Test results and my Dr

[Jacksmom516]

Started seeing endo 4 years ago as Thyroid disease runs in the family  Have tested positive for anit-bodies
Have large nodules

Here are results
most recent t3 .97m        ft4 1.29          TSH 1.460
9/2010         t3 not done     ft4  1.11         TSH  1.316
3/2010         t3 not done    ft4 1.21          TSH   1.05
8/2009          t3 not done  ft4 .85             TSH   1.57

Apparntly nodules have grown from 9/2010 to present as she wants them sonogranmed again in March 2012

Had a biopsy of the nodules and it says that there are numerous lymphocytes that suggest hashimotos.  Additionally symptoms,  hair loss , extreme fatigue, dry skin, always cold.  Should I be looking for a new Dr or is she just being cautious and not doing anything too soon - just not sure!
Also have vitamin D deficiancy and am getting a battery of tests done due to abnormalities on spine -  

[gimel]

Just sent a PM with name of doctor recommended previously by fellow member.

[Jacksmom516]

In the interim I started doing so research - I have called three Dr's and was told I cannot make an appt on my own my PCP must do it -  that is ridiculous -  So any suggestions in the Baltimore, Harford county area of Maryland would be helpful -  It is nuts!  My insurance does not require a referral but these Drs do!

Thanks for the heads up on what to ask -  I am so tired of feeling tired and sluggish and want some anwers

[gimel]

As you search for a good thyroid doctor, I suggest the following.

When you call to ask about an appointment, tell them that before making an appointment you have a couple of questions you would like to ask one of the nurses.  This almost always works to get a nurse on the phone.  Then ask if the doctor treats thyroid patients clinically, for symptoms , or just by blood test results.  The second question would be if the doctor is willing to prescribe T3 type meds like Armour or Nature-Throid.  If you don't get the right answers, then just keep looking.

[Jacksmom516]

Thanks for the advice -  I like her but I guess i just do not feel she is doing enough -  My PCP is very not step on specialist toes which is okay so I think I will look for a thyroid specialist - I am in Baltimore so I am sure that there are some here -  With the strong family history and being symptomatic I agree I think I need to take a handle of things and find someone new to visit.  I am getting tested for B-12 deficiencies since I have this other neuro issue.  As well as a host of other tests.  I am somewhat upset that the Ft3 is so important and she is not testing this every time i am there -  So on to get a 2nd opinion,.

[Super_sally888]

What is the range for your FT3, FT4 results?  If you are in the lower half of the reference range there is room for improvement, regardless that your TSH "looks ok".

Given that you are clearly symptomatic, could you ask your doctor to let you trial a low dose of thyroid meds to get your FT3 and Ft4 up to upper 1/2 of the range and see if you feel much better?

[gimel]

Just because your doc is an Endo does not mean that he is a good thyroid doctor.  Many of them specialize in diabetes, not thyroid.  Many doctors also have the "Immaculate TSH Belief", by which they think that TSH is all they need to diagnose and medicate a patient.  This is erroneous because TSH is a pituitary hormone that is affected by so many variables that it doesn't correlate adequately with the actual thyroid hormones, FT3 and FT4, much less with symptoms.  

Other doctors use "Reference Range Endocrinology", by which they will tell you that any thyroid test result that falls anywhere within the reference range is adequate for you.  That is also erroneous because the reference ranges are far too broad, since they have never been corrected like done for TSH over 8 years ago.  FT3 results that fall in the lower end fo the range is frequently associated with being hypo and having symptoms such as you mentioned.  

You should always get tested for Free T3 and Free T4 each time you go in for testing.  Free T3 is the most important test because it largely regulates metabolism and many other body functions.  Scientific studies have shown that FT3 correlated best with hypo symptoms, while FT4 and TSH did not correlate.  Doctors often resist testing for Free T3 on the basis that if they know FT4, then they can adequately estimate the FT3 level.  This is frequently not the case, because many patients do not convert T4 to T3 well, especially when taking thyroid meds.  For that reason you should always insist on being tested for FT3 as well as FT4 and TSH.  If the doctor resists then you should just keep insisting and don't take no for an answer.  

So you need to get the free T3 test done.  You should also request testing for Vitamin B12, iron/ferritin, selenium, and RBC magnesium.  Patients with hypothyroidism frequently are low in those areas as well.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  symptom relief should be all important to you, not just test results.     I think you will get a lot of good insight into clinical treatment from this link to a letter written by a good thyroid doctor for patients that he sometimes consults with from a distance.  The letter is sent to the PCP of the patient to help guide treatment.


http://hormonerestoration.com/files/ThyroidPMD.pdf

If you are not confident that you can find a good thyroid doctor, then let us know and members may be able to recommend one based on their personal experience.