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High TPO in new very symptomatic patient. Advice for treatment? List for PCP?
Hey there, I'm the husband.
My wife was fine in July. Then in August, everything went to hell. She has a TON of symptoms - from weight to lack of energy to fluid retention.
We initially thought it was psychological, so we've been treating it like this since Aug with almost no changes. Horrible time it has been. After feeling defeated, I just started reading for hours and I wised up at some point that it could be a symptom and not just depression/suicidality. I thought maybe Estrogen Dominance.
A test of her Estrogen/Progesterone levels show a ratio of 12. The low end is 100 and the high end is 500. Hers was 12. Top top top end of scale for Estrogen and bottom low end of scale for Prog.
Before waiting two months to see a OBGYN, I researched the ED for hours and hours, frequently seeing ED caused by thyroid dysfunction. I thought the same thing as with the depression --- what if the ED is ALSO a symptom and not a cause.....
So I chased that one down, nagged the hell out of the doc, and got her to call in a full Thyroid panel for the wife. Bam. Got it. TPOA is supposed to be under 9UI/mL....it's 301.
So the biggest concern is the insane fatigue and depression she has. It's killing her. I worry about her snapping one of these days. I really do. She says she will tell me if it gets there, but she's sobbing just getting up out of bed some days after 14 hours in bed, then going down and sitting on the couch and falling asleep sitting up. It's scary and depressing for me too.
The reason why I post is we have one of those PCP docs that if you tell him you want something, he will most the time just do it. And while I would much rather get her in to see a specialist Endo, the three in network are booked solid until JULY !! So I'm not okay with just letting the wife suffer for five months waiting to see a specialist.
So MY QUESTION IS----What can we throw at this to start trying to narrow in on a treatment...at least at the level of the PCP so we can get her some relief (because we've tried every antidepressant in the book and none help)? My research says start with 15-30mg Armour (slowly stepping up) with of course exercise and diet positive changes. Most of her levels are fine except for TPOA is off the charts, but she is HIGHLY and DEBILITATINGLY symptomatic.
Happy to add info or labs if you need/ask. Appreciate the help.
My plan that I've created on my own up to this point lol was just to have PCP (A) give referral to Endo in July, (B) referral for ultrasound of thyroid, (C) start the Armour "exploratory" trial. (D) Already starting her on Centrum once a day, (E) Just ordered Selenium 200mcg 1xday and (F) just ordered Methyl B12 5000mcg 1xday.
Anything else? Does that sound great or terrible lol? Appreciate your help.
My wife was fine in July. Then in August, everything went to hell. She has a TON of symptoms - from weight to lack of energy to fluid retention.
We initially thought it was psychological, so we've been treating it like this since Aug with almost no changes. Horrible time it has been. After feeling defeated, I just started reading for hours and I wised up at some point that it could be a symptom and not just depression/suicidality. I thought maybe Estrogen Dominance.
A test of her Estrogen/Progesterone levels show a ratio of 12. The low end is 100 and the high end is 500. Hers was 12. Top top top end of scale for Estrogen and bottom low end of scale for Prog.
Before waiting two months to see a OBGYN, I researched the ED for hours and hours, frequently seeing ED caused by thyroid dysfunction. I thought the same thing as with the depression --- what if the ED is ALSO a symptom and not a cause.....
So I chased that one down, nagged the hell out of the doc, and got her to call in a full Thyroid panel for the wife. Bam. Got it. TPOA is supposed to be under 9UI/mL....it's 301.
So the biggest concern is the insane fatigue and depression she has. It's killing her. I worry about her snapping one of these days. I really do. She says she will tell me if it gets there, but she's sobbing just getting up out of bed some days after 14 hours in bed, then going down and sitting on the couch and falling asleep sitting up. It's scary and depressing for me too.
