# My surgery is complete, where to begin on thyroid management?



## ETaylor1015 (Jan 4, 2013)

I am 32 years old was diagnosed with papillary thyroid cancer in Nov 2012. I just had a total thyroidectomy this past Friday. Waiting for the final pathology report but disease was so minimal they dont think I will need RI. I weigh 145 lbs and they started me on 137mg of synthroid. I have never had hypothyroid symptoms before (levels were all normal) and I am trying my best to collect lots of information to not end up hypo and feel like my normal self in a month when all my natural thyroid is truely gone. There are lots of sites and people out there that swear by natural thyroid (ie armour) instead of synthetic because the natural addresses t3 and t4. All endo's and md's seem only to recommend synthetic. Can I please get any advice to get ahead of the thyroid madness? What tests should I ensure they are ordering. What to watch out for if I am getting hypo? Who has had success with synthetic meds vs natural?


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## chopper (Mar 4, 2007)

My mother had a thyroidectomy years ago and is on Synthroid and her numbers are just fine and she feels great. My ex wife is on Synthroid too and is doing fine. Synthroid, they say, is more consistent and more readily available. On the Internet you tend to find a lot of Armour advocates because those are usually problem cases. You don't see the millions and millions of people who are on Synthroid and feeling well posting on boards because they don't need to.

As for hypo.....I am hypo myself now. It feels like a hangover a little that you just can't shake off. Also, one of the earlier signs is usually constipation. In women, heavy periods tends to be an early sign of hypo. Weight gain as well. At 137 mcg starting dose, I don't think you'll end up in hypo land too bad if at all. If you start feeling tired and sluggish it might betime to get retested.

As for the tests while you are adjusting your dose, I like to see a full panel:

TSH
Free T3
Free T4
Total T3
Total T4

If you doc is stingy on labs, at least get TSH, FT4 and FT3 but I would really push for above.

Also get that Calcium checked for the first few months post op.


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## joplin1975 (Jul 21, 2011)

Remember both meds are synthetic.  By the time they are processed, there's not much natural about dessicated thyroid medication...it's is derived from porcine glands, but it's is far from "natural."

Still, they are important for people who don't convert t4 (which is synthroid) to t3 (your "active" hormone). If you do convert well, you don't need it.

So, the general standard of care is to start with synthroid, get your TSH (goal here is suppression), free t3, and free t4 tested at 6-8 week intervals. If, after a few shots of synthroid, you either aren't feeling well and/or have free t3 numbers that look low, you can add cytomel to the mix or look at dessicated thyroid meds


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## ETaylor1015 (Jan 4, 2013)

joplin1975 said:


> Remember both meds are synthetic.  By the time they are processed, there's not much natural about dessicated thyroid medication...it's is derived from porcine glands, but it's is far from "natural."
> 
> Still, they are important for people who don't convert t4 (which is synthroid) to t3 (your "active" hormone). If you do convert well, you don't need it.
> 
> So, the general standard of care is to start with synthroid, get your TSH (goal here is suppression), free t3, and free t4 tested at 6-8 week intervals. If, after a few shots of synthroid, you either aren't feeling well and/or have free t3 numbers that look low, you can add cytomel to the mix or look at dessicated thyroid meds


Thanks very helpful reply! How do they know if you arent converting well? Low Free T3? Do most people convert fine?


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## ETaylor1015 (Jan 4, 2013)

Thank you very helpful positive reply's!


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## joplin1975 (Jul 21, 2011)

ETaylor1015 said:



> Thanks very helpful reply! How do they know if you arent converting well? Low Free T3? Do most people convert fine?


Yes, you'll often see free t4 levels are fine, but your free t3s are low. I think it is hard to make generalizations...but I do think it is important to try t4 meds first, because t3 meds are powerful. If you are sensitive to the drugs and/or convert well, they can be somewhat dangerous.

My advice? Patience. Try the synthroid. If it works, great. If not, hang in there and formulate a new plan. Andros told me to give myself a good 18 months before things were totally sorted out and, darn it, she was right!


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## Juggie (Jan 20, 2013)

Hi anyone. Had PTC with hurthle cell thyroid removed Monday. Surgery was easy but has anyone had difficulty sleeping even though very tired.


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