Avatar universal

Please help me find a good practitioner.

I have Hashimoto's and am currently on NatureThroid.  My story is a familiar one to many of you;  my TSH is within the reference range, but I'm still symptomatic, and my practitioner doesn't want my TSH suppressed.

Does anyone know a good practitioner in Asheville or Charlotte NC or anywhere in the Southeast?  I travel sometimes to Michigan and Colorado and could see someone in either of those states as well.  In fact,  I will travel anywhere in the country, if I have to, to see someone who will diagnose and treat me correctly.

Thank you.
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Avatar universal
Somehow it didn't get through.  I'll try again.  
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Avatar universal
I am sending a PM with info.  To access, click on your name and then from your personal page, click on messages.
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Should I have received your PM by now?  

I don't see a message on my page.
Avatar universal
So your TPO ab test showed a high result indicating Hashimoto's Thyroiditis.  With Hashi's the autoimmune system erroneously identifies the thyroid gland as foreign to the body and produces antibodies to attack and eventually destroy the gland.  As that progresses, the output ot the gland drops and the pituitary increases output of TSH to try and stimulate more output from the thyroid gland.   Your test results are consistent with that scenario.  

It is important to know that TSH is useful as a diagnostic only when at extreme levels, and in the untreated state.    Most doctors don't understand that each patient can be different in their equilibrium among TSH, FT4 and FT3 at which they feel normal.   Thus within a group data base of thyroid test results, TSH has only a weak correlation with FT4 or FT3,.  It has also been shown to have a negligible correlation with hypothyroid symptoms, except at  extreme levels, as I mentioned.   Individually FT3 has the most effect on symptoms, followed by  FT4, since part of FT4 is converted to FT3.   Having multiple symptoms like yours, that are typical of hypothyroidism, is the best indicator of a person 'being hypothyroid.  

So, with the test result showing Hashi's, the doctor finally diagnosed you as hypothyroid and prescribed medication.  Obviously the doctor had no idea about medication dosage.  Thyroid medication is not additive to prior levels.  The med causes TSH to go down and that reduces output from the gland,  the net result is essentially no change in levels, until TSH is low enough to no longer be affecting thyroid gland output.
At that point further increases in your med dosage will raise your FT4/FT3 levels.    I should also point out that doctors' fear about suppressed TSH should not apply to the treated state.    In the treated state  a suppressed TSH does not mean hyperthyroidism unless there are hyper symptoms due to excessive levels of FT4 and FT3.  

Our body is used to a continuous low flow of thyroid hormone from the gland.  When taking a significant dose of thyroid med all at once it spikes thyroid levels for a short time, but suppresses TSH for most of the day.   This has been proved in several studies.  

Your Vitamin D, B12 and ferritin have all been okay.  They are important.  Your continuing symptoms are due to inadequate levels of Free T4 and Free T3, and perhaps adversely affected by high Reverse T3.  Many of us have found that we required FT4 around mid-range, and FT3 in the upper half of the range, and adjusted from there as required to relieve hypo symptoms.  Symptom relief should be all important, not just test results, and certainly not TSH levels.  Your current FT4 of .98 is only at 18% of its range.  Your FT3 of 2.5 is less than 11 % of its range.  Both are much too low.  

Not sure what your cortisol level (total cortisol) meant at that time of day.   It would be good to get a diurnal saliva cortisol (free cortisol) panel of 4 tests at different times of the day.   Doctors typically won't order saliva cortisol, so you would have to order a kit and take the samples and return to lab.  Cost is about $135.

If you want to confirm what I have said, please click on my name and then scroll down to my Journal and read at least the Overview of my paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.  

If you thin there is any possibility that your current doctor would be agreeable to reading info such as the above,  and agree to treat you clinically, I can provide lots of such material.  If not then I will search for a good thyroid doctor in your area or nearby.  

Helpful - 0
Thank you for your time and effort to help me and many others.

I very much want to see a good thyroid doctor, so if you can recommend one, I'd be indebted.  I've already encountered too much resistance with my current doctor.  

I've read your paper.  I would pore over any other material you could provide.

