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Avatar universal

Need an Endocrinologist in Chicago

Hi,

I'm in Logan square, I don't care where to go, but I need an endocrinologist who understands Hashimotos. The Endo I have only wants to check TSH, but after some serious begging she did check my Free T3 and Free T4. I have Humana insurance. I'm tired of asking for really basic things from Endo's.

My tsh is 6
FT3 is 3 pg/mL      ref. range is= 2.0 -4.4
FT4 is 1.41 ng/dL   ref. range is= ..82- 1.77  

I take 100mcg of Tirosint and 10mcg of cytomel split in half.

I still feel a deep ache in my legs and arms. I'm 32 and felt perfect 10 months ago.
I need to get my tsh down to around 1 and my FT3 up a little bit before I totally freak out.
My rhuematologists labs say I might have MCTD or Subcutaneous Lupus, but I have no symptoms of them. SO I really hope the aches goes away with the TSH going down. Please Private Message me with an Endo who takes humana or any Endo that is good with Hashimotos.
Thanks from the bottom of my heart, This is so hard , and I wish everyone good luck.
-Tom
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Avatar universal
TSH is irrelevant. It is a screening test at best.  And even more becomes irrelevant when on T3 medication and will often times quickly be s uppressed with will cause many Dr's to freak out and immediately cut your medication.

The rule of thumb for most people to feel well is to have BOTH of the following:

1) Free T4 to be 50% of the range or a bit higher. You are currently testing out at at 62% of range. So that seems fine if not even a bit high.

2) Free T 3 to be in the UPPER 1/3 of the range which is 66.7%. You are testing at 41.7%.  So this is a bit low  you certainly want to be up above 50%.

Your tests would indicate to me that you are having issues with proper conversion of T4 to T3.  So being on Cytomel is a VERY good thing.  I would think that with the FT4 being already sufficiently high, that you would want to leave the T4 dosage alone and add a bit more T3 (Cytomel).   Finind a Dr to Rx this for you sounds like your issue.

You could also cut back on the T4 dosage, but generally you want to only change one thing at a time. So you can evaluate what that single change results in. If you change two things, you never really know which one of the changes caused the final result.

Just my opinion.
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Avatar universal
Thank you flying fool,

I'll post my most recent tests soon. I'll bring up all these points with my integrative doctor, my endo is not very helpful.
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Avatar universal
Just sent PM with doctor info.  To access, just click on your name and that takes you to your personal page.  Then click on messages.  
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Avatar universal
thanks everyone.

I'm seeing some new endos because of your help! but its a few weeks away.

Im not feeling any better and my new labs look good.

TSH: 2.2
free t4: 1.4 ng/dl     ref range - 0.7-1.7
free t3 : 3.96 pg/ml   ref range - 2.3- 4,2
TPOab- 457   ref range 0-34

I'm on 100mcg of tyrosint and 10 mcg of cytomel

so….things are looking bad. my labs look great , its a been 2 weeks since my test , still feel deep body aches and now new symptoms: motion sickness.

what do ya think ?  switch to desiccated ? seems like my only option

Thanks
Tom


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Avatar universal
Did you defer your morning dosage of the T3 until after the blood draw for tests?  How long have you been on the current doses of T4 and T3?   I don;t see switching to desiccated as a viable option.  Separate doses of T4 and T3 can provide the same result.  It is all about adjusting Free T3 and Free T4 levels as necessary to relieve symptoms.  

Your current FT3 and FT4 levels are consistent with what we usually recommend as good.  So, we need to look into other possibilities.  In addition to the questions asked above, have you been tested for Vitamin D, ferritin and cortisol?  If so, please post those results.  
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Avatar universal
1. No , I took the T3 and T4 the day of the bloodwork.

2. I have been on my current dose of T4 for 9 months and T3 for for 2 months.

3. The STTM book says that I some people simply never do well on synthetic meds. and I should try Desiccated thyroid meds. Any thoughts on this concept? I think it would benefit me to figure out T3/T4  synthetic dosage perfectly, so If I do attempt a trial run of Desiccated thyroid medication then and it doesn't work I can just switch back easily to the proper dosage of synthetics. so frustrating...

4. Vitamin D is low but supplements bounced the levels up . Iron levels were just barely below norma, and are ok now.. and cortisol checked out but I'm waiting for my 24 hour saliva test to come back next week.

5. I'm getting my bloodwork back from the rheumatologist next week too. It will tell me if my ANA levels have changed and if I'm still testing positive for MCTD and Sub-Cutaneous Lupus even though I don't have symptoms( other than fatigue/ muscle ache and an occasional small heat rash, but no clinical diagnosis..

