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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.
Has she been tested for diabetes and PCOS? Diabetes and PCOS can both accompany hypothyroidism or Hashimoto's. She could have PCOS even if she doesn't have unusual body hair growth. Has she been tested for sleep apnea? Weight gain can cause sleep apnea, or sleep apnea can cause weight gain. Sleep apnea and sleep disturbance deprives the brain of oxygen, and that can cause many of the symptoms you say she has. The fatigue, inability to cope with stress, cognitive dysfunction, depression, anxiety, irritability, mental fog/poor concentration, aches and pains.
Wow! You are such an amazing husband to be such a wonderful health and medical advocate for your wife! If only more husbands were like you. Your interest in thyroid knowledge is impressive. If I understand correctly, your wife was totally fine in July and had all of her symptoms start in August? It sounds like something might have suddenly trigger her immune system. Can you think of anything in the months previous to August that might have triggered her immune system? Does she have allergies to pollen, plants, animals, or food? Has she had any recent illnesses? If you can determine if there is any trigger of her immune system that could be removed from her environment, this might help her to feel better.
I have Hashimoto's too. I second what Gimmel said about not bothering with an endocrinologist. They will only make her worse if she followed their advice. How about going to an naturopath or someone similar?
I know that 300 TPO sounds high and alarming. If it's any reassurance, the level of antibodies do not exactly always correlate with the severity of symptoms. If they did, then when my TPO has been 20-25 times higher than your wife's, I would not be alive. When my TPO was in the upper half of 5 figures, my TSH was 0.090, FT3 was 4.0, and my FT4 was1.35. I am a thin person with Hashimoto's. Now, when my TSH was very high, my FT3 and FT4 were very low, and I gained 10 lbs until I got my medication sorted. I also do not have the more common low DHEA-s, mine is over range. I'd say on an average my TPO is around 1,500, and that is with me having no hypo symptoms. It's been slightly under 1000 several times, but not for long because something always triggers it to go up to around 1,500 again.This disease definitely effects everyone differently.
Another thing that I can say about selenium (frequently taken with vitamin E because they have a synergistic effect) is that it does not definitely reduce antibodies, at least not in my years of experience in taking it. I have been on 200 mcg selenium every day and still had antibodies at several thousand. Who knows, maybe it would be even high if I wasn't taking selenium at that time. There are a few studies out there that have shown selenium taken with inositol reduces antibodies. I'm not sure if there are positive studies done on selenium by itself.
Your wife's symptoms are mainly caused by FT3 and FT4 that are not at her best level. That will take finding the right dosage of the right medicine. She might not have a good reaction to NDT since she has Hashimoto's and some Hashimoto's patients cannot take it. They take Synthyroid and Cytomel, or generic T4 and T3 instead.
I have Hashimoto's too. I second what Gimmel said about not bothering with an endocrinologist. They will only make her worse if she followed their advice. How about going to an naturopath or someone similar?
I know that 300 TPO sounds high and alarming. If it's any reassurance, the level of antibodies do not exactly always correlate with the severity of symptoms. If they did, then when my TPO has been 20-25 times higher than your wife's, I would not be alive. When my TPO was in the upper half of 5 figures, my TSH was 0.090, FT3 was 4.0, and my FT4 was1.35. I am a thin person with Hashimoto's. Now, when my TSH was very high, my FT3 and FT4 were very low, and I gained 10 lbs until I got my medication sorted. I also do not have the more common low DHEA-s, mine is over range. I'd say on an average my TPO is around 1,500, and that is with me having no hypo symptoms. It's been slightly under 1000 several times, but not for long because something always triggers it to go up to around 1,500 again.This disease definitely effects everyone differently.
Another thing that I can say about selenium (frequently taken with vitamin E because they have a synergistic effect) is that it does not definitely reduce antibodies, at least not in my years of experience in taking it. I have been on 200 mcg selenium every day and still had antibodies at several thousand. Who knows, maybe it would be even high if I wasn't taking selenium at that time. There are a few studies out there that have shown selenium taken with inositol reduces antibodies. I'm not sure if there are positive studies done on selenium by itself.
Your wife's symptoms are mainly caused by FT3 and FT4 that are not at her best level. That will take finding the right dosage of the right medicine. She might not have a good reaction to NDT since she has Hashimoto's and some Hashimoto's patients cannot take it. They take Synthyroid and Cytomel, or generic T4 and T3 instead.
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. :)
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.
1 Comments
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. :)
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.
((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....
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