Dr. Frank Kuitems answered Internal Medicine 38 years experience An elevated TSH the vast majority of the time is caused by hypothyroidism, which is an underactive thyroid. Theres a lot there, but these tests have not been fully validated. You may need to have your dose decreased slightly. Knowing how cancer spreads and what organs it can spread to will help your medicul plan your care. Q: What are the current routine ways to monitor for thyroid cancer recurrence? However, i would see you pcp sooner than later with such an initial elevation. Our categorical scale is simple and allows for easy recall whe Its okay for your free T4 to be high, but only if your free T3 level is also high. About one third of euthyroid patients who undergo hemithyroidectomy develop hypothyroidism. In order to fully assess the significance of serum thyroglobulin, antithyroglobulin antibodies are requested at the same time. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. TSH: thyroid stimulating hormone produced by the pituitary gland that regulates thyroid function; also the best screening test to determine if the thyroid is functioning normally. Your doctor will likely look a little deeper into your thyroid labs t All laboratory results need to be interpreted in the clinical context and the doctor who ordered the tests is usually in the best position to do that. is an indication of hypothyroidism. Inflammation of the Thyroid Gland (Thyroiditis) tsh. The good news is that this appears (so far) to only be a problem for roughly about 20% of patients without a thyroid but it is a big problem for those people. Monitoring is a huge topic, so I will focus my comments on differentiated thyroid cancers, namely papillary thyroid cancer and follicular thyroid cancer. Updated June 8, 2018. And if the level started off low and then starts increasing, that is concerning because the level should be very, very low. Adthyza Thyroid Medication Review: Should You Use it? https://www.uptodate.com/contents/differentiated-thyroid-cancer-overview-of-management. Correlation and agreement between superb micro-vascular imaging and contrast-enhanced ultrasound for assessing radiofrequency ablation treatment of thyroid nodules: a preliminary study. and low. Researchers are looking at that modality to pick up cervical lymph node involvement. In contrast, RAI treatment is indicated in patients with distant metastases and evidence of iodine avid disease on radioiodine scan. Our team is made up of doctors andoncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing. 18 months after thyroidectomy , my tsh is 30. my dr just increased my armor. If someone is very stable, if the resection margins of the cancer are free and clear, and if the staging is appropriate and the patient has positive outlook factors, we may not do the monitoring and testing as frequently. I would think your trouble with breathing needs to be investigated by someone, whether it be endo or otherwise, because it is worrisome even if not related. More recent sensitive thyroglobulin assays may detect much lower levels of serum thyroglobulin and provide similar information to the values done previously through TSH stimulation. Dr. Peiris: Certainly, yes. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. However, the location of the recurrence is not always clear. Thyroid. I never had high blood pressure before thyroidectomy andits treatment with medicines. Hypothyroidism was more common in age-quartile 2 (32 %), age-quartile 3 (37 %), and age-quartile 4 (42 %) than in age-quartile 1 (25 %) [adjusted odds ratio (OR) = 1.87; 95 % confidence interval (CI) 1.27-2.76, p = 0.002; age-quartile 4 compared to age-quartile 1]. This is why many post-thyroidectomy patients who take one of these (or Levoxyl) also end-up on anti-depressants and meds for ADD/ADHD. Nurse Practitioners/Physician's Assistants, 2022 ASCO Genitourinary Cancers Symposium Urothelial Cancer Updates, Contemporary Concepts in Hematologic Oncology, Insights from Experts at Mayo Clinic on Translating Evidence to Clinical Practice, Optimizing Outcomes in Patients with HER2+ Metastatic Breast Cancer. Int J Endocrinol. This paper examines the . If so, then this article may help to explain why you are feeling the way that you do. Cervical nodes are present in everyone and they often get larger during, for example, a respiratory tract infection. will a partial thyroidectomy help? The first place that thyroid cancer spreads is to the lymph nodes. Initially, the shock phase overwhelms every emotion and touches every area of one's life. Even patients who have a sluggish thyroid are still able to produce at least SOME of both of these hormones which are then supplemented by thyroid medication. Unauthorized use of these marks is strictly prohibited. (feeling very sick). However, if the TSH remains high for months or years after the removal of the thyroid gland, it may mean