If you’ve had your thyroid removed after thyroid surgery (a procedure known as a thyroidectomy), your body will no longer be able to produce the thyroid hormone it requires. You will need to take levothyroxine which is the cheapest thyroid drug in order to replace the hormone that your body naturally produces. These pills will also assist in preserving your metabolism’s normal state and may reduce the likelihood of the cancer returning.
Table of Contents
Introduction
The pituitary gland is responsible for maintaining a normal level of thyroid function. Thyroid hormone is produced by the body’s thyroid gland in response to thyroid stimulating hormone (TSH), which is produced by the pituitary gland. Additionally, TSH encourages the growth of the thyroid gland as well as, most likely, thyroid cancer cells.
In turn, the level of TSH is controlled by the amount of thyroid hormones that is present in the blood. When there is not enough thyroid hormone in the body, the pituitary gland will produce more TSH. When there is a high level of thyroid hormone, the body does not require as much TSH, so the pituitary gland produces less of it.
Thyroid stimulating hormone levels can be maintained at very low levels if the doctor administers thyroid hormone in doses that are significantly higher than those typically prescribed. This may reduce the risk of certain thyroid cancers, particularly those with a high risk of recurrence, as well as the growth of any remaining cancer cells.
Patients who develop hypothyroidism are required to take thyroid hormone for the rest of their lives. Levothyroxine, taken on a daily basis, is the treatment that the American Thyroid Association’s guidelines for the treatment of hypothyroidism recommend as the choice to replace the thyroid hormones that the thyroid gland provided.
An appropriate dose of levothyroxine should result in normal levels of thyroid stimulating hormone and thyroid hormones in the blood; however, the precise amount of levothyroxine that a patient needs to take can vary from person to person.
Thyroid surgery
On September 14, 2016, a highly skilled head and neck surgeon in Rome named Fabrizio Frattagli performed a total thyroidectomy on a patient of his. A cervical ultrasound was performed approximately six months after the operation to evaluate the complete thyroidectomy. The remaining amount of thyroid tissue is significantly less than 1.5 milliliters.
The surgical removal of all or part of a person’s thyroid gland is referred to as a thyroidectomy. The butterfly-shaped gland that makes up your thyroid can be found at the base of your front neck. It produces hormones that control every aspect of your metabolism, from the rate at which you burn calories to the rate at which your heart beats.
Thyroidectomy is a procedure that is used by medical professionals to treat thyroid disorders. These conditions include cancer, an enlargement of the thyroid that is not cancerous (goiter), and an overactive thyroid (hyperthyroidism).
During a thyroidectomy, the surgeon will remove varying amounts of your thyroid gland depending on the underlying medical condition being treated. If only a portion of your thyroid needs to be removed during surgery (a partial thyroidectomy), then your thyroid may function normally after the procedure. In the event that your entire thyroid needs to be removed (a procedure known as a total thyroidectomy), you will require daily treatment with thyroid hormone in order to replace the natural function of your thyroid.
Who needs thyroid surgery?
If you have conditions such as the following, your doctor may recommend that you get a thyroidectomy:
- Cancer of the thyroid. The most common medical condition requiring a thyroidectomy is cancer. If you are diagnosed with thyroid cancer, one of the possible treatments involves removing most or all of your thyroid gland.
- Thyroid enlargement that does not indicate the presence of cancer (goiter). When dealing with a large goiter, surgery to remove all or part of the thyroid gland might be an option. It’s possible that a large goiter will make swallowing and breathing difficult, as well as cause discomfort. In some cases, removal of a goiter is necessary if the growth is responsible for hyperactive thyroid function.
- Thyroid that is overactive (hyperthyroidism). The condition known as hyperthyroidism occurs when your thyroid gland produces an abnormally high amount of the hormone thyroxine. If you are unable to take anti-thyroid medications or do not wish to undergo radioactive iodine treatment, a thyroidectomy may be an alternative for you to consider. These are two additional treatments for hyperthyroidism that are commonly used.