I wish you the greatest blessings.
Avatar universal
For comparative purposes, what were your thyroid related test results before starting on the NatureThroid?
Helpful - 0
I don't know if my TSH was ever tested before these results:

2013 --
TSH   3.87   (0.40- 4.50)
Cholesterol, total   185   (125 - 200)
Vitamin D   45   (30 - 100)

2015 --
TSH   3.85  
Cholesterol, total   188
Vitamin D    52

2017 --
TSH   3.96
Cholesterol, total   221  H
LDL   132   (<130)   H

2018 --
TSH   4.04
Cholesterol, total   241  H
LDL   144   H

2019 --
TSH   4.16
Free T3   2.4   (2.3 -4.2)
Free T4   1.0   (0.8 - 1.8)
Cholesterol, total   216   H
LDL   130

My primary care doc was not concerned about any of these results.   My diet was good,  I got a reasonable amount of exercise,  and I ate even more carefully and tried taking krill oil as I saw the cholesterol increase.  I knew next to nothing about thyroid problems, so I didn't ask about the TSH creeping up.  He didn't mention it either, because it was still in the accepted range.

Looking back now,  I think I may have had some symptoms for many years.   Then about two years ago my symptoms  seemed worse, but my concerns were brushed off with the usual comments about age and stress and diet.  Last summer I started reading online about thyroid numbers.  At my annual check-up, he said my thyroid was fine, but after a little more discussion he agreed to let me try 25 mcg levothyroxine.  I still knew very little.

My symptoms worsened considerably.  After a month on the levothyroxine, my TSH was 4.5, at the top of the range, while my Free T3 had risen to 2.9.  Certain that my symptoms had nothing to do with a thyroid condition, he sent me to a handful of specialists, but of course not one was an endocrinologist.

I spent the next couple of months seeing the specialists and having chest x-rays, EKGs, an echocardiogram, a 24-hr Holter monitor, a CT scan, a neurological assesssment, an evaluation for hemochromatosis and polycythemia, etc.  Meanwhile, I was still on the 25 mcg levothyroxine.  Slumped on the sofa, I spent hours reading more about hypothyroidism.

I finally managed to get a test for Hashimoto's, which showed the elevated TPO antibodies but not those of thyroglobulin.  And I had a thyroid ultrasound, which showed one nodule on the right side, and I was advised to have a recheck in a year.

November --
TSH   3.26  
Free T3   2.8
Free T4   1.09
Vitamin D    52

In January I convinced my doc to let me try natural desiccated thyroid.  I chose NatureThroid over Armour  because of the cost, but if Armour works more reliably, I would ask to switch.  He started me at 1/4 grain.  

January --
TSH   3.11
Free T3   2.5
Free T4   0.98
Anti-TPO   290

In March I was allowed to increase the NatureThroid to 1/2 grain and in April to 3/4.  I've been grateful to get as far as I have at this point, but I think I still have room for improvement.  

Also I've avoided gluten since last summer.
Avatar universal
I'll  be glad to look around for doctors like you need.  In the interim I would very much like to have a look at your thyroid related test results and reference ranges shown on the lab report.  Also, if tested for Vitamin D, B12 ans ferritin, please post those as well.

What is your thyroid med and daily dosage?

What symptoms do you have?
Helpful - 0
Thanks, gimel.

I am on NatureThroid, 3/4 gr (48.75 mg) daily.

My latest lab results:

April --
TSH   2.5   (0.45 - 4.5)
Free T3   3.2   (2.0 - 4.1)
Free T4   0.9   (0.7 - 1.48)
Anti-TPO   281   (0-6)   H
Ferritin   154   (15 - 150)   H
Cholesterol, total   216   (100 - 200)   H

March --
Reverse T3   22   (9.2 - 24.1)
Vitamin D   54.8   (30.0 - 100.0)
Vitamin B12   1590   (232 - 1245)   H

Blood was drawn in early morning both times.   I did not take thyroid med until after the draw.

Serum cortisol, checked in November at about 4:00p.
              10.49  (range not given)

Debilitating fatigue, especially in afternoon and evening
Inability to exercise
Muscle twitches or spasms
Muscle aches in upper arms and other odd pains in body
Cramps in calves and feet
Shaky hands
Lightheadedness, wobbliness
Heart arrhythmia
Slow bowels
Some difficulty swallowing food
Heartburn and other digestive discomfort
Whitish areas on tongue and some scalloping
Swollen nodes under jaw
Droopy eyelids, haggard face
Headaches of assorted types
Impaired cognition and memory
Hot flashes
Cold hands and feet, purplish toes
Generally low body temperature, shivering before lunch
Bit more than normal hair loss

I'm almost 62 but now looking quite a bit older.  I have a history of PCOS, migraines, and seasonal/environmental allergies.  I've lost weight, not gained.  I've always been thin, and I think I've lost muscle and bone mass from lack of exercise.  Some days my symptoms seem to have improved slightly, since the increase in April from 1/2 grain to 3/4, but then the next day will be almost as bad as ever.

I forgot to mention that I have constant tinnitus and  some unexplained hearing loss.
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