that the cancer is still present. One area of controversy comes from the fact that most of these differentiated thyroid cancers have really good outcomes. The second way you can tell is by assessing your clinical symptoms. Doctors have learned that by giving higher than normal doses of thyroid hormone, TSH levels can be kept very low. If youve been diagnosed with thyroid cancer, its important to have it checked regularly. S post-surgical hypothyroidism which needs to be treated with an appropriate dose of BRAND NAME T4 replacement to return your levels to normal. Epub 2022 Jan 24. If so, did you find that your levels were low? It can cause many symptoms, but achy throat is not one of them. It takes a long time to grow back. And relying upon your TSH as the only marker of thyroid function may lead to inappropriate treatment. What I want you to take away from this article is that not all thyroid patients are alike and that you, as a patient without a thyroid, may need different treatment compared to other people even in your same situation. More complete removal of thyroid tissue is called a thyroidectomy. Taking higher than normal levels of thyroid hormone seems to have few short-term side effects, but some doctors have expressed concerns about taking them for long periods of time. That was 7 years ago. Get my free thyroid downloads, resources, and PDFs here. Usually they receive a T4 dose large enough to suppress their blood level of thyroid stimulating hormone (TSH) below the normal TSH range. Suspicious ultrasound findings can be further evaluated using fine-needle aspiration, with the needle washout fluid also tested for thyroglobulin. After thyroid cancer, patients should ask their doctor about TSH levels and Thyroid Hormone Replacement Therapy (THR). This might seem like a big problem, especially if you are inundated with the conventional medical model, but Im here to tell you that there are MANY thyroid medications that exist beyond levothyroxine. Oncology On-The-Go Podcast: COVID-19 Vaccination and Cellular Therapy in Cancer. Thyroid produces T3 and T4. I have tsh 4.910 high and t4 12.1 high - why are both high? Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. In some cases, radiation therapy is used in conjunction with surgery. As a result, if someone has one of these nutrient deficiencies then this can lead to decreased production of thyroid hormone, which in turn will cause an elevated TSH. Hypothyroidism Causes There are two fairly common causes of hypothyroidism: inflammation of the thyroid gland and medical treatments that affect the thyroid's ability to make enough thyroid hormone. The most significant predictor is the preoperative TSH level, with an approximate doubling of risk for each 1 unit of TSH increase over 1 IU/ml. Patients who did not take Thyroid Hormone before the procedure may be given a different dose, which is usually based on the patients weight. Normal thyroid function is regulated by the pituitary gland. There must be an important reason and it probably has to do with the fact that not everyone can function well on one type of thyroid hormone. Do not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. The imaging may be ultrasound, which is a very easy thing to do. If you have hypothyroidism and you are receiving treatment for this condition then you should not expect to have continued symptoms with your treatment, assuming your treatment is appropriate for you. If you fit into this category then you know that even though you are technically still hypothyroid you are still in a class of your own. TSH normal range goes up to 4 or 5, so some people will still be hypo when TSH is normal but on the higher end of its normal range. Periodic risk assessment may allow the change in a patients status to higher or lower risk. Hypoparathyroidism is when you have too little parathyroid hormone, which can lead to low calcium levels. Learn which foods you should avoid if you have thyroid disease of any type. Philadelphia, Pa. Elsevier: 2014. And while this may be true for some people, its not true for all people. Restart Medical LLC. Epub 2011 Jun 23. Check out my thyroid supplements. A high TSH is seen after thyroid removal if thyroxine replacement is not adequate or from injection of biosynthetic TSH. Untreated under active thyroid can lead to. Lol and I was worried when my endo brought up 125mcg since I was paranoid of being "hyper". If you find that your free t3/free t4 are in the bottom 30% of the reference range or even off the charts low, then this is a problem. American Cancer Society medical information is copyrightedmaterial. Now, in some situations these cancers are initially responsive to radioactive iodine but then later become unresponsive to radioactive iodine. Markers, if they can provide synergy to the current testing, are a very exciting potential future development. The dose and frequency of medication