HomeAnswersEndocrinologyhypothyroidismHow to treat hypothyroidism after thyroid cancer treatment?

Is it common to experience hypothyroid symptoms after thyroid removal?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

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Published At October 14, 2022
Reviewed AtNovember 29, 2023

Patient's Query

Hello doctor,

I had thyroid cancer a few years back and it was treated. I am having hypothyroidism symptoms since several months. I have brain fog, headache, cold hands and feet, and fatigue. I was on tablet Levothyroxine 125 mcg that was increased to 137 mcg two weeks back. However, there were no changes in symptoms. Recently, I have started tablet Liothyronine 5 mcg. One day after using the tablet, my brain fog reduced. However, I feel overstimulated. I also take tablet Atorvastatin 20 mg and tablet Sertraline 100 mg. Kindly guide me on the course of medicines.

Thank you.

Hello,

Welcome to icliniq.com.

I understand your concern.

I suggest you increase the tablet Levothyroxine dose to 150 mcg daily. The other option for taking T3 (triiodothyronine) is to take Levothyroxine 100 mcg and Liothyronine 5 mcg daily. However, I strongly discourage this option if you have heart issues, osteoporosis, anxiety, palpitations, etc.

  1. What is the status of your thyroid cancer?
  2. Was it in the initial stage?
  3. What was the type of cancer?
  4. Did you get radioactive iodine treatment?
  5. When was your most recent ultrasound done?
  6. What are the levels of your thyroglobulin?

The initial stage and current response to therapy decide on your TSH (thyroid-stimulating hormone).

I hope this helps.

Thank you.

Patient's Query

Hello doctor,

Thank you for the response.

I had papillary carcinoma of the thyroid over 30 years ago with no recurrence. I did have radioactive iodine treatment ten years after the surgery as I developed another cancer (Ewings Sarcoma), which they thought might be metastatic thyroid cancer at that time. There was no recurrence of the Sarcoma either. My TSH is now supposed to be in the range of 0.5 to 2 mIU/mL. I have been on Levothyroxine 200 mcg most of my life until about a year ago and felt normal most of the time. My TSH was 0.017 mIU/mL. My doctor decided it had to be suppressed and asked me to bring the tablet Levothyroxine down to 125 mcg. As I have hypothyroidism symptoms, she has now suggested increasing my dosage. I will follow your recommendation to take a tablet Levothyroxine 150 mcg. How long will it take to start feeling the positive effects?

Kindly advise.

Hello,

Welcome back to icliniq.com.

We should consider TSH levels between 0.5 mIU/mL and 2 mIU/mL. 2 mcg of Levothyroxine for each kilogram of body weight will keep TSH levels below 2.0. I would titrate the dose until you feel better and keep TSH in the target range. 150 mcg would be the right dose for you; else, you can increase it to 175 mcg. It will take about four weeks to start feeling better. You can recheck the TSH levels after eight weeks.

I hope this helps.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Thiyagarajan. T
Dr. Thiyagarajan. T

Diabetology

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