How do you approach persistent fatigue in a patient after thyroidectomy whose TSH is within the target range, given that fatigue affects the majority of thyroidectomy patients yet its underlying mechanisms remain poorly understood?

How do you approach persistent fatigue in a patient after thyroidectomy whose TSH is within the target range?

• I investigate alternative causes of fatigue such as iron deficiency, sleep apnea, or mood disorders before attributing it to thyroid status
• I adjust the LT4 dose to target the lower end of the normal TSH range
• I consider combination T3/T4 therapy in select patients with debilitating fatigue, low T3 levels, and no contraindications
• I reassess at 6-12 months post-thyroidectomy rather than earlier visits, as fatigue often improves with time
• I refer for psychological support or fatigue management given the poorly understood mechanisms underlying post-thyroidectomy fatigue
• Other