Thyroid

[Brooksie16]

i have Hashimotos Disease and am on .75 mcg of synthroid.  I have been on meds for about 4 yr.  I started with .25 then upped to .50 and now for about a year or more on .75.  The problem is I still have all the symptoms of hypothyroid; leg cramps @ night, dry skin, constipation, chronic dry eyes, brittle weak fingernails, thinning hair, no hair on arms, underarms & outside of eyebrows, fatique, no sex drive, slow pulse, low blood pressure. If the meds do not help the symptoms why even take?

[gimel]

I agree with Barb about your D.O. checking your FT3 and FT4.  Why wait for 3 months and possibly be disappointed with the Endo.  Just because a doctor is an Endo does not mean that he is automatically a good thyroid doctor.  Many specialize in diabetes, not thyroid.  Many of them have the " Immaculate TSH Belief' and will tell you that TSH is all they need to know.  This is very wrong.  Others use "Reference range Endocrinology" and will tell you that a thyroid test result that falls anywhere within the range is adequate.  This is also very wrong.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can get some good insight into the type of treatment you need from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance.  The letter is sent to the PCP of the patient to help guide treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf

Perhaps if you gave a copy to your D. O., he might be more comfortable with doing the Free T3 and Free T4 tests and treating you clinically.

[Brooksie16]

The DO who is a terrific dr. said he had not really been trained to check anything but total TSH and felt like I would be better taken care of if I saw an Endo. That he would know exactly what all needed and felt like he would run a thorough bloodwork.  But I think my DO  may be wrong!

[Barb135]

Why couldn't your D.O check the FT3 and FT4?  

3 months is a long time to be miserable and if he still refuses, you're going to have another wait to get into a different doctor.

The doctor can often tell by palpating your thyroid, rather or not the nodules have grown or if the thyroid is swollen.  Many of us with Hashi's nodules and they are no concern.  

[Brooksie16]

Yes, I told him the reason my regular DO dr. sent me to him was so that he could check T3 and T4 plus other bloodwork that may need to be done.  I told him my DO said he was really only trained to check total TSH.  The endo then told me there was no need to check anything except total TSH.  I was really disappointed in him even though he did have a good personality and spend time with me.  I am supposed to go back in 3 months and I think I am going to ask him again and give him another opportunity to do better and if he still doesn't want to run any other blood work I will look elsewhere for another dr.  He did tell me I did not have to have an ultrasound on my thyroid every year even though I have nodules.  I told him my regular dr ordered to make sure they weren't growing.  He said there is no need to have another scan.

[Barb135]

Sometimes, doctors won't test Free T3 and Free T4, but if you get them tested and have them in hand when you see the doctor (or talk to him), he will pay more attention. It also tells the doctor that you willing to advocate for yourself and do what's necessary to feel well.  Did you ask, either your pcp or endo to test FT3 and FT4?  Some doctors will do it, if asked; others simply refuse, no matter what.  Those are the ones who need to be kicked to the curb.  Had one like that; did that.......

The website flyingfool is referring to, is healthcheckusa.com.  You order the tests, they send you a lab order and tell you what lab to go to, in your area.  Within a couple days, you have the results.  I've done this myself, between testings.  As flyingfool said - having those results, will tell you if you are still hypo and need to find a different doctor, or if you have some other issue.

Hashimoto's is the most common cause of hypothyroidism in the developed world, so that's probably why your endo "assumed" that you have it.  

[flyingfool]

The healthcheck will tell you where the nearest lab is to draw the blood.

The Dr may or may not write a scrip. But YOU will have the knowledge and YOU will then or may then have evidence to show that your Free T's may be whacked despite what the useless TSH says!

YOU will also know that the Dr is useless and thus YOU will know that you need to go to a Dr who WILL look at those results and test for those in the future.

YOU will also know how different dosages affect your blood levels.

Since the Dr's won't do it, or at least some Dr's won't if YOU want to feel well YOU might have to just do it for yourself.