The reason why I post is we have one of those PCP docs that if you tell him you want something, he will most the time just do it. And while I would much rather get her in to see a specialist Endo, the three in network are booked solid until JULY !! So I'm not okay with just letting the wife suffer for five months waiting to see a specialist.
So MY QUESTION IS----What can we throw at this to start trying to narrow in on a treatment...at least at the level of the PCP so we can get her some relief (because we've tried every antidepressant in the book and none help)? My research says start with 15-30mg Armour (slowly stepping up) with of course exercise and diet positive changes. Most of her levels are fine except for TPOA is off the charts, but she is HIGHLY and DEBILITATINGLY symptomatic.
Happy to add info or labs if you need/ask. Appreciate the help.
My plan that I've created on my own up to this point lol was just to have PCP (A) give referral to Endo in July, (B) referral for ultrasound of thyroid, (C) start the Armour "exploratory" trial. (D) Already starting her on Centrum once a day, (E) Just ordered Selenium 200mcg 1xday and (F) just ordered Methyl B12 5000mcg 1xday.
Anything else? Does that sound great or terrible lol? Appreciate your help.
Responding to your list.
2A. Weight gain/difficult to lose weight. Hypothyroid patients typically have below normal Resting Metabolic Rate. The actual RMR depends on the severity of hypothyroidism. There is a company I know about that developed a test for tendon reflex time as a measure of a patient's thyroid status. It has been known for a long time that tendon reflex time correlated well with hypothyroid symptoms., but it was never utilized due to lack of reliable test equipment, I think. This company established a tendon reflex time threshold for euthyroidism. Patients that had a longer tendon reflex time and symptoms typical of hypothyroidism and relatively low FT4 and FT3 were treated as needed to achieve their recommended level of tendon reflex time. They reported that the change in RMR averaged about 400 calories per day. To assess the effect on a person you can use the formula for RMR, by which you could estimate that over an extended period, 400 calories per day increase would cause a female to lose 400 divided by 4.35, which is about 92 pounds, assuming that diet and exercise habits
went unchanged.
2B. I know of no reason that T3 would need to be added to the Armour for absorption. If the person was not getting an adequate effect, it was probably due to an inadequate dose, maybe because the dose was being determined by TSH levels, not by symptoms.
4A. the 10,000 dose of Vitamin D every day is way too much, so she had a reaction. If her D is as low as you mentioned, then I suggest 3000 IU daily and then re-test later. D needs to be at least 50 ng/mL. If not tested for B12 and ferritin it needs to be done and then supplemented to get B12 in the upper part of its range, and ferritin needs to be at least 100. Ferritin is important for conversion of T4 to T3 and low ferritin can cause symptoms. It is also necessary for good hair growth.
5. Yes, two Centrum tablets plus K2. I take 45 mcg of K2 daily.
6. I am sending you a PM with some doctor info. To access, just click on your name and then from your personal page click on messages.
2A. Weight gain/difficult to lose weight. Hypothyroid patients typically have below normal Resting Metabolic Rate. The actual RMR depends on the severity of hypothyroidism. There is a company I know about that developed a test for tendon reflex time as a measure of a patient's thyroid status. It has been known for a long time that tendon reflex time correlated well with hypothyroid symptoms., but it was never utilized due to lack of reliable test equipment, I think. This company established a tendon reflex time threshold for euthyroidism. Patients that had a longer tendon reflex time and symptoms typical of hypothyroidism and relatively low FT4 and FT3 were treated as needed to achieve their recommended level of tendon reflex time. They reported that the change in RMR averaged about 400 calories per day. To assess the effect on a person you can use the formula for RMR, by which you could estimate that over an extended period, 400 calories per day increase would cause a female to lose 400 divided by 4.35, which is about 92 pounds, assuming that diet and exercise habits
went unchanged.
2B. I know of no reason that T3 would need to be added to the Armour for absorption. If the person was not getting an adequate effect, it was probably due to an inadequate dose, maybe because the dose was being determined by TSH levels, not by symptoms.
4A. the 10,000 dose of Vitamin D every day is way too much, so she had a reaction. If her D is as low as you mentioned, then I suggest 3000 IU daily and then re-test later. D needs to be at least 50 ng/mL. If not tested for B12 and ferritin it needs to be done and then supplemented to get B12 in the upper part of its range, and ferritin needs to be at least 100. Ferritin is important for conversion of T4 to T3 and low ferritin can cause symptoms. It is also necessary for good hair growth.
5. Yes, two Centrum tablets plus K2. I take 45 mcg of K2 daily.
6. I am sending you a PM with some doctor info. To access, just click on your name and then from your personal page click on messages.
Thank you for your information. It is more informative than most of my doctors have been to be honest. So sad really, that so many doctors don't care enough to treat the person.
So far it's been a struggle. My PCP is completely useless. I (as the husband) see the same PCP. My wife has her three month appointment next week, so during my three month appointment this week, I explained everything I have explained in the last posts about Wife even though it was my appointment. I ran this by him to see if he was going to be of any help, and, if so, how much help he was going to be. I told him in the end that Wife is probably going to need
((A)) a referral to an ultrasound,
((B)) tests for D, B12, DHEA-S, and Ferritin, and,
((C)) start standard treatment for her many symptoms by prescribing 30mg of Armour/NDT.
((D)) I also told him I had ordered (out of my own pocket) a test for Diurnal Cortisol x4 (which arrived yesterday evening, will be administered Sunday, and will be shipped back on Monday (2/10/2020) to hopefully get results back by Friday (2/14/2020) and that she may need Hydrocortisone supplementation of 30mg-35mg evenly distributed throughout the day to treat those specifically applicable symptoms as well.
((E)) I also explained the TSH levels -- the old ones from 20 years ago (0.50-4.50), the new ones from the American Kidney Association found more accurate over the last 10 years (0.50-2.50), and the ones found best for Hashimoto's patients by reports where those with Autoimmune Thyroiditis have been found most symptom-free (0.50-1.00).
My PCP was absolutely worthless beyond belief. So said. He's 70-something years old and stuck in his old ways I believe. I believe mentally he's not there to forge any new roads or learn any new information or treat individuals more than just check three-month boxes of "I saw patient, will see in another 3 months, blah blah blah....". The answers were all bad...sigh....
This is what responses I got from him:
((A)) "A referral is best given by an endocrinologist" (even though I said it would be mid-May or June before I could get Wife into see one),
((B)) "Those tests have little impact and little to do with your thyroid...they are more promoted online for those 'natural rose petal extract anti-vax naturalist PAs who really have no business prescribing anything most the time with their snake-oil ideas (while laughing off my idea)." (This is even though I explained I read Mayo Clinic studies where incorrect levels of some of them produced hyper- and hypo-thyroid symptoms).
((C)) "If her TSH is within range, prescribing her needless hormones could kill her...bad idea....." (I don't believe that for a sec...in fact lol, I may have irritated him at that point because I made a passing comment about how "if the depression and anxiety of not being treated doesn't kill her first.").
CONTINUED (ONE OF TWO POSTS)
So far it's been a struggle. My PCP is completely useless. I (as the husband) see the same PCP. My wife has her three month appointment next week, so during my three month appointment this week, I explained everything I have explained in the last posts about Wife even though it was my appointment. I ran this by him to see if he was going to be of any help, and, if so, how much help he was going to be. I told him in the end that Wife is probably going to need
((A)) a referral to an ultrasound,
((B)) tests for D, B12, DHEA-S, and Ferritin, and,
((C)) start standard treatment for her many symptoms by prescribing 30mg of Armour/NDT.
((D)) I also told him I had ordered (out of my own pocket) a test for Diurnal Cortisol x4 (which arrived yesterday evening, will be administered Sunday, and will be shipped back on Monday (2/10/2020) to hopefully get results back by Friday (2/14/2020) and that she may need Hydrocortisone supplementation of 30mg-35mg evenly distributed throughout the day to treat those specifically applicable symptoms as well.
((E)) I also explained the TSH levels -- the old ones from 20 years ago (0.50-4.50), the new ones from the American Kidney Association found more accurate over the last 10 years (0.50-2.50), and the ones found best for Hashimoto's patients by reports where those with Autoimmune Thyroiditis have been found most symptom-free (0.50-1.00).
My PCP was absolutely worthless beyond belief. So said. He's 70-something years old and stuck in his old ways I believe. I believe mentally he's not there to forge any new roads or learn any new information or treat individuals more than just check three-month boxes of "I saw patient, will see in another 3 months, blah blah blah....". The answers were all bad...sigh....
This is what responses I got from him:
((A)) "A referral is best given by an endocrinologist" (even though I said it would be mid-May or June before I could get Wife into see one),
((B)) "Those tests have little impact and little to do with your thyroid...they are more promoted online for those 'natural rose petal extract anti-vax naturalist PAs who really have no business prescribing anything most the time with their snake-oil ideas (while laughing off my idea)." (This is even though I explained I read Mayo Clinic studies where incorrect levels of some of them produced hyper- and hypo-thyroid symptoms).
((C)) "If her TSH is within range, prescribing her needless hormones could kill her...bad idea....." (I don't believe that for a sec...in fact lol, I may have irritated him at that point because I made a passing comment about how "if the depression and anxiety of not being treated doesn't kill her first.").
CONTINUED (ONE OF TWO POSTS)
((D)) "Not to offend you, but you wasted your money. I can call you in a Cortisol test [note: the total 'one-shot' that you spoke of earlier]." When I explained it was a FOUR panel "over the day" test, he said, "Those are just so labs make more money. If your Cortisol levels in the morning are within range, they won't deviate much over the day and won't cause symptoms for the most part." (another truckload of dismissive BS I don't believe...so sad).
((E)) "The 'old' TSH levels (-4.50) are fine. The American Kidney Association or whoever said 2.5 is a better upper level probably found one study and is trying to trailblaze to attempt to remain relevant or promote membership. I've found that even higher levels - like I have patients at a 6 or a 7...even a 9 - don't necessarily mean that anything needs to be done, but that's why as SOON as I see your antibodies are higher than where they should be, I just refer you out to an endocrinologist and let him deal with all that junk." (So not only does he not believe in the "new" 2.50 levels, and as well does not believe in the Hashimoto's preferred ranges of 0.50-1.0, he seems like he doesn't even want to bother with making his patients feel better at all in any form, and it doesn't bother him that a patient he's treated for almost a decade will suffer severely for months waiting to see an endocrinologist. I even told him that "she's really really really bad off, doc, and it can't really get any worse to be honest. At least we could throw a little something at it and see if we can get something...anything...positive out of it" and his response was, "I'm not throwing anything at it because when the endo does his own TSH blood tests, what I prescribe is going to alter that result". My only protest was, "But an experienced endocrinologist is going to know if you are supplementing with..say..30mg Armour...what that will do to the tests and they can factor that in...and that's IF they even WANT to do their own tests...because we just did the TSH and all the T's and TPOab and everything just last week and that should work at least for a basic generic start point, shouldn't it?" And his response was, "I don't know what they want to do, so that's why I just let them do their thing and I stay out of it." Obviously, ZERO interest in helping treat his patient.
I returned home from my appointment and told my wife to cancel her three-month appointment next week and not to pay that lazy-arse "doctor" anything.
So I called the Psychiatrist that my wife has been seeing for the past few months (this is the one that is much younger and seems to be more open-minded, but only to a certain point it seems, but much much better than old-arse PCP guy). She's the one that I initially explained a month ago that we have thrown multiple antidepressants at this thing and they have little to no effect and I'm starting to think there may be something else at play, so I want to explore other options. She has been more than helpful, and I have called her nurse every week with new ideas from my research and she has called in tests based on my requests, which is what led me to/allowed me to pull Estrogen/Progesterone levels and find them WAY off (Estrogen dominance by a factor of nearly 10), and then, through more research, led me to/allowed me to pull TPOab and find Wife's levels at just above 30-times the normal level of TPOAb. Without the flexibility and her open-mindedness, I wouldn't be as far as I am now, so I like her a lot more.
So I explained to the Psych the above info. (Note: I should mention that when I say "I talked to the Psych", the Psych doesn't actually talk directly to patients on the phone. She's busy seeing patients and she has her Nurse (PA I think)...we will call her "Brandy"....field all of her patient calls and pass the info onto her (her as in Psych gal). It makes sense and I would probably do it that way too. So when I say "I talked to the Psych, I actually talked to Brandy FYI and so there is an assumption that Brandy spoke with Psych and told her the same thing I said to Brandy.") I had not yet talked to the PCP, so none of the PCP encounter was included. I just explained to Brandy about the list of things needing to be done to continue honing in on this problem (which was the list in yours/my post of things to get done).
These were Brandy's responses:
((A)) "Yes, I will tell Psych to refer her for an ultrasound. No problem."
((B)) (Admittedly, I was driving at the time Brandy called me back (on Thurs of this week) and I didn't have the list of important stuff to talk about in front of me. So I forgot to mention the D/B12/DHEA-S/Ferritin tests. I will call her back on Monday and whenever she returns my call, I will ask and find out what she says when I ask her to run these.)
((C)) "As far as I know, Psych is not specifically knowledgeable about thyroid disorders and may not want to prescribe anything for this. She may want to wait until you see a specialist. (I told her the standard treatment is start 30mg of Armour/NDT.) I will ask her if she wants to do this and call you back. She may just want to refer you out to an endocrinologist, even though it will take two months for you to get in the door to see one."
((D)) (I told Brandy that I'd ordered a Cortisolx4 test from a lab to see if Wife needed to be prescribed 30-35mg of Hydrocortisone per day because of the symptoms that were hypocortisol-related.) "Okay, I'll let her know."
((E)) (I didn't talk to her about this because it wasn't relevant at the time.)
TWO OF TWO POSTS. ONE MORE OF THOUGHTS MOVING FORWARD....
((E)) "The 'old' TSH levels (-4.50) are fine. The American Kidney Association or whoever said 2.5 is a better upper level probably found one study and is trying to trailblaze to attempt to remain relevant or promote membership. I've found that even higher levels - like I have patients at a 6 or a 7...even a 9 - don't necessarily mean that anything needs to be done, but that's why as SOON as I see your antibodies are higher than where they should be, I just refer you out to an endocrinologist and let him deal with all that junk." (So not only does he not believe in the "new" 2.50 levels, and as well does not believe in the Hashimoto's preferred ranges of 0.50-1.0, he seems like he doesn't even want to bother with making his patients feel better at all in any form, and it doesn't bother him that a patient he's treated for almost a decade will suffer severely for months waiting to see an endocrinologist. I even told him that "she's really really really bad off, doc, and it can't really get any worse to be honest. At least we could throw a little something at it and see if we can get something...anything...positive out of it" and his response was, "I'm not throwing anything at it because when the endo does his own TSH blood tests, what I prescribe is going to alter that result". My only protest was, "But an experienced endocrinologist is going to know if you are supplementing with..say..30mg Armour...what that will do to the tests and they can factor that in...and that's IF they even WANT to do their own tests...because we just did the TSH and all the T's and TPOab and everything just last week and that should work at least for a basic generic start point, shouldn't it?" And his response was, "I don't know what they want to do, so that's why I just let them do their thing and I stay out of it." Obviously, ZERO interest in helping treat his patient.
I returned home from my appointment and told my wife to cancel her three-month appointment next week and not to pay that lazy-arse "doctor" anything.
So I called the Psychiatrist that my wife has been seeing for the past few months (this is the one that is much younger and seems to be more open-minded, but only to a certain point it seems, but much much better than old-arse PCP guy). She's the one that I initially explained a month ago that we have thrown multiple antidepressants at this thing and they have little to no effect and I'm starting to think there may be something else at play, so I want to explore other options. She has been more than helpful, and I have called her nurse every week with new ideas from my research and she has called in tests based on my requests, which is what led me to/allowed me to pull Estrogen/Progesterone levels and find them WAY off (Estrogen dominance by a factor of nearly 10), and then, through more research, led me to/allowed me to pull TPOab and find Wife's levels at just above 30-times the normal level of TPOAb. Without the flexibility and her open-mindedness, I wouldn't be as far as I am now, so I like her a lot more.
So I explained to the Psych the above info. (Note: I should mention that when I say "I talked to the Psych", the Psych doesn't actually talk directly to patients on the phone. She's busy seeing patients and she has her Nurse (PA I think)...we will call her "Brandy"....field all of her patient calls and pass the info onto her (her as in Psych gal). It makes sense and I would probably do it that way too. So when I say "I talked to the Psych, I actually talked to Brandy FYI and so there is an assumption that Brandy spoke with Psych and told her the same thing I said to Brandy.") I had not yet talked to the PCP, so none of the PCP encounter was included. I just explained to Brandy about the list of things needing to be done to continue honing in on this problem (which was the list in yours/my post of things to get done).
These were Brandy's responses:
((A)) "Yes, I will tell Psych to refer her for an ultrasound. No problem."
((B)) (Admittedly, I was driving at the time Brandy called me back (on Thurs of this week) and I didn't have the list of important stuff to talk about in front of me. So I forgot to mention the D/B12/DHEA-S/Ferritin tests. I will call her back on Monday and whenever she returns my call, I will ask and find out what she says when I ask her to run these.)
((C)) "As far as I know, Psych is not specifically knowledgeable about thyroid disorders and may not want to prescribe anything for this. She may want to wait until you see a specialist. (I told her the standard treatment is start 30mg of Armour/NDT.) I will ask her if she wants to do this and call you back. She may just want to refer you out to an endocrinologist, even though it will take two months for you to get in the door to see one."
((D)) (I told Brandy that I'd ordered a Cortisolx4 test from a lab to see if Wife needed to be prescribed 30-35mg of Hydrocortisone per day because of the symptoms that were hypocortisol-related.) "Okay, I'll let her know."
((E)) (I didn't talk to her about this because it wasn't relevant at the time.)
TWO OF TWO POSTS. ONE MORE OF THOUGHTS MOVING FORWARD....
So....thoughts and actions moving forward:
((1)) I hopefully will have the Cortisol test results by this time next week. Looking forward to knowing, and, as always, appreciate the assistance immensely.
((2)) I am not surprised at all at the "old" PCP's behavior. He's been borderline useless for a while, so I should not have been surprised at all.
((3)) I am, however, surprised at the "new" gal's - the Psych's - behavior, or at least her nurse's behavior. We will see if the Psych's behavior mirrors the nurse's sentiments she expressed over the phone. Hoping the Psych is not yet another doc who is too skittish and/or too ignorant to treat symptoms and not labs.....I will be VERY disappointed if the Psych ends up being another one like this. I had hopes she was going to be different.
((4)) Of the two people you recommended, one does not take insurance. If it comes down to it, I can afford this, but I'd rather not if possible. The Family Medicine gal DOES take my insurance (BCBSOK), so I plan to call her this coming week. I'm hoping it isn't a two-month wait to get in to see her. It also worries me she's a "Family Medicine" specialist and not sure if she will also try to boot me over to an endo.
((5)) I'm wondering if I'd be better off, at least for the immediate future to get Wife at least SOME relief, going to a place like "Balance Hormone Center in Norman, Oklahoma" (They have a website here: https://www.balancehormoneoklahoma.com/). I've called them and talked with them. They are all cash/no insurance (ewww) but I have a feeling they will do more the way Wife and I want done if we are paying out cash. I'm wondering if we need to go to one of these "naturalist-type" places in order to get the out-of-the-box thinking that you have and we need. The "doc" is just a PA, not any type of a specialist, which is somewhat of a worry, but it does seem to be one of those places that treats the person, not the lab numbers.
((6)) Wife's Psych's husband is a PCP at the same office as Psych. I told Wife to at least go see him. He's 40-something first of all not 70-something LOL, and he may be more willing to play with numbers and treatments than old PCP guy. Waiting for a call-back next week for an appt time and date.
So that's what's been going on at least on my end. More to follow as I get it. As always, appreciate the help and guidance so far.
((1)) I hopefully will have the Cortisol test results by this time next week. Looking forward to knowing, and, as always, appreciate the assistance immensely.
((2)) I am not surprised at all at the "old" PCP's behavior. He's been borderline useless for a while, so I should not have been surprised at all.
((3)) I am, however, surprised at the "new" gal's - the Psych's - behavior, or at least her nurse's behavior. We will see if the Psych's behavior mirrors the nurse's sentiments she expressed over the phone. Hoping the Psych is not yet another doc who is too skittish and/or too ignorant to treat symptoms and not labs.....I will be VERY disappointed if the Psych ends up being another one like this. I had hopes she was going to be different.
((4)) Of the two people you recommended, one does not take insurance. If it comes down to it, I can afford this, but I'd rather not if possible. The Family Medicine gal DOES take my insurance (BCBSOK), so I plan to call her this coming week. I'm hoping it isn't a two-month wait to get in to see her. It also worries me she's a "Family Medicine" specialist and not sure if she will also try to boot me over to an endo.
((5)) I'm wondering if I'd be better off, at least for the immediate future to get Wife at least SOME relief, going to a place like "Balance Hormone Center in Norman, Oklahoma" (They have a website here: https://www.balancehormoneoklahoma.com/). I've called them and talked with them. They are all cash/no insurance (ewww) but I have a feeling they will do more the way Wife and I want done if we are paying out cash. I'm wondering if we need to go to one of these "naturalist-type" places in order to get the out-of-the-box thinking that you have and we need. The "doc" is just a PA, not any type of a specialist, which is somewhat of a worry, but it does seem to be one of those places that treats the person, not the lab numbers.
((6)) Wife's Psych's husband is a PCP at the same office as Psych. I told Wife to at least go see him. He's 40-something first of all not 70-something LOL, and he may be more willing to play with numbers and treatments than old PCP guy. Waiting for a call-back next week for an appt time and date.
So that's what's been going on at least on my end. More to follow as I get it. As always, appreciate the help and guidance so far.
It is good that you have taken the initiative to get her saliva cortisol tests done. That will give useful info to better understand her situation. It is also very important that she get tested for Vitamin D, B12, DHEA-S and ferritin. I would try to get those done anywhere you can: the psych or wherever possible.
In view of how badly she feels, and the confirmed hypothyroidism, I think you should go ahead and get her started on Armour, if possible.
I suggest that you go ahead and try to get an appt. with the doctor that takes insurance. Just in case it becomes necessary I would also ask if the doctor treats patients with low cortisol. I would also explain just how bad your wife is feeling and say that she needs to see the doctor ASAP, and also ask about getting on their appointment cancellation list.
I would not bother with any Endo for which you did not have assurance of clinical treatment for hypothyroidism, instead of just based on TSH. Also would want to know about treatment of low cortisol, if that becomes necessary. Many doctors don't want to handle low cortisol issues. To help with your understanding about the need for clinical treatment, I suggest that you click on my name and then scroll down to my Journal and read at least the Overview to my paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.
In view of how badly she feels, and the confirmed hypothyroidism, I think you should go ahead and get her started on Armour, if possible.
I suggest that you go ahead and try to get an appt. with the doctor that takes insurance. Just in case it becomes necessary I would also ask if the doctor treats patients with low cortisol. I would also explain just how bad your wife is feeling and say that she needs to see the doctor ASAP, and also ask about getting on their appointment cancellation list.
I would not bother with any Endo for which you did not have assurance of clinical treatment for hypothyroidism, instead of just based on TSH. Also would want to know about treatment of low cortisol, if that becomes necessary. Many doctors don't want to handle low cortisol issues. To help with your understanding about the need for clinical treatment, I suggest that you click on my name and then scroll down to my Journal and read at least the Overview to my paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.
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Hey Gimel,
There is more to update, but it has been a long day and it is almost one am where I am. I will update more info later, but for now, the Cortisol Test came in. I will jump on here sometime tomorrow and update you with the other info...nothing spectabular or highly relevant, just stuff that has occured and looking for your judgement on what to do next or if something should be done to begin with....you know what I mean hopefully....:)
Without having yet started to research via Google, I don't know what I'm looking at or what to tell a doc to convince him if and or how much hydro-cortisone to supplement. I figure I'd let you get first crack at it fresh from coming in about three hours ago via email. Here's a link to the test results:
https://drive.google.com/file/d/1hGY0FPwBxLxOocvsVmP2thotw7f8kxCC/view?usp=sharing
As always, thank you for your assistance. :)
There is more to update, but it has been a long day and it is almost one am where I am. I will update more info later, but for now, the Cortisol Test came in. I will jump on here sometime tomorrow and update you with the other info...nothing spectabular or highly relevant, just stuff that has occured and looking for your judgement on what to do next or if something should be done to begin with....you know what I mean hopefully....:)
Without having yet started to research via Google, I don't know what I'm looking at or what to tell a doc to convince him if and or how much hydro-cortisone to supplement. I figure I'd let you get first crack at it fresh from coming in about three hours ago via email. Here's a link to the test results:
https://drive.google.com/file/d/1hGY0FPwBxLxOocvsVmP2thotw7f8kxCC/view?usp=sharing
As always, thank you for your assistance. :)
Hey Gimel,
There is more to update, but it has been a long day and it is almost one am where I am. I will update more info later, but for now, the Cortisol Test came in. I will jump on here sometime tomorrow and update you with the other info...nothing spectabular or highly relevant, just stuff that has occured and looking for your judgement on what to do next or if something should be done to begin with....you know what I mean hopefully....:)
Without having yet started to research via Google, I don't know what I'm looking at or what to tell a doc to convince him if and or how much hydro-cortisone to supplement. I figure I'd let you get first crack at it fresh from coming in about three hours ago via email. Here's a link to the test results:
https://drive.google.com/file/d/1hGY0FPwBxLxOocvsVmP2thotw7f8kxCC/view?usp=sharing
As always, thank you for your assistance. :)
There is more to update, but it has been a long day and it is almost one am where I am. I will update more info later, but for now, the Cortisol Test came in. I will jump on here sometime tomorrow and update you with the other info...nothing spectabular or highly relevant, just stuff that has occured and looking for your judgement on what to do next or if something should be done to begin with....you know what I mean hopefully....:)
Without having yet started to research via Google, I don't know what I'm looking at or what to tell a doc to convince him if and or how much hydro-cortisone to supplement. I figure I'd let you get first crack at it fresh from coming in about three hours ago via email. Here's a link to the test results:
https://drive.google.com/file/d/1hGY0FPwBxLxOocvsVmP2thotw7f8kxCC/view?usp=sharing
As always, thank you for your assistance. :)
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