- Thyroid nodules that raise red flags. After running tests on a sample obtained from a needle biopsy, it is impossible to determine whether certain thyroid nodules are cancerous or not. In the event that your nodules have a higher likelihood of being cancerous, you might be a candidate for having your thyroid removed.
Types of Thyroid Operations
In general, there are three different kinds of thyroid resections, and they are as follows:
Surgical removal of the entire thyroid gland is referred to as a “total thyroidectomy.”
A total thyroidectomy is one treatment option for a number of conditions, including thyroid cancer, Graves disease, multinodular goiter, and substernal goiter, to name a few. In some instances, the surgeon may decide to perform a procedure known as a near-total thyroidectomy.
During this procedure, the surgeon removes nearly all of the thyroid gland but leaves behind a small piece of tissue, which is typically located in the region of the parathyroid glands and the recurrent laryngeal nerve. This is done to avoid causing any damage to the aforementioned structures. Patients who have undergone a total thyroidectomy are going to be required to begin taking thyroid hormone replacement pills (one pill a day for the rest of their lives). Doctors will provide optimization of thyroxine replacement therapy for each patient having benign thyroid disease following total or nearly total thyroidectomy
Hemithyroidectomy, also known as a thyroid lobectomy, is the surgical removal of one half of the thyroid.
Indeterminate lesions on fine needle biopsy a toxic nodule, substernal goiter, and an enlarging thyroid nodule are some of the diseases that can be treated with a thyroid lobectomy. Another reason for this procedure is an enlarging thyroid nodule.
Some surgeons refer to a thyroid lobectomy as a diagnostic lobectomy when it is performed on patients with indeterminate lesions. This is because the primary goal of the operation is to determine whether the patient has cancer or a benign thyroid disease. Hyperthyroidism and hypothyroidism are typical examples of benign thyroid disease. Approximately one week after the operation, the final pathology report is ready to be analyzed.
If a patient still has at least half of a normal thyroid gland in their body, there is a good chance that they will not need to take thyroid hormone replacement pills. This percentage is lower in older women, patients who have a personal or family history of Hashimoto’s thyroiditis or hypothyroidism, and patients who have a family history of autoimmune disease.
Thyroidectomy with complete removal of any remaining thyroid tissue is known as a “complete” thyroidectomy.
In most cases, a completion thyroidectomy is performed after a thyroid lobectomy reveals cancer in the first half of the thyroid. However, a completion thyroidectomy may also be performed for multinodular goiter or for hyperthyroidism. Patients who have undergone a total thyroidectomy will require thyroxine replacement therapy after the procedure is finished (one pill a day for the rest of their lives).
The patient’s preferences and the nature of the disease being treated are two of the most important considerations that go into determining the type of thyroid operation to carry out. It is essential to choose the appropriate operation for each individual patient through collaboration with a group of thyroid specialists who are experts in the field.
The importance of hormone therapy after thyroid surgery
When your thyroid is unable to produce an adequate amount of thyroid hormone on its own, your doctor may recommend that you undergo thyroid hormone therapy. This condition is known as hypothyroidism, and it can be quite dangerous. Other reasons, though less common, for using thyroid hormone therapy include the following:
- In order to rein in the expansion of the thyroid gland that was previously seen (also called goiter)
- For the purpose of preventing the expansion of nodules on the thyroid gland
- After removal of the thyroid, treatment for diseases, both benign and malignant, may be necessary.
- Following the administration of radioactive iodine ablation for the treatment of hyperthyroidism
If you’ve had your thyroid removed, your body will no longer be able to produce the thyroid hormone it requires. You will need to take thyroid hormone pills (levothyroxine) in order to replace the hormone that your body naturally produces. These pills will also assist in preserving your metabolism’s normal state and may reduce the likelihood of the cancer returning. For the treatment of hypothyroidism, levothyroxine is widely recognized as the drug that is both the most widely used and the least successful.