If on the other hand your Free T4 are mid range and Free T3 is upper 1/3 of the range, then you know you have another issue.  But this is valuable information.

If the Dr still fails to test you. You must ask yourself why he will keep going to see you and charge several hundred dollars a visit instead of just testing you for an $85 test.  Who is he looking out for, yours or his bottom line????

[Brooksie16]

If you order your own tests where do you go for the bloodwork?  And after you get the results if you do not have a dr. who will prescribe anything from the results of this bloodwork aren't you just out the $85.00 plus your all the other you've already been out trying to find a dr. who will help you.  I know there has got to be a dr. somewhere in the area I live who will go by your symptoms and not just total TSH.  I have looked on the internet but have not been able to find one.

[flyingfool]

if you do not get tested for Free T4 and Free T3 the Dr's will almost assuredly keep you not feeling well.  Unless they are simply luck and happen to hit upon the right dose.  Usually however they will keep you on a roller coaster ride of hell continually adjusting your meds up and down.

TSH is just short of worthless and is NOT accurate enough to accurately adjust your medication.  All recent research points this out but Dr's and the medical profession is slow to adapt.

If you have to go to healthcheck.com and order your own lab tests.  Costs $85 or so and you get TSH, FT3 and FT4.  Then you will have this information for yourself.  It is a shame it has to come to that at times.

My suggestion would be to try to find a new Dr.

[Brooksie16]

My endo called yesterday and said my total TSH was 1.36 which is down from 3.25 when I tested in January.  He says I have Hashimotos Disease, but I don't know how he knows other than feeling of my neck area and letting me know my thyroid was very small.  I do have nodules on thyroid, and did have an ultrasound once a year, but he said there wasn't any need to have this anymore. When he called yesterday he told me to say on the .75 of synthyroid and come back in July.  The trip to the endo in April was my first time to see him.  I have been treated by my DO dr. Who also only tests for total TSH.  He sent me to the endo because my TSH does go up and down and will not stay down below 2.  He thought he might be able to help me.  I was very disappointed.  I did ask the nurse while I was at his office did he treat thyroid because all I saw in his office was about diabetes.

[flyingfool]

You are not taking enough. You sound severely undermedicated.

You really need to have blood tests and please post the lab results here.

The key thyroid things to have tested are:

TSH

FREE T4 hormone ( NOT total T4 but "free T4)
FREE T3 hormone (again not Total but free)

Many people who are hypo are also tend to be low in the follwoing and it would make sense to be tested for:

Vitamin D
Vit B-12
Iron
Ferritin
Selenium

The T4 medication you are taking takes about 6 weeks to stabilize in your blood. Symptoms some times can lag blood levels as well. The point is that you need to wait about 6 weeks between each medication dosage change to determine what response you are having. And do NOT expect that symptoms will be alleviated in a few days.  This is a painfully slow process to get right a lot of times.

You may also want to find out if you are Hypo because of an autoimmune condition.  Hashimoto's is the most common reason for being Hypo.  You can  have this tested by testing for the two antibodies.  These are TPOab and TGab.  If they show a significant elevation above the upper part of the range it would indicate that you have Hashi's.  This is a progressive disease where your immune system slowly (or not so slowly) destroys your Thyroid glands ability to produce thyroid  hormone. What this means is that you need to continue to be tested to keep adjusting the medication dosage to make up for the loss of hormone from your thyroid gland.

Most people to feel well need to have the following two conditions met.  Everyone is different but this is a MUCH better target to shoot for than simply being somewhere within the so called normal or reference range.

People to feel well need:

1) Free T4 to be at least in the MIDDLE of the range or slightly higher.

AND (That means in addition to)

2) Free T3 to be in the UPPER 1/3 of the range.

Simply being within range means almost nothing.  you need to be well into the so called normal range for many people to feel well.

With your symptoms I would guess that you are well below those levels and very low in the ranges.