I agree. I did not mean to imply that you should focus on D, B12 and ferritin to the exclusion of her thyroid levels. Those are the most important.
As far as the remaining labs of Ferritin, DHEA-S, and Vitamin B12, I feel it is more expedient and cost-effective enough to purchase these tests online and less aggravating than fighting the docs. I found walkinlab *******, who allowed me to order online and walk into a Quest/DLO center nearby (same one I go to every time I get tests from my PCP in fact). These folks had A WHOLE BUNCH MORE available tests than ZRTLabs. Easier to search for the right ones too. Faster because no shipping needed to and from. Cheaper by a little bit too....maybe 20%. I'll let you know what my experience is like, however.
As far as the Vitamin D goes, it was just tested a month ago and the level was at 19. I have currently supplemented her with 5000u 1xday. I will probably wait on the Vitamin D one (it's $50 all by itself) and since it was just tested, it and not having to ship it to me and back again is much quicker as well.
I may just wait until they test Vitamin D again via PCP. I do not believe a suboptimal level of D would cause the majority of symptoms. It may still be suboptimally low, but I don't think it would be horribly low........since it is a 19 + 5000u a day equals 60-80? - bad D level would cause all these problems. I'm sure it may still need to be fine-tuned, but I'm focused on the bigger stuff first. If I'm completely wrong, then tell me. I don't think I know it all LOL....I'm just trying to be efficient here. Your feedback is always appreciated.
Thanks for the update.
I think metabolic syndrome is a label they use for weight issues, rather than focusing on the most important part of that, which is low metabolism related to low Free T3 and Free T4 levels. There is also a need to test for Reverse T3 along with the Free T3 so that the ratio can be determined. If I haven't mentioned it there is a company that makes equipment to test for tendon reflex time, since it is a well known indicator of thyroid status. That company claims that the difference between severe hypothyroidism and euthyroidism after effective treatment averages about 400 calories per day in the Resting Metabolic Rate. That amount of increase in RMR would result in a huge weight loss over time.
The Vitamin D B12 and ferritin also have a significant effect on thyroid and symptoms.
Please let us know if you are able to get her in to see that doctor soon.
Hey Gimel, thanks for the reply.
I did call the new PCP two days ago and asked him how long he sees he needs to wait on 25mcg of Levo before he decides to do something else given no change in symptoms.
He did state that the literature says it takes 6 weeks for levels to stabilize (and this is reflected in my googling, so he's not completely wrong, but I know how literature and real-life can differ). So I pressed him for an increase in 2-4 weeks (she's been on it for about 9 days now). He said, "We pulled her labs about 9-10 days ago (two weeks now), so we will probably pull her labs 8 weeks from that time (eta about the middle of April) and see where her levels are at. They are technically normal now, but her normal may not be everyone else's normal, and that's why she's having symptoms. I'm cognizant of that normal means different things to each person. That's why I started her on the thyroid meds, to see if it treats the symptoms." So he's kinda sorta saying what I wanted to hear and kinda not. Very wishy washy. And I don't like the 8 week wait for another 25mcg....
Not the detail you suggested though. I will follow up when I see him next. I think there is an appointment scheduled for like 9 days from now.
I also asked him about the Vitamin D, B12, DHEA-S, and Ferritin. He said, "I prefer to focus on the larger more likely issues, such as the diabetes and the excessive weight. I believe she is suffering from metabolic syndrome and that's a lot of why the Metformin should start helping her. Once we get those under control and get at least some Levo into her, and if then we are still not seeing the differences we would expect, then I will go hunting for the little obscure things that may be causing it." I don't like the response, but that's what he said.
We have an appointment with an OBGYN specialist on Tuesday, March 3rd, to discuss the estrogen dominance.
Of the two people you suggested, the one in Edmond (I think off the top of my head) takes no insurance. So not a good thing for us. I did call and verify and yea, he doesn't. It was like $150.00 to do initial appt plus $200-$300 for blood work....already more than I can really afford or honestly want to spend. The other one, the gal in Midwest/Del City, does take Blue Cross/Blue Shield of Oklahoma, and we have a call into her for an appointment to be scheduled.
As always, appreciate the help and guidance. We are both following what you say pretty damn close to the letter. If only it was easier to find docs worth a crap or that could be questioned as to what they will or won't do before making and waiting for appts to come up......
The saliva cortisol test results do not confirm any concern. So I suggest that you proceed to make sure she gets the additional tests done: Vitamin D, B12, DHEA-S and ferritin. Also have you followed up on one of the doctors I suggested in the PM? I think you can have much more confidence in that doctor.
Your wife needs to continue to increase her thyroid med, with the objective of symptom relief. That will likely require a number of dosage increases to get her FT3 high enough, which is difficult with T4 med only. I suggest that you ask her doctor if he is willing to increase her dosage enough to relieve hypo symptoms without being influenced by resultant TSH levels. Also ask if he is willing to prescribe T3 med if needed to get Free T3 levels into the upper half of its range. If the answer to either is no, then you are wasting your time there. Also ask the doctor about the high estrogen. If the doctor agrees it is too high I understand it can be reduced with very small amounts of a prescription med called Anastrozole.
Thanks for your info, K9, really appreciate it.
No, I cannot think of anything that occurred then that would have triggered it. Nothing. We've seen the correlation before now, and both of us have searched our minds. Never come up with a single thing. No clue.
She's got diabetes and PCOS. The diabetes appeared in August and we assumed it was caused by the Hashimotos. She's had PCOS her whole life, diagnosed at 14 I believe....may have been 15.....never caused any symptoms except crazy periods her whole life.
The new PCP we have put her on 25mcg 1xday of Levothyroxine for Hashimotos, 1000mg 2xday Metformin for diabetes, 5000u 1xday of D3 since her D was low, 375g 1day of Phentermine for weight loss, and 1000mg 2xday fish oil for slightly elevated triglycerides.
She's been on this new regimen for a week with zero improvement.