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Thyroid cancer

A place for people affected by thyroid cancer to support one another, ask questions, and share their experiences.

Thyroid hormone replacement following total thyroidectomy

Posted by

Dear All - following a very recent diagnosis, I am to have a total parathyroidectomy and total thyroidectomy. I know that Levothyroxine is commonly used, but does this just replace my T4?  How does my T3 get replaced?  Should I be looking at the possibility of obtaining T3 privately?  

Thanks for your words of wisdom!  

Posted by

Hey there Magic,

Welcome to the forum though I'm sorry you find yourself needing to be here!

Can I first of all ask, do you know why you're having a parathyroidectomy? That's not the usual treatment, so I'm curious as to what's going on there if you don't mind sharing?

Thyroxine is always used in the UK after a thyroidectomy, as you need thyroxine to live. I have a feeling you've been googling and finding the websites where folks are being a bit dramatic about it all, so I'll try and explain it from the start. The thyroid hormones in your body are T0, T1, T2, T3, and T4. Your thyroid produces a negligible amount of T3, and mostly produces T4. If you think of T4 as like a storage hormone, floating around in your body ready to be unpacked. When needed, your liver, kidneys, brain, and other organs will 'unpack' the T4, and convert it into T3. During this process, T0, T1, and T2 are thought to be produced. So there is no need to replace T3, because your body will create it from the thyroxine (t4) that you'll be taking.

Please don't look to get T3 privately, because after a thyroid cancer diagnosis you need to have your levels controlled properly to stop a recurrence. Taking T3 will cause all sorts of fluctuations, and your blood tests won't be accurate, and so could result in a recurrence.

Now, if you have your parathyroids removed, you'll also need to take calcium for life as well. Thyroxine needs to be taken first thing in the morning before any food or drink, with just a drink of tepid water. You then need to wait a minimum of 30 mins before eating or drinking anything, though it's better to wait 60 mins. You can then take any other meds, have your breakfast, etc. However, you need to wait 4 hours before you can take calcium, and 6 hours before you can take iron. That includes multivitamins that might contain those.

Also, once you're on thyroxine you shouldn't take any cold and flu remedies that contain Pseudoephedrine or phenylephrine as they can strain your heart and cause a heart attack or make high blood pressure worse. So time to clear the cupboards!

I hope that helps, and good luck with your operation. I hope all goes well! Please do shout if you've any other questions and we'll try and help!



Hope is important because it can make the present moment less difficult to bear. If we believe that tomorrow will be better, we can bear a hardship today. - Thich Nhat Hanh

Posted by

Hi - thanks for your reply. So, I was initially referred to endocrinology due to an elevated PTH and kidney stones. Due to my age and history, I fell into the category for a targeted parathyroidectomy which I was being worked up for. It was during the work up that they discovered the thyroid issue, so last week I was taken back to clinic and informed that I needed a total parathyroidectomy and also the thryroidectomy. 

Hopefully this makes sense and thanks again for your reply.