Post-Thyroidectomy Complications: Managing Symptoms and Treatment Options

Q: Post-Thyroidectomy Complications: Managing Symptoms and Treatment Options

Dear Mr. <br>Hsiao Tsai：<br>1. <br>Eltroxin® Tablets are available in different dosages of 50 mcg and 100 mcg, primarily used for thyroid hormone replacement therapy, which may be necessary in cases of hypothyroidism or post-thyroidectomy. <br>Generally, the therapeutic effects a

Complications after total thyroidectomy?

Hello, Director Hsiao! My mother (75 years old, 155 cm tall, 45 kg) underwent surgery for a right thyroid nodule on March 24 of this year (she had surgery on the left side for a nodule over a decade ago).
She is now without thyroid function and started taking Ontexin (two capsules daily, each 50 mg) on April 5.
However, after the surgery, she began experiencing symptoms such as general weakness, anxiety, palpitations, cold intolerance, and eye strain.
Blood tests conducted at the outpatient clinic showed that aside from a slightly elevated T4 level (1.68), all other indices, including TSH, cortisol immunoassay, sodium (Na), and low-density lipoprotein, were normal (all indices were also normal in her adult health check report prior to the surgery in February).
The physician suggested trying only one capsule of Ontexin (50 mg) per day, but the symptoms returned the next day after a symptom-free day (the symptoms typically occur in the afternoon).
What should I do next or what direction should I take for further medical care?

Xiao Cai, 50~59 year old female. Ask Date: 2016/05/08

Dr. Xiao Yongxun reply Internal Medicine

Dear Mr.
Hsiao Tsai:
1.
Eltroxin® Tablets are available in different dosages of 50 mcg and 100 mcg, primarily used for thyroid hormone replacement therapy, which may be necessary in cases of hypothyroidism or post-thyroidectomy.
Generally, the therapeutic effects and symptom improvement can be observed within 7 to 14 days after administration.
Therefore, your mother's attending physician is quite precise in the medication schedule.
2.
There may be concerns about the dosage being too high, which is why the dosage was reduced when the T4 levels were slightly elevated; this adjustment in dosage is also very appropriate.
It is somewhat unusual to see fluctuations in symptoms just 1 to 2 days after dosage adjustment, as mentioned regarding the pharmacological action time.
It may also be worth considering the presence of any anxiety.
3.
I recommend that you and your mother discuss these matters in detail with the attending physician.
If you are worried about forgetting any points during the discussion, it might be helpful to prepare a note in advance.
Thyroid surgery is considered a specialized technique in surgery, as it involves not only the thyroid gland but also the parathyroid glands and other endocrine functions and organ responses.
It is not advisable to change physicians arbitrarily to avoid misunderstandings of the actual situation.

Reply Date: 2016/05/08

More Info

Post-thyroidectomy complications can be quite challenging to manage, especially when patients experience a range of symptoms that can significantly affect their quality of life. In your mother's case, it appears that she has undergone a right-sided thyroidectomy and is now experiencing various symptoms, including generalized weakness, anxiety, palpitations, cold intolerance, and eye discomfort. These symptoms can be attributed to the loss of thyroid function, which is critical for regulating metabolism and energy levels in the body.

After a total or partial thyroidectomy, patients often require lifelong thyroid hormone replacement therapy, typically with levothyroxine (Eltroxin). It is essential to monitor thyroid hormone levels regularly to ensure that the dosage is appropriate. In your mother's situation, she has been prescribed 100 mcg of levothyroxine daily, which is a common starting dose. However, the symptoms she is experiencing may indicate that her dosage needs adjustment, particularly since her T4 levels are slightly elevated.

1. Understanding Symptoms: The symptoms your mother is experiencing can be indicative of both hypothyroidism and hyperthyroidism. While she has undergone thyroidectomy and is on hormone replacement therapy, the fluctuation in her T4 levels could lead to symptoms of both conditions. For instance, generalized weakness and cold intolerance are often associated with hypothyroidism, while palpitations and anxiety can be signs of hyperthyroidism. It's crucial to find a balance in her medication to alleviate these symptoms.

2. Medication Adjustment: Given that your mother has experienced relief when reducing her levothyroxine dosage to 50 mcg, it may be beneficial to continue monitoring her symptoms closely. It is not uncommon for patients to require dose adjustments based on their symptoms and lab results. Regular follow-ups with her healthcare provider are essential to determine the optimal dosage. It may also be helpful to keep a symptom diary to track when symptoms occur and their severity, which can provide valuable information for her healthcare team.

3. Follow-Up Care: It is advisable for your mother to have regular follow-up appointments with her endocrinologist or primary care physician. Typically, after a thyroidectomy, patients should have their thyroid hormone levels checked every 6-8 weeks until stable, and then every 6-12 months thereafter. If her symptoms persist or worsen, more frequent visits may be necessary.

4. Addressing Other Factors: Besides medication management, it is also important to consider other lifestyle factors that could be contributing to her symptoms. Stress management techniques, such as mindfulness, yoga, or gentle exercise, can help alleviate anxiety and improve overall well-being. Additionally, ensuring she has a balanced diet rich in nutrients can support her recovery and overall health.

5. Potential Referral: If her symptoms continue to be problematic despite medication adjustments, it may be beneficial to refer her to a specialist, such as an endocrinologist or a geriatrician, who can provide a more comprehensive evaluation of her condition and treatment options.

In conclusion, managing post-thyroidectomy symptoms requires a multifaceted approach that includes careful monitoring of thyroid hormone levels, medication adjustments, and addressing lifestyle factors. Open communication with her healthcare provider is key to ensuring that her treatment plan is tailored to her individual needs and that her symptoms are effectively managed.

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