Your body is unable to function properly if you do not have enough thyroid hormone, which can lead to a number of undesirable side effects, including stunted growth, a lack of energy, excessive tiredness, constipation, weight gain, hair loss, dry, thick skin, increased sensitivity to cold, joint and muscle pain, heavy or irregular menstrual periods, and depression. Levothyroxine is capable of reversing these symptoms when taken as directed.
When levothyroxine administration is a necessity
The most abundant form of thyroid hormones in the blood is thyroxine. Thyrocytes are the cells that are responsible for its production. Deiodinases in the organs convert thyroxine into triiodothyronine after it has been transported there by active transport. The form of thyroid hormone known as triiodothyronine is the active form.
Although the thyroid gland is responsible for producing a small amount of it, the vast majority of it is generated outside of the gland by the conversion of the prohormone thyroxine. Hypothyroidism is a relatively common endocrine disorder that requires prompt and ongoing treatment for the rest of the patient’s life. It is possible for it to cause high blood pressure, high cholesterol, and heart failure if it is not treated.
It is also possible for it to cause dementia, infertility, and symptoms in the nervous, musculoskeletal, and digestive systems if it is not treated. Replacement of thyroid hormone is currently the only method that can be used to treat hypothyroidism successfully. Levothyroxine is the drug that is most commonly prescribed as a first-line treatment for primary hypothyroidism in patients who are clinically euthyroid. This is because of the drug’s long half-life, which is approximately 7 days.
How to take levothyroxine tablets after thyroid surgery
Six to eight weeks after the operation, your doctor will have you undergo blood tests to evaluate how well your thyroid is functioning. If you have a total thyroidectomy, you will need to begin having levothyroxine dosage immediately after surgery in order to replace the thyroxine that was produced by your thyroid gland.
To emphasize again, these tablets will need to be taken for the rest of your life. The correct levothyroxine dosage must be individualized for each patient in order to achieve normal levels of thyroid stimulating hormone and thyroid hormones in the blood. These levels should be considered healthy.
Initial levothyroxine dosage and Dose Adjustment of During Therapy
Initial Dosing
The initial dose of levothyroxine a patient needs depends mostly on: the amount of thyroid function the patient still has, the patient’s body weight or lean body mass, and the level of thyrotropin or thyroid-stimulating hormone that needs to be reached during treatment. Other factors, like the patient’s age, sex, and whether or not they are menopausal, may also have a smaller effect. Other physiological factors, like pregnancy and how well the digestive system works, may also be important in some patients or at certain times.
When starting levothyroxine therapy, the first dose can vary a lot, from small doses like 25–50 μg for people with mild or subclinical disease, in which case the therapy may be supplementing endogenous function, to larger doses like 88–175 μg for people with almost no endogenous thyroid function. In line with this idea, the initial dose of levothyroxine for a patient with primary hypothyroidism who comes to a clinic can be predicted by the patient’s TSH level before treatment starts.
When someone has surgery to remove their thyroid, they may need a slightly higher dose of levothyroxine than someone with autoimmune thyroid disease. This is likely because people with autoimmune thyroid disease still make some thyroid hormones. The initial dose of levothyroxine for thyroid hormone replacement therapy after total thyroidectomy is typically based on body weight, with the most popular formula being 1.6 µg/kg body weight, without adjustment for the patient’s body mass index.
Body weight or body mass index can be used to figure out how much levothyroxine a person needs after a thyroidectomy. Evaluation of thyroid hormone replacement dosing in overweight and obese patients after a thyroidectomy should be implemented. The initial dose needs can be predicted by body weight, body mass index, ideal body weight, and lean body mass, with the last three giving the most accurate estimates.
The most recent research mandated that obese patients’ hormone maintenance therapy be different from that of non-obese patients. Moreover, to help choose the starting levothyroxine dose, ideal body weight calculators are being developed in place of actual weight calculators. Several formulas have been suggested for figuring out the dose needed. Currently, the most accurate estimation for levothyroxine replacement therapy following thyroidectomy is a 1.5- and 1.3-g/kg dosage calculation based on actual weight. There are simple formulas based only on body weight or body mass index, and there are also more complicated formulas that take into account things like the patient’s sex.