Thanks again .
Tom


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Avatar universal
T3 med is very fast acting.  It reaches peak effect on serum levels in  about  4 hours and then diminishes over the next 4 hours or so.  So, your representative Free T3 level is likely to be significantly lower than shown  above.  For the future, it is recommended that you defer your T3 med until after the blood draw.  

I don't know what STTM has against synthetic thyroid meds, but I would not even consider switching until you get your Free T3 and Free T4 to optimal levels with current meds, and then monitor results for a while.  

What are your actual Vitamin D and ferritin results.  Tested for B12?
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Avatar universal
Hi,

real quick. I deferred  my t3 and t4 dose before getting tested

All I remember is that my T4 went from 2.2 to 3.9
and my FT3 and FT4 went well below optimal.
Will post exact results later.

Is that possible that t4 being deferred until after testing would change my tsp up?
I think I missed a bunch of afternoon t3 meds, because I forget a lot, its still new to me.
Tom
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Avatar universal
Deferring taking T3 med until after blood draw avoids false high results that could occur due to how quickly T3 goes into the blood. T4 is much slower acting and does not need to be delayed.  I assume that the 2.2 and 3.9 results are for TSH.  TSH is affected by a lot of things.  Free T3 affects TSH levels more than Free T4.  So it may be that your lower results for FT3 affected TSH results.  Don't forget that when already taking thyroid meds, TSH is pretty much a waste of time to test.   In the words of a good thyroid doctor, "In the best tradition of
clinical medicine, a physician should prescribe thyroid hormones as needed to eliminate the symptoms and signs of
hypothyroidism without producing any symptoms or signs of thyroid hormone excess."
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Avatar universal
Yes of course
My tsh went from 2.2 to 3.9. Not t4,
Sorry

I'm off the 5 mcg cytomel now , because I'm not tired , just pain. Increasing from 100 to 112 Levo.

going to increase until I feel better every 4-6 weeks

But rheumy now has me on prednisone 40 mcg a day. I assume if I  i feel better in a few weeks it's the prednisone suppressing a possible diagnosis for MCTD. If not , I will keep increasing the levo, and check the ft4 and Ft3.
Thanks ,  stay patient out there. Man this is a tough one
T


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Avatar universal
Yes of course
My tsh went from 2.2 to 3.9. Not t4,
Sorry

I'm off the 5 mcg cytomel now , because I'm not tired , just pain. Increasing from 100 to 112 Levo.

going to increase until I feel better every 4-6 weeks

But rheumy now has me on prednisone 40 mcg a day. I assume if I  i feel better in a few weeks it's the prednisone suppressing a possible diagnosis for MCTD. If not , I will keep increasing the levo, and check the ft4 and Ft3.
Thanks ,  stay patient out there. Man this is a tough one
T


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Avatar universal
Here are the labs from Jan 15

FT4 :   1.19     range: .82-1.77ng/dl
FT3: 3.2          range : .45-4.5pg/ml
TSH: 3.9

for those of you just reading this, I didn't take my levy or cytomel before the lab test.

my tsh went up 2 points, and FT$ went down and FT3 went down.

My doc has taken me off cytomel and uped my Levo dose from 100 to 113.
Its been 3 weeks with no change.

Rheumatologist took me off prednisone because it didn't help. Now I'm on Cymbalta. Ive been on it for a week , no change, but we are giving it a month.

Thats all I know, I'll up date you in 3 weeks . does anyone else not take their levothyroxine before their labs?
-Tom
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Avatar universal
Hi all,


Update 3/5/15

Tsh is 1.33
ft4 : 1.56
ft3 : 3.7

These results and the previous ones I DID NOT take my thyroid meds on the day of the test. 6 weeks ago I dropped the cytomel and increased my levo to 112 mcg.

My labs seem perfect. Maybe the TSH could drop a little lower. I have ZERO improvement of symptoms!


I'm feeling discouraged
I don't think I should add too much more levo, maybe a one extra 112 a week?
Honestly I think I'm going to try and switch to desiccated thyroid !

In other discouraging news , i'm still positive for MCTD.
I have tried

Prednisone ( 20 daily for a month )
Prednisone ( 40 for a month)
Gabapentin ( for a month)
Cymbalta  ( for a month)
Plaquinel ( for a month)

None helped me one bit.

My rheumy says we try the Plaquinel for 3- 6 months. And in the mean time to see ANOTHER rheumatologist for a second opinion, she can't personally figure it out. The only MCTD symptoms I have are muscle pain, and an itchy rash ( itchy doesn't fit with sclerdoma or lupus , mctd etc...)

well, gotta back to work even though the muscle ache is pretty bad and all over. Rash stopped itching with hydrocortisone , and now have another bout of mysterious vertigo that can last up to a month..,

Thanks for you time.
Stay informed ! But stay busy out there, thinking about this stuff all day will only make it worse,
sincerely,
Tom

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