Testing for T-3 with Hashimoto's

[garnet31]

I've been on Synthroid since my 2003 diagnosis of Hashimoto's thyroiditis. However, as I approach 45 I'm starting to think that perhaps T4/T3 treatment might be good. One of the reasons is that when I first began Synthroid at age 36, I immediately began gaining weight but my endo said that it's not the medication. Every other endo told me the same thing, but nobody seemed to test for other issues. I'm an otherwise healthy female and since I wasn't taking any other medications at the time, I really didn't think it could be anything other than the medication. I realize that it could've been not so much the hormone itself but a reaction to a dye or other material used to make the pill, but nobody has ever looked into it. However, a hypothyroid friend suggested T4/T3 is something I should look at. My current endo is somewhat dismissive of the T3 theory but has otherwise been a good doctor about watching for my family history of diabetes, etc. But having the extra weight, about 30-40 pounds, isn't good for that situation, either. I know thyroid-related weight gain is tougher to battle than regular weight gain---and I've been having my battle with it. My big question is this: If I approach another doctor about T3 testing right off, what are the chances she/he will be just as dismissive, or are more endocrinologists becoming more open to that?  I'm not up for constantly spending money to talk to a doctor only to get the same old response. I'm in the Arlington/Northern Virginia area if anybody has any endo recommendations.  Thanks.

[ddmk]

Have you tried Dr. Donna Hurlock? She should be near you. She is a gynecologist but specializes in helping thyroid patients. She's has helped me so much. She treats symptoms rather than blood levels. She gave me back my life. She doesn't take insurance, but she is worth every penny. Her # is 703-823-1533. Hopefully you have already found the help you need.

[gimel]

You don't necessarily need an Endo.  I say this because many of them specialize in diabetes, not thyroid.  In addition they tend to be more rigid in the "Immaculate TsH Belief" and only want to use TSH to diagnose and medicate thyroid patients.  When they do go beyond TSH they tend to over rely on "Reference Range Endocrinology", by which they will tell you that  a thyroid test result that falls anywhere within the so-called "normal" range is adequate.  This doesn't work for many patients either.  

A good thyroid doctor will test 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, not just test results.  You can get some good insight into clinical treatment from this 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

I have been gathering a list of member recommended doctors, but unfortunately I don't have one for your area.  The best I can offer is this link on the Top Thyroid Doctors in Virginia.  