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Forum Name: Endocrinology Topics

Question: Rise in TSH post thyroid lobectomy - affecting fertility?


 Rok Gerl - Sun Jun 13, 2010 7:07 pm

Hello,

I am a 32 year old female and underwent a thyroid lobectomy in April 2009 due to the appearance of a thyroid nodule (which turned out to be begnin). I was informed that the entire right lobe plus the isthmus was removed. During this year following my surgery, I have begun to feel more lethargic. Nothing completely horrible, but tired enough to notice a difference from my "pre-surgery self". I have been going for regular tests to check my thyroid every 6 months. While my GP states that my tsh levels are within the normal range, there has been a steady rise in my these levels (from 1.8 pre-surgery to 3.44 as of February 2010). Is this something to be concerned about? My doctor doesn't seem to be worried about it however, I am concerned with how this change in tsh would affect my chances of conception. I suffered a miscarriage 10 months ago and have read that thyroid problems, should they remain untreated, can cause infertility.

Thank you for your time.
 Dr.M.Aroon kamath - Wed Jun 23, 2010 1:51 pm

User avatar Hi,
As a screening tool for thyroid function in a population, serum TSH levels are good.For management of an individual patient, TSH levels can not be viewed in isolation. They have to be interpreted in conjunction with the symptoms, and the free thyroid hormone levels.

Serum TSH levels are determined by the
- action of the pitutary gland which secretes the TSH in response to low levels of the thyroid hormones in the blood and
- the ability of the thyroid follicular cells to respond to the TSH and increase their secretion of the thyroid hormones.

If the thyroid is able to respond, then the level of thyroid hormones in the blood will increase and the stimulus for TSH release no more exists.Thus, the TSH level normalizes.

In case, the thyroid is diseased and not able to respond, the TSH levels remain elevated or continue to rise.

Since late 2002, the American Association of Clinical Endocrinologists (AACE) revised the normal range to 0.3-3.0 for serum TSH levels.Prior to 2002, the commonly used range was 0.5-5.0. As explained earlier, TSH levels must not be interpreted in isolation.

As you have undergone a 'hemithyroidectomy', only one of your thyroid lobe now remains. If it is healthy, the TSH values should not continue to rise.A rising TSH may indicate that the remaining lobe is not functionally adequate.

I urge you to repeat the TSH & free thyroid hormone levels (if you so desire,in another laboratory). If the TSH levels are even above 2.0, you may need to be treated for hypothyroidism as you are symptomatic.Consult an endocrinologist who will be able to guide you through this.The remaining lobe also needs to be assessed(FNAC, radiactive iodine uptake etc as indicated).
Best wishes!
 Rok Gerl - Sat Jun 26, 2010 3:15 pm

Thank you very much for your response, I really appreciate it. I have asked for a re-test of my TSH and T4 and my doctor has also requested TPO antibodies.

My last T4 came up at 13.8 pmol/L. Paired with the above TSH level, should there be reason for concern? She assures me that my lethargy is not hormonal and is not interested in referring me to an endocrinologist. Upon your advice, I may go to ask for a referral elsewhere.

Thanks again for your time!
 Dr.M.Aroon kamath - Tue Jul 20, 2010 6:15 am

User avatar Hi,
Here we go again! You have not provided the normal laboratory reference range and also, the T4 level is usually reported as ug/dl, and not as pmol/L. T3 is reported as ng/dl and FT3 as pg/ml (i do agree, it is rather confusing!). Hope you mean a T4 level of 13.8 ug/dl. Was FT4 and FT3 not requested? i would prefer not to comment on the T4 value as the reference range is not available as well as the values of the rest of thyroid panel.

As i explained earlier, for TSH levels over 2.0mU/L, some endocrinologists would prefer to start on thyroxin if the symptoms and findings of physical examination are compelling. As mentioned earlier, the remaining thyroid lobe needs to be assessed before starting thyroxin.
Best wishes!

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