Hip Replacement Surgery Was Delayed Due To High TSH. Given Eltroxin. How Is It Correlated?

Posted on Wed, 4 Dec 2013

Question: my mother has to undergo hip joint replacement operation. But her TSH value is found to 63. So doctors have given 100 mcg eltroxin and they said surgery is possible only after the TSH level comes to normal range. What is the relation between TSH and the surgery? Is the dose correct? How long it will take to bring down TSH to normal range?

Answered by Dr. Sujoy Khan (54 minutes later)

Brief Answer: Dose needs to be adjusted by Endocrine specialist Detailed Answer: Hello, Welcome to Healthcare Magic. The TSH is very high, suggesting of an underactive thyroid, so severe that I am surprised if she is able to walk or get up from bed. It is quite right that the routine operation is deferred until the thyroid is corrected, as there is a chance of multiple problems intra- and post-operative with this level of thyroid function. The dose can be increased for a week, then lowered and checked after 2-3 weeks to see a response. But this should be done under close supervision with an Endocrine specialist. Thyroid specialists should take over care and ensure there is no other complications currently such as pericardial effusion (water around heart), cardiac rhythm abnormalities, muscle problems or GI issues. All this will be related to the thyroid. Allergies are worsened in underactive thyroid states. The TSH will come to a normal range within a few weeks (4-6 weeks) but that depends on the Eltroxin dose. A very rapid normalisation is usually not attempted. Cholesterol and triglycerides are very abnormal with such a thyroid state and sometimes may need to be treated. The cholesterol levels normalise on their own at times when the TSH normalises. I hope that was useful. Best Wishes.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Sujoy Khan (14 hours later)

thank you so much doctor for your kind review. My mother's blood test revealed serum creatinin value at 1.4, hemoglobin 11.5, sodium 143, potassium 5, uric acid 8.8, blood urea 83, alkaline phosphatase 186. she is bed ridden for 2 months now and keeps on vomiting most of the times when I try to feed her. She is having severe piles problem also as natural bowel clearance is not occurring regularly. Are all these due to higher TSH value only? Doctors say that arthritis does not cause vomiting and the endoscopy report was normal. Please suggest.

Answered by Dr. Sujoy Khan (30 minutes later)

Brief Answer: Renal function abnormal Detailed Answer: Hello, The renal function is abnormal, more pre-renal failure as Urea is 83, while the creatinine is just abnormal at 1.4 suggesting less intake (more fluid intake must), unless cardiac function is not good which would mean having an eye on how much she is taking. The uric acid is also high, that would need treatment to lower the levels. The vomiting could be due to abnormal renal function. The potassium is very high, that would need correction. Please discuss these urgently and hopefully she is admitted in a hospital now. These values can be made abnormal with a long standing severe underactive thyroid. Best Wishes.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Sujoy Khan (3 days later)

My mother's latest status is as follows: free T4 1.09, TSH 20, creatinine 1.4, Na+ 136, K+ 3.8, BUN 32.7 She is feeling better now with reduced TSH. But she is suffering from anus pain. Doctors have given ointment to use. Please suggest about the health conditions whether she can be operated upon now or not.

Answered by Dr. Sujoy Khan (2 hours later)

Brief Answer: Blood results much improved Detailed Answer: Hello, Of course the blood results (thyroid, electrolyte abnormalities) have much improved. A local anaesthetic ointment is enough for the pain, I would suppose. The BUN is good, so no requirement for renal support at this stage. If the hip joint operation is not URGENT, then a week or so would be enough for her to normalise the thyroid function (TSH near normal or normal), to prevent cardiac arrythmias perioperative. She must keep intake of fluids to maintain a positive balance with close consultation with Renal team. Best Wishes.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar