Thyroidectomy advice

[k_lockling]

Hello everyone,
I was diagnosed with both Hashimoto's and Grave's in November of last year, and before that I'd been battling hypothyroidism for the past 4 years with numbers rising and dipping at random.After 4 different Endos my current one finally made this diagnosis and we made the decision to operate and remove it completely.
I have surgery on the 19th of February and would LOVE any and all advice that you can give me. I'm one of those people that freaks out if I don't know what to expect.

[Barb135]

A little bit more information would be helpful.  On what basis were you diagnosed with, both, Hashimoto's and Graves Disease?  I ask because it's quite normal for levels to rise and fall with Hashimoto's before one becomes permanently hypo.  Would you mind posting your antibody test results so we can see what they were?  

It would also be helpful to know which "numbers" kept rising and dipping, causing to you so much trouble.

Be sure to include reference ranges with any lab results posted, since ranges vary from lab to lab and have to come from your own reports for the best correlation.

A Total Thyroidectomy will leave you dependent on a daily dose (or multiple doses) of replacement thyroid hormones.  Hopefully, your doctor is one that will allow your dosage to be controlled by symptoms and Free T4/Free T3, not just TSH.

The medication can be a synthetic medication, such as generic levothyroxine, or a brand name like Synthroid, Levoxyl, etc or a desiccated hormone such as Armour, WP, NatureThroid, etc.  The desiccated hormones are derived from pig thyroid.  The type of medication is something you might want to discuss with your doctor prior to your surgery.

[k_lockling]

These readings were all taken in July when we decided to start looking at surgery as an option. I have been on a various levels of Levothyroxine since January 2013 ranging from 25 mcg to 200 mcg(which is what I am on right now.) When I was first diagnosed my TSH, T4 and T3 were all in the 200-300 range which diagnosed me as hypothyroid. Since then all three of my numbers have not stayed consistent for longer than 6 months. I know that surgery will make it necessary for me to take medication for the rest of my life, but I was looking at having to do that anyways. Being 26, starting a family is in my future and with inconsistent numbers like I have, having a baby easily is not likely or even safe. Any recovery advice and what to expect in the hospital would be greatly appreciated.

Component Your Value Standard Range
Thyroglobulin <0.1 ng/mL 2.8 - 40.9 ng/mL
Thyroglobulin AB 199 IU/mL <=1 IU/mL
Thyroid stimulating Ig's 608   <140
TPO AB         898 IU/mL <9 IU/mL
TSH         0.061 uIU/mL 0.320 - 5.500 uIU/m
Free T4         1.90 ng/dL   0.70 - 1.80 ng/dL
T3 free      4.15 pg/mL         2.30 - 4.20 pg/mL

[Barb135]

Yes, either way, you're going to have to take medication for the rest of your life; it's just that, often, it's not necessary to remove the thyroid, since Hashimoto's destroys it anyway.  Of course, it takes longer; many of us have Hashimoto's for years, before our thyroid is no longer functional and we settle in to permanent hypothyroidism.

Long term recovery will depend on your doctor and whether s/he is willing to prescribe medications based, primarily, on symptoms and, secondarily, on Free T3/Free T4 levels, instead of TSH levels, which is what most doctors actually look at, even if they test the Free T3 and Free T4.

Most likely, as long as your surgery goes well (and there's no reason to think it won't), you won't be in the hospital more than overnight, unless your doctor has told you otherwise.  Your discharge instructions should contain everything you need as far as how to care for your incision, what you should/shouldn't eat, etc, but you shouldn't have to have a special diet, unless you have allergies or a medical condition that requires a special diet.

Strenuous activity will be curtailed until your incision heals, but you should be able to do some light exercise fairly soon.  Again, this should all be spelled out in your discharge instructions.  If it isn't, make sure you ask or have someone with you who will ask so you don't overdo.  Many times, you can go by how you feel, but sometimes we don't feel like doing anything when getting up and moving around actually makes us feel better than just lying around.    

You'll want to make sure to ask if any of your parathyroid glands were removed and if there are any instructions you need to follow as far as calcium supplements, etc to make up for shortages there.

Has your doctor discussed your thyroid hormone dosage with you?  Sometimes, the dosage is lowered, then increased slowly, as needed, but your doctor may not plan to do this.  S/he may plan to keep you on the 200 mcg levo you're on now.  If so, make sure you're tested at about 6 weeks post-op to make sure your levels are where you need them, but if you have any symptoms, insist on testing sooner.