will be determined by your doctor. Thyroidectomy is the partial or total removal of the thyroid gland. The initial level of TSH after thyroidectomy is usually below normal, but over time it will become elevated. High energy beta particles plus gamma radiation. The aim of this retrospective study was to evaluate the time to TSH normalization in a group of patients who underwent total thyroidectomy for Graves' disease receiving a LT4 therapy dose regimen based on a . However, i would see you pcp sooner than later with such an initial elevation. Hypothyroidism was more frequent with increasing preoperative TSH levels 36, 72, and 92 % in patients with TSH levels of 1.0-2, 2.01-3, and 3.01-4 IU/ml, respectively, compared to 17 % in those with TSH levels <1 IU/ml [adjusted OR = 45.1; 95 % CI 13.5-151, p < 0.0001; 3.01-4 IU/ml compared to <1 IU/ml]. It means that this sub-group of patients will likely experience persistent symptoms of hypothyroidism despite being treated adequately. It means that a large percentage of patients without a thyroid is not able to adequately utilize the thyroid medication that they are taking by mouth. After removal of the thyroid gland, Thyroglobulin can be used as a "cancer marker." Its number should be as low as possible. The American Cancer Society is a qualified 501(c)(3) tax-exempt organization. Data sources PubMed, EMBASE, Cochrane Library, Web of Science and SCOPUS were searched from inception to 24 February 2021. Here we see that as TSH drops (meaning the more medication you take) the free T3 level increases but it never actually approximates the healthy levels seen in controls. At that point, we may use other imaging methodologies like PET-CT scans. is that a symptom of high tsh? Artificial Intelligence for Pre-operative Diagnosis of Malignant Thyroid Nodules Based on Sonographic Features and Cytology Category. TSH and Total Cholesterol Level before and after Thyroidectomy. I do not understand what could cause my TSH levels to be high????? We also monitor for the thyroglobulin with antibodies and imaging, the frequency of which really depends on the individual patient. I had a total thyroidectomy (thyroid papilliary cancer) for 17 years and with a high level of tsh result. and transmitted securely. A patient may also have a higher TSH level if they have extrathyroidal extension, which is known to increase the risk of developing thyroid cancer. You can apply this same calculation to your free T3 level. and I'm proud to say that over 80,000+ people have used them over the last 7 years. This gives you the bottom 30% of the reference range that I previously mentioned. The pituitary makes a hormone called TSH that causes the thyroid gland to make thyroid hormone for the body. NCCN Clinical Practice Guidelines in Oncology: Thyroid Carcinoma. This has to be done gradually. Had total thyroidectomy 6 months ago now all of a sudden my tsh keeps going up no matter how high they increase my synthroid (thyroxine). Clipboard, Search History, and several other advanced features are temporarily unavailable. Davidge-Pitts CJ and Thompson GB. absorption issues r/o? -, Surgery. After thyroid surgery, there are some limited exercises and activities you can do to help promote recovery and keep your body healing. As for the question of new markers, weve learned a lot over the past few years. Here you'll find in-depth information on specific cancer types including risk factors, early detection, diagnosis, and treatment options. Some patients in intermediate risk group might require RAI treatment. Some people are going to be higher risk and need more frequent monitoring, and other people will be at very low risk and their interval for monitoring will be much longer. However, some patients will have abnormally elevated TSH levels. I never had high blood pressure before thyroidectomy andits treatment with medicines. The pharmaceutical companies are capable of replacing T3, too (it is less significant, but it is the 'active' hormone produced by thyroid - T4 is not active). If it is greater than 5 you are hypothyroid. Those people who dont have a thyroid find it more difficult to lose weight, find it harder to normalize their symptoms, and overall struggle with a more intense version of hypothyroidism. Patients with thyroid cancer of any size are more likely to develop a recurrence if the tumor has spread to lymph nodes. Another option is to enroll these patients into clinical trials. Can anyone help me with this? When it is elevated, it can mean that the thyroid cancer has returned. You will have your blood calcium levels monitored, and will receive further instructions. Hypothyroidism after hemithyroidectomy About one third of euthyroid patients who undergo hemithyroidectomy develop hypothyroidism. The site is secure. Currently, we could do with some help with newer technologies, but its important to realize that not everyone gets the same risk assessment. Another treatment is targeted therapy, which targets specific parts of the cancer cells and is usually taken in pill form. After a thyroidectomy, it is important to follow the thyroid hormone replacement therapy recommended by your doctor. Data extraction and synthesis Two authors independently . P.S. I'm Westin Childs D.O. This lump may be painless, or it may be hard to detect. Thyroid. This resource is dedicated to helping people with thyroid problems, hormone imbalances, and weight loss problems get the help that they need. If youre concerned about your TSH levels after thyroid cancer, youve come to the right place. Over the long run, high doses of thyroid hormone can also lead to weak bones (osteoporosis). Why Doctors Remove a Thyroid Gland. i can't take the thyroid meds. Dr. Peiris: It is helpful to focus on the differentiated thyroid cancers as those account for most of the thyroid cancers. (TSH 0.01 U/ml, fT3 5.43 pg/ml, fT4 7.02 ng/dl) and elevated TSH receptor . I have a high tsh after thyroidectomy 4 years ago. Until recently, suppression of TSH was routinely prescribed to patients with thyroid cancer to reduce recurrence of their disease after total thyroidectomy, with or without radioactive iodine (RAI) ablation, which often translated into a lifetime treatment. Problems are not caused by an underactive thyroid. The independent effect of age-quartile, gender, race, thyroiditis, and preoperative TSH level on the development of hypothyroidism was evaluated. web after thyroidectomy some people may experience neck pain and a hoarse or weak Several steps may occur concurrently in the monitoring for recurrence in differentiated thyroid cancers. If you do fit into that category then you will likely need a combination of both T4 and T3 thyroid hormones. You should also talk to your doctor about the risk of relapse. The study listed above helps to define this range but basically, you should be looking for these values to match those found in healthy adults with a functioning thyroid. As a thyroid patient, you are probably well aware of the thyroid lab test known as the TSH. Thyroid cancer. See the section above on thyroid hormone replacement therapy. For high-risk patients, the dose will be high enough to suppress the thyroid stimulating hormone (TSH) below the range that is normal for someone not diagnosed with thyroid cancer. Hey There! If you notice any lumps or bulges in the thyroid area, you should consult a physician immediately. Discuss your options with a genetic counselor who can explain your risk of thyroid cancer and your treatment options. During the first year after your treatment, your physician may order blood tests several times to make sure you are on the right dosage of thyroid hormone replacement. All of the labs and radiology results should be placed in the context of talking to your patients and examining them. Ideally, once the patient has had an intervention for papillary or follicular thyroid cancer, the thyroglobulin level should be really low because theres no thyroid tissue left, as the patient has had surgery and/or radioactive iodine. This is perfectly normal and that is exactly what we see here. You should aim to get your free thyroid hormone levels up to higher levels. High levels of thyroid hormone can lead to problems with a rapid or irregular heartbeat. Based on the 2016 American Thyroid Association guidelines for DTC, the risk of recurrence should be categorized as low risk group, intermediate risk group and high risk group, in addition to the American Joint Committee on Cancer (AJCC) tumor, Node, Metastases (TNM) stage. James J. Driscoll, MD, PhD, and James Ignatz-Hoover, MD, PhD, share a perspective on a study published recently in ONCOLOGY. This retrospective study identified euthyroid patients who underwent hemithyroidectomy between 2000 and 2010 for benign disease in Kaiser Permanente Southern California regional hospitals. Typically, patients with thyroid cancer should maintain TSH levels below 0.5 mU/L for the first few months. When the TSH is above 4 mIU / L, the thyroid does not produce enough hormones. Whereas most patients with other types of thyroid cancercertainly the most common onescome to the endocrinologist. The type of treatment used depends on the type of cancer, the location of the tumor, and your overall health. my tsh levels were 0.50 last week and yesterday, my blood pressure went to 183/97.what should i do. 509 Objectives: Elevated serum thyroglobulin (S.Tg) with negative anti-thyroglobulin antibody titre or a rising serum anti-thyroglobulin (S.ATg) titre is known to indicate biochemical disease in patients with differentiated thyroid cancer (DTC), post-surgery. Been having elevated bp since total thyroidectomy 3 weeks ago. I'm Dr. Westin Childs. While using T3 be sure to keep an eye on your TSH, free T3, and free T4 levels as we discussed in the previous section. Accessed February 19, 2019. If the body is able to preserve thyroid function after a partial thyroidectomy (as evidenced above) then it is certainly able to preserve function if 10-50% of the thyroid gland is destroyed. Thyroids in general, produce Thyroglobulin. Tax ID Number: 13-1788491. We can also help you find other free or low-cost resources available. However, in case of multiple progressive metastases, recent novel treatment with tyrosine kinase inhibitors, has shown promise in the management of progressive thyroid cancer. People need thyroid hormones throughout life, and the thyroid gland secretes these hormones. T4 only has potential and hardly has any activity by itself (2). Surgery may be followed by radioactive iodine to destroy the remnant or residual thyroid tissue. If we see a thyroglobulin level, it tells us that there is some normal thyroid tissue or thyroid cancer. It is not a substitute for professional medical advice. I also have been having trouble breathing to my full capacity of my lungs. what that means? Methods Patients with thyroid nodule(s) who underwent fine-needle aspiration biopsy under ultrasonographic guidance in a tertiary, university-based hospital were . Objectives We assessed thyroid-stimulating hormone (TSH) suppression effects on bone mineral density (BMD) in postmenopausal women who underwent thyroidectomy. Because of this, doctors might avoid giving high doses of thyroid hormone unless you havea differentiated thyroid cancer and are at high risk of recurrence. 2022 Dec 22;14(12):e32837. This might seem surprising to you, and you may even think that its a good thing, but it isnt once you understand the function of T4 in your body. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. You didn't have RAI, so that benign tissue is still producing Thyroglobulin. The American Cancer Society medical and editorial content team. Her 0.7 value does fall within the normal range but you can clearly see that she is at the very bottom of this range. In the past, weve occasionally had the need to sample these lymph nodes through fine-needle aspiration and measure thyroglobulin in the lymph nodes because normal lymph nodes should not have thyroglobulin. Cancer.org is provided courtesy of the Leo and Gloria Rosen family. We always have to stop and think whether this enlargement is temporary and related to infection or whether it might mean recurrence of thyroid cancer. I presume the entire gland has been removed. I am 46 years old. You will need to take thyroid hormone (levothyroxine) pills to replace the natural hormone and help maintain normal metabolism and possibly lower your risk of the cancer coming back. ORL J Otorhinolaryngol Relat Spec. Want to know why I'm so passionate about these topics? Use of this online service is subject to the disclaimer and the terms and conditions. Foods to Avoid if you Have Thyroid Problems: Ive found that these 10 foods cause the most problems for thyroid patients. Q: Finally, in the context of monitoring recurrence, could you briefly highlight advances as far as treatment and diagnosis? The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. The goal of THR therapy is to prevent the growth of papillary thyroid cancer cells and to supply essential thyroid hormone to the body. Q: Are there additional ways recurrence of thyroid cancer can be detected that are currently being developed? Here are 4 ways you can get more help right now: #1. My doctor upped my dose of synthroid from 150 to 175, and my tsh test test a month later came back at 28! Once the cancer has spread to the lymph nodes, it may spread to other organs, including the lungs, bones, and brain. Abeloffs Clinical Oncology. An official website of the United States government. I love to write and share what I've learned over the years. Doctor visits and follow-up tests Your health care team will explain what tests you need and how often they should be done. The level of TSH, in turn, is regulated by how much thyroid hormone is in the blood. For information on this topic: https://www.niddk.nih.gov/health-information/endocrine-diseases/ thyroid levels are much more likely due to your prior thyroid surgery. As you might suspect, as you take more thyroid medication by mouth you would expect your free T4 level to increase and your TSH to decrease. It is important to monitor for recurrence especially in the first 5 years; however, recurrence can rarely occur many years later. Patients may receive pills, shots, or IV chemo. Bethesda, MD 20894, Web Policies How often we do this really depends on the context of the patient. Include reference ranges since they vary lab to lab and have to come from her own lab report. After all, why does your body produce both T4 and T3? How Long Does it Take to Lose 50-100 Pounds (or more) Safely? 10th ed. You can help reduce your risk of cancer by making healthy choices like eating right, staying active and not smoking. Your pituitary monitors thyroid hormone, and if there isn't enough, it makes TSH (thyroid stimulating hormone. There are several forms of thyroid cancer. Post thyroidectomy(over a year) show elevated. However, the utility of thyroglobulin levels after lobectomy remains unknown. To learn more, please visit our. Your thyroid makes thyroid hormone. In addition, we also see a much different pattern here compared to the free T4 graph. Despite the fact that this is an FDA-approved medication (6) to treat your condition, your doctor may be hesitant (or just downright resistant) to use it. For starters, perhaps the easiest way to identify whether you fit into this category has to do with your thyroid lab tests. Differentiated thyroid cancers also have the ability to make this. Epub 2022 Nov 6. National Comprehensive Cancer Network. I was on levothroxine for years with back and forth symptoms, never real What does it mean when your Thyroglobulin and THYROID PEROXIDASE ANTIBOD Im 30 YO . By testing and evaluating your free t3 and free T4 you can find out if you are someone who has trouble with peripheral thyroid conversion. The percentage of patients who were given too high a dose of LT4 remained the same (46% vs 42%), and . (total thyroidectomy w/parathyroid removal 11mos). What would cause my TSH level to be high if I do not have a thyroid? A patient may also have a higher TSH level if they have extrathyroidal extension, which is known to increase the risk of developing thyroid cancer. And, it turns out, this is a big problem for up to 20% of patients who do not have a thyroid gland. While TSH receptor mutations are relatively rare in thyroid cancer, some evidence suggests that TSH is related to cancer. They take it both to avoid hypothyroidism (underactive thyroid condition) and to prevent growth or recurrence of their thyroid cancer. What Are Treatment Options After Progression in PDL-1Positive Metastatic Lung Adenocarcinoma after Chemo/IO? But how do we define a low free T3/free t4? Positron emission tomography (PET scan) can detect recurrence in patients with negative RAI scan and rising Tg levels. A couple months ago my tsh levels started elevating, in the 14 range. Now out of the blue I am not feeling myself and I went to the Dr, they called me back and said that my TSH levels are at 9.03 and my B12 levels are at 1476. There has been a rise in the incidence of thyroid cancer over the last 30 years, especially in small thyroid cancers. Epub 2019 Sep 5. MeSH Being hypo-thyroid or hyper/thyroid or having a sudden dramatic change in thyroid hormone levels can cause hair to fall out. 2011;73(2):68-71 Results: help! In intermediate-risk patients, the initial TSH goal is 0.1 to 0.5 mU/L. Among the many important points illustrated by this study is the fact that it showed a certain sub-group of patients without a thyroid are not able to maintain normal free thyroid hormone concentrations with T4-only thyroid medication. Could this mean that my cancer is coming back? Risk factors for thyroid hormone replacement therapy after hemithyroidectomy and development of a predictive nomogram. web jan 19 2022 most people with hypothyroidism have high tsh because their thyroid gland is not releasing enough hormones in response to this the body produces more tsh in order to get the thyroid to . Lets take a look at this image from the study first: Here you can see the TSH on the X-axis and the FT4 on the Y-axis. If your thyroid was removed surgically, you will receive thyroid hormone replacement therapy (levothyroxine) for the rest of your life. Thyroglobulin measurement is most useful if done when the TSH is high. Transient (temporary) hypoparathyroidism can happen after thyroid surgery. Daniel V. T. Catenacci, MD, and colleagues present findings from a study of circulating tumor DNA as a predictive biomarker for gastric and gastroesophageal cancer. For potential or actual medical emergencies, immediately call 911 or your local emergency service. if left untreated, what might occur? eCollection 2022 Dec. Jassal K, Koohestani A, Kiu A, Strong A, Ravintharan N, Yeung M, Grodski S, Serpell JW, Lee JC. Making Strides Against Breast Cancer Walks, ACS Center for Diversity in Research Training, Radioactive Iodine (Radioiodine) Therapy for Thyroid Cancer, External Beam Radiation Therapy for Thyroid Cancer, Treatment of Thyroid Cancer, by Type and Stage. This option, while it may work, is not preferable as it will also cause TSH lowering (or even TSH suppression). Untreated under active thyroid can lead to How high? Patients with TSH levels that are either too high or too low should see their physician. Even moderate suppression of TSH improves survival in stage II patients. Dosing T3 in the setting of not having a thyroid can be tricky but it is only slightly more difficult when compared to using T4.
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