Most of the time, both a TSH-based estimate and a body weight-based estimate give similar initial dose estimates. However, levothyroxine dose following thyroidectomy is influenced beyond just body weight. When it comes to age, it is best to start levothyroxine therapy with smaller doses, like 25–50 μg levothyroxine, for patients who are older, have cardiac disease, or may have had long-term hypothyroidism that hasn’t been treated. This way, you won’t cause cardiac ischemia too quickly.
Dose Adjustment
No matter what method is used to estimate the initial dose of levothyroxine, the dose often needs to be changed. This could be caused by a number of things, such as the fact that it is hard to predict how much levothyroxine a patient will need, differences between patients, how well levothyroxine is absorbed, or the effects of other medical conditions or medications being taken at the same time.
Given that the half-life of levothyroxine is about a week, serum TSH levels and, if desired, free thyroxine levels should be checked again after 6 weeks of treatment, when the pharmacokinetic steady state has been reached. If the TSH level is not where it should be, the dose of levothyroxine can be changed up or down. TSH levels that are just a little bit out of range can be fixed by making a single dose change, like going from 100 to 112 g or from 175 to 150 g.
TSH values that are very far from normal may need bigger percentage changes. When taken on an empty stomach, about 75% of the dose is absorbed. So, if levothyroxine is taken at other times of the day to make things easier, the dose may need to be higher and may change more. Once the desired TSH level has been reached, it could be re-confirmed by a lab test in 3–6 months and then checked every year after that.
In one study, the size of the levothyroxine dose was inversely related to how stable the TSH was while on levothyroxine therapy. This could mean that those who needed smaller levothyroxine doses still had some thyroid function that helped to keep the TSH stable.
Consider other options like synthetic T3+T4 combo or Natural Desiccated Thyroid (NDT) if you are still gaining weight and experiencing low energy after numerous months of taking levothyroxine only medications and numerous dose adjustments.
Lifespan Factors Possibly Influencing the Need for Levothyroxine Dosage Modifications
Pregnancy
The dramatic rise in levothyroxine dose needs during pregnancy and the subsequent drop in needs after giving birth are probably the most well-known changes in levothyroxine needs. The reason for the higher need is that the total amount of thyroxine in the body needs to go up, along with the amount of thyroxine-binding globulin and the amount of plasma. About 50–85% of pregnant women need to take more levothyroxine, and they need to start taking more early in the first trimester.
Changes in weight and hormones
As was said above, the amount of levothyroxine you need depends on your body weight, your ideal body weight, and your lean body mass index. As these factors go up, so does the amount of levothyroxine you need. But if a person’s actual body weight is used to figure out how much levothyroxine they need, the dose may be too high. Ideal body weight is a better predictor. Also, studies on levothyroxine needs in obese patients often come up with different results, such as increased or decreased needs. This could be because of the effects of both the increased body weight and the effects of obesity on levothyroxine absorption and kinetics.
Ageing
Several studies have shown that older people need less levothyroxine than younger people. But a new study suggests that this lower need may be caused by the changes in weight that come with getting older. Other important things to think about when giving levothyroxine to older people are age-adjusted TSH reference ranges and avoiding over-replacement, which could make other health problems worse.
Alternatives to Levothyroxine
If you are looking for a natural alternative to levothyroxine, you might want to consider using Natural Desiccated Thyroid (NDT) such as VitaliThy. Levothyroxine is prescribed to treat hypothyroidism, but there are many other options available if you cannot find the right dosage. NDTs work by replacing the missing hormones in the body, so if you are not getting the desired results from levothyroxine, a NDT may be a good option for you.
VitaliThy is a NDT made in Vietnam and you can buy it online, it’s currently available in the United States, United Kingdom, Australia and European Union. It is a natural product and is not subject to the same safety concerns as levothyroxine. It is also a more effective treatment option, as it can help to restore proper thyroid hormones levels. If you are unable to find the right dosage of levothyroxine, try a NDT such as VitaliThy.