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Forum Name: Endocrinology Topics

Question: Just had thyroidectomy, how long til Hypothyroidizm?


 mgoldschmidt - Sat Aug 21, 2010 3:11 pm

Just had a complete thyroidectomy, how long til Hypothyroidism kicks in?

Surgery was 8-19, Im at home now. Feeling good except week, bit dizzy, etc, Im off all pain meds

I have a follow up with surgeon this coming thurs,then with Endo doc thursday that follows. Wish I could have the thyroid meds sooner.
 Dr.M.Aroon kamath - Thu Aug 26, 2010 9:03 am

User avatar Hi,
You have not indicated if radioactive iodine ablation (to destroy the thyroid remnant, if any) has been planned.

For effective radioiodine ablation, it is necessary to obtain high iodine uptake levels by the thyroid remnant after surgery. To achieve this, the thyroid hormone suppression therapy (THST) must not be started immediatly after surgery. The delay in initiation of the thyroid hormone therapy after the total thyroidectomy brings about the progressive increase of the Thyroid stimulating hormone (TSH) serum levels. Maximal TSH stimulation is necessary to ensure that any remnant of thyroid gland will avidly take up the radioiodine and thus get destroyed in the process. The half-life of T4 is 5-7 days; the half-life of T3 is only 1 day. Most investigators consider that serum TSH levels needed to obtain this stimulus of the thyroid tissue is typically achieved in 4 to 6 weeks(TSH levels higher than 25-30 mUI/l).

The main problem with this approach is that the hypothyroid symptoms that the patients develop is often too distressing. A newer approach tries to overcome this problem in a way that patients can be started on (or continue) thyroxin therapy and still undergo thyroid ablation with radioiodine. This has become possible with the introduction of Recombinant human TSH (rhTSH).

Thyrotropin alfa was initially approved in the US in 1998 and Europe in 2001 for use as a diagnostic tool in the management of patients being tested for the recurrence of well-differentiated thyroid cancer.
In December 2007, the US Federal Drug Administration(FDA) approved the use of rhTSH for adjuvant treatment with radioiodine in patients with differentiated thyroid cancers (DTC) without evidence of metastasis.

Recombinant human TSH (rhTSH) has been found to be an effective and safe alternative to thyroid hormone withdrawal during the post-surgical management of papillary and follicular thyroid cancer.

You may discuss with your surgeon as to whether this alternative modality is suitable for you and also the expenses involved. rhTSH is fairly expensive and some insurance plans may not cover this treatment.
Best wishes!

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