What are the risk factors for the morbidly obese having total thyroidectomy?

[Caryn2214]

I am morbidly obese and have multiple nodules in my thyroid. I need to have a thyroidectomy because I feel pressure and have trouble swallowing. The nodules are benign, but one is 3cm and three others are over 2cm. I am really nervous as my health isn't great. I have diabetes(but not on meds yet), high blood pressure(that is controlled by meds), high cholesterol, and sleep apnea.

[gimel]

I have to tell you that you are being terribly treated.  You haven't been adequately tested, since TSH is totally inadequate as the sole diagnostic for hypothyroidism.  In addition, I am not sure why they decided to place you on 25 mcg of Levo, in view of only testing for TSH, but that dosage is also totally inadequate.  When you start on thyroid med taken in a single daily dose, , the hypothalamus/pituitary system responds by reducing the TSH level.  That in turn causes less T4 and T3 to be produced by the thyroid gland.  Since serum T4 and T3 levels are a sum of both natural thyroid hormone and thyroid medication, the reduction in TSH thus results in little or no increase in serum levels until the medication dosage is high enough that the TSH is suppressed enough to no longer be a factor.  That is the reason that medication dosages need to be gradually increased until the Free T4 and Free T3 levels rise enough to relieve hypo symptoms.   For many of us those levels are Free T4 at the middle of the range, at minimum, and Free T3 in the upper third of the range, or as needed to relieve symptoms.  

You can read about this in the link I gave you above.  Right now you need to start looking for the good thyroid doctor and make an appointment.  In the interim you should try to get tested for Free T4 and Free T3 (not Total T4 and Total T3), along with Vitamin D, B12, ferritin, Reverse T3, and cortisol.  If your current doctor resists, try to push hard enough to get them to do it.  Then you will have some test results in hand and we can help interpret and advise further, as you try to get in to see a good thyroid doctor.  

[Caryn2214]

Thank you so much for your help. I will ask for the testing you suggested.

[gimel]

So far it sounds like you need a good thyroid doctor.   TSH is a pituitary hormone that is affected by so many things that it is totally inadequate as the sole diagnostic for thyroid status.  At best it is only an indicator, to be considered along with much more important indicators such as symptoms and also levels of the biologically active thyroid hormones, Free T4 and Free T3 (note that those are not the same as Total T4 and Total T4, so make sure they test for the Frees).  

So in the future you should make sure they always test for both Free T4 and Free T3 every time you go in for tests.  In fact it would be a good idea if you could get those, and several other tests done right now.  Do you think that is possible?  The other tests needed are Reverse T3, cortisol, Vitamin D, B12 and ferritin.  

A good thyroid doctor would be treating you clinically, by testing and adjusting Free T4 and Free T3 as needed to relieve hypothyroid symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  If your test results confirm that you are too low in Free T4 and Free T3, and deficient in the other areas, that will likely account for the symptoms you have, all of which can be caused by hypothyroidism, including low metabolism and weight gain.  

I highly recommend reading at least the first two pages of the following link.  It will provide the info you need to understand how you should be tested, diagnosed and treated, as opposed to current approach.  The rest of the paper is a discussion and scientific evidence supporting the suggestions on page 2 which you might also want to read.  You might also want to consider giving a copy of the full paper to your doctor and then request those tests and to be treated clinically as described.  In view of your treatment so far I don't have much hope that your doctor will read and accept that approach, but you should try and at least get the testing done.  

  
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

Regarding those nodules, I wondered if they were found by ultrasound, or by palpation by the doctor?  Also, how long have you been on the 25 mcg of Levothyroxine?  

Please hang with us because we can help you a lot with our experience and knowledge gained through research of hypothyroidism.  In addition, since I expect that you need another doctor I have sent you a PM with doctor info.  To access, just click on your name and then from your personal page, click on messages.  

[Caryn2214]

They were found when I had a CT scan of my neck.  One of them on the right you can see real well.  Especially when I swallow. I have been on 25 MCG of levothyroxine for at least the last three years.

[gimel]

Have you been previously diagnosed as hypothyroid and possibly with Hashimoto's Thyroiditis?  You have a lot of symptoms already that are often related to being hypothyroid.  In order to give you the best response, please post your thyroid related test results and reference ranges shown on the lab report.  

[Caryn2214]

I am hypothyroid. My TSH results have been 2.22, 1.83, 2.98, 2.91, 1.78. I am on levothyroxine, 25 MCG.