Symptoms after TT

[Suffering_In_ND]

I have had hypothyroidism since 1997.  Over the last couple years I have had varying symptoms and did some research on hypothyroidism.  My symptoms include: muscle and joint pain in the hips and shoulder, menstrual irregularities, depression/anxiety, severe Severe fatigue.  I saw my dr. who suggested it may be due to me getting old.  I showed her my research and asked for some labs.  My TPO Ab was 222 and has gone as high 437 and down to 30.1.
I had a couple nodules last spring that I had rechecked this spring.  Ultrasound followed up by a biopsy in April-Diagnosed with mild to moderate chronic lymphocytic thyroiditis (Hashimotos) with Hurthle cell onocytic changes.
I am scheduled for a total thyroidectomy in 2 days.
Couple questions: 1) does my TPO Ab variation mean in going from hypo to hyper?  2) After my TT will I still have the hypo symptoms?  I have insomnia and lay awake for 3+ hours even when I am exhausted and feel the need to sleep 12+ hours and really could nap shortly after waking up.
Hoping someone can shed some light on what my life will be like after TT.  Thanks all.

[Red_Star]

Why you are having your thyroid gland removed?  If you aren't treated optimally you'll still be suffering hypothyroid symptoms with or without a thyroid gland. My TPOAb skyrocketed when I was hyperthyroid. Serious oxidative stress going on there!

"TPO Ab titer positively correlated with the OS [oxidative stress] parameters and extent of low grade inflammation in TPO Ab positive hypothyroid patients. Oxidative stress was found to be more in TPO Ab positive untreated hypothyroid patients in our study indicating that autoimmunity could be one of the mechanisms contributing to the elevated OS level in hypothyroidism." - Oxidative Stress In Anti Thyroperoxidase Antibody Positive Hypothyroid Patients

What thyroid patients should know about Oxidative Stress...

"Some Causes of oxidative stress

There are quite a few situations mentioned in articles and studies which can cause your body to be overly stressed from the results of oxidation and all the reactive oxygen species. They include, but are not limited to:

excess endurance exercising
excess weight lifting
lack of key antioxidant nutrients like Vitamin C, Vitamin E, Selenium, Magnesium and other minerals
excess radiation or sunlight
smoking (huge cause of oxidative stress)
excessive drinking or drug use
over-exposure to toxins in our air, water and foods like pesticides, chemicals, heavy metals and more
prescription medications
processed foods with all their artificial dyes, additives or flavorings
excess physical trauma
Graves disease aka hyperthyroidism
excess copper levels from the MTHFR defect"

"Ten suggested strategies for informed thyroid patients to consider to counter oxidative stress

1. Be on a thyroid treatment which gives the best results, and thus, may play a role in lowering your oxidative stress, which reported patient experience reveals to be natural desiccated thyroid (or adding T3 to your T4 treatment, or even being on T3-only).
2. Get a wide variety of antioxidants in foods.
3. Optimize and balance your blood sugar levels
4. Identify and address your food intolerances
5. Optimize your gut health
6. Treat your low cortisol
7. Dr. Kharrazian recommends the following nutrients: N-acetyl-cysteine (NAC), Alpha Lipoic Acid (ALA), L-Glutamine, Selenium, Cordyceps, Gotu kola and Milk thistle. (Learn about each before using)
8. Consider meditation and/or Yoga or any other stress-busting activities
9. Find ways to laugh…and laugh….and laugh!
10. Get plenty of sleep."

[goolarra]

I agree...why are you having a T?.  TT is seldom recommended just for Hashi's, unless there are extenuating circumstances.  

Please post your recent thyroid labs with reference ranges.

Which meds do you take?

After the TT you will still be hypo.  You will have no thyroid, so you will be totally dependent on meds for the rest of your life.

[Suffering_In_ND]

Thanks for the info.  I'm having the total thyroidectomy because there are Hurthle cells that they can't determine if they are cancerous or not until they are removed and tested.  

I switched from generic synthyroid to Naturethyroid.  I am also on a huge amount of supplements including selenium, D3, B complex, iron, and herbals for adrenal fatigue.  
Mylabs from3/20/14.  This was went I first went in and requested labs.
T4 free 1.01  ref range 0.61-1.12
                                 T3 free 3.24  "          " 2.50-3.90
                                 T4 total 6.9 "            " 6.0-12.2
                                 T3          77                 80-190
                                 TPO Ab 222                0-99
                               TPO AB Interp >= 120; Positive
                               Thyroglobulin antibody  48      0-99
                               Thyrglobulin antibody interp <; negative

Most current labs: T3 Reverse 10                10-24
                            TPO Ab      30.1             <9.0
This was all that was tested.

[goolarra]

Your FT4 is at 66% of range, which is on the high side of the 50% target.  FT3 is at 53%.  Upper half of range is recommended for FT3, and you're there, but for someone on desiccated, it can be a bit on the low side.  FT3:RT3 ratio looks really good.

How much NT do you take?

Of course, all of this will change once your thyroid is removed and is no longer producing any more hormone of its own.

[Suffering_In_ND]

I had my TT and it went really well.  They put me on 150 mcg of levothyroxine.  I am finding I am just a fatigued if not more fatigued than I was before.  I go back to see the ENT dr next week for a check up and I saw an endo but he isn't going to do any tests until I find out the results of my pathology on the nodules in my thyroid.  I will post any updated labs I get.  I am wondering should I be on NDT rather than Levo?  Should my dosage be increased to lessen my fatigue?  

[goolarra]

It's really too early to tell.  When was your TT?  It's quite possible you will need a dose increase or that you might want to switch back to desiccated again, but meds take 4-6 weeks to stabilize in your system.  You also need blood work before making any changes.  

Have you had vitamins D and B-12 tested?  

[Suffering_In_ND]

Goolarra, I had my TT on May 20th.  Just had recheck today and the path came back benign but with changing Herthle cells.  I had TPO and T4 checked.  Both in normal range.  I need to go see endo again for other testing as he wanted to find out what results of path were.  Haven't had my D or B-12 tested for awhile.  What labs should I request now after my TT?  Should I wait to test them in 4-6 weeks?  

[goolarra]

You should have FT3, FT4 and TSH tested every time blood is drawn.  You have to insist on all three.  It would also be a very good idea to request D and B-12.  And remember that both need to be well up into the range, not just on the bottom of it.

You really do have to wait about four weeks for the dose to stabilize.  Otherwise, you're chasing a moving target.  You said TPOab and T4 were checked?  What was your T4 this time (please provide range as well).

[Suffering_In_ND]

Ok.  I will schedule in 4 to 6 weeks. Do I need TPO??  I had T4 and TSH .

T4 was 0.9 on May 21---1.7 on June 3  Range 0.9 - 1.7
TSH was 4.32 on May 21---0.49 June 3  Range 0.30 - 5.00

I REALLY appreciate all you helping me.  

On a side note, my depression was what I call severe before my TT.  Now it is just about non-existent.  My fatigue is stll off the charts.  For an example I went to bed at 11 pm last night and got up at 1:30 pm.  This is how it is every day.  I am hoping when I get my meds right that will get better.  My libido is non-existent as well.

[goolarra]

Since you've had a TT, TPOab is irrelevant.  The antibodies will eventually go into remission, but that can take years.  You'd said a couple of posts above that you had TPO and T4 checked.  I think you meant to say TSH and T4.

It looks like you are overmedicated.  Your FT4 on 6/3 was right at the top of the range, and the dose hasn't finished building in your blood yet.  How much desiccated had you been taking before your surgery?

[Suffering_In_ND]

Yes I mis-spoke. It was TSH & T4.  I was on 48.75 of the Nature-throid.    Would the over medication be what is making me so fatigued?  

[goolarra]

Typically, if you are overmedicated and fatigued, it's because you aren't getting enough rest due to insomnia, which is a hyper (overmedicated) symptom.  If you're sleeping well or too much and still feel fatigued, it's a hypo symptom.  

Your whole body is having to rebalance now that you've had your TT.  And don't forget that surgery is trauma, and you're only a couple of weeks post TT.  Your FT4 is on the high side, so you shouldn't be having hypo symptoms from that.  Of course, what we don't know is what your FT3 is doing.  When you test again, be sure they test FT3 as well.  Before your surgery, you were taking some T3.  Now, you're not.  We have to see what your FT3 is doing.  If you're not converting T4 to T3 well and your FT3 is low, you are going to continue to have hypo symptoms.

Also, don't forget to request D and B-12.  B-12 deficiency can cause fatigue that makes fatigue from thyroid look like child's play.