internist that I saw on yesterday somehow managed to 'FORGET' to request the Free T3. I say that because I saw him write it down, but I imagine that, too, would come back low as well. I felt so sick the other day that I've not taken ANY meds, not even 50 mcg and I've felt my best. I was waiting for the labs so now I see that I must increase. It's just that the 75 - 100 mcg is downright scary to consider taking. Too low a dose, the 50mcg, isnt helping much as you can see with the labs and too high a dose FEELS LIKE I'M DYING!!

The internist says *at this point* now that we have the labs, the symptoms are less likely to be related to a "dump" because that would show in my labs. I asked if having TSI (even if they are lower than before surgery) if that might make it difficult for me to tolerate even a small dose. He just looked at me as though I was growing a third eye.

I am going to attempt to take the 62.5.....I will update soon.

thanks to you each


----------



## Octavia (Aug 1, 2011)

What about changing to a different drug? For example, switch to Tirosint?


----------



## jenny v (May 6, 2012)

Agreed. Levo isn't your only option and your body may be reacting to one of the fillers in it.


----------



## joplin1975 (Jul 21, 2011)

Oh I didn't have a period either for a number of months. Three or four maybe? I was crazy hypo and I think my body was just trying to function...the whole menstral thing just could get done.

Armour is a great drug, but I believe that any kind of NDT should be prescribed based upon labs. That is, Levo is kind of your first line of defense because it's so dang simple. But if warranted your labs and symptoms support the need to additiona or different kinds of meds, then it's perfectly reasonable to give Armour (or Levo/Cytomel) a shot. Right now, I think you are so hypo that you can't really say Levo is working - especially if you were on varying doses.

Try the Levo consistently for a good six weeks. Get new labs. If your free t4 remains low, bump up your dose until your free t4 is around 50-75% of the range. If your free t3 is still low at that point, start experimenting with NDT or cytomel.


----------



## Reporter (Mar 17, 2011)

Thanks so much for your quick reply. So I've been taking the levo consistently at 100 mcg.

I received my lab results from Monday. They are as follow:

TSH 4.0 (.450 - 4.5)

Free T3 1.8 ( 1.2 - 4.9)

Free T4 1.01 (0.82 - 1.77)

TSI 228

The symptoms I'm having are like I'm hyper. That is peculiar to me as my labs do not reflect that. Also I still have TSI after surgery I was hoping that would be much lower by now but it's lower than presurgery.

I read that taking Selenium supplements will help with the conversion of T4 to T3. *Does anyone have any knowledge about that?*

*Also having TSI and TPO, will taking NDT or cytomel have any kind of adverse affect?*

*What is considered dangerously hypo? I have no cardiac problems but that is a concern.*

I'm going to bump up my dose from 100 mcg to 125 I suppose is okay until I hear back from my doctor. In doing so, *are you saying that will raise the Free T4 only or the Free T3 as well and how will doing that affect the TSH or does that TSH not matter when you have TSI and TPO? *So confused on that.

Thanks and Happy New Year to you all!


----------



## joplin1975 (Jul 21, 2011)

I would not take any medication with t3 until that TSI sinners down.

My TSI was 129 before surgeRyan and I couldn't even tolerate a low dose of synthroid. I can't imagine adding t3 into the mix.

Once that TSI goes down, I bet you'll start to feel quite hypo. My TSH was 121 (see my signature). I don't particularly recommend going that high because it was not fun, BUT I was chugging along. It wasn't dangerous short term and you have a long long long way to go before you are in the danger zone.

TSI is just evil!


----------



## Reporter (Mar 17, 2011)

This is an update to when I started taking Cytomel, 1/05/16.

*1. Is it safe to take 200 mcg Selenomethionine to reduce the TSI?* I feel hyper since having begun the Cytomel (5mcg). Anxiety, muscle twitching, and slight shortness of breath. My FT3 was not tested due to a lab running the wrong test!!! Total is low.

2. *Should I split the Cytomel (although a very small dose) in half and space it out over some hours? I'm asking what is the benefit in doing so since it is such a small dose. Also is it okay to take it at the same time as my T4 med? *That is how it was prescribed, but wondering...can't understand why I feel hyper. Prior to taking the Cytomel I did not have these symptoms.

Thanks. I value your opinions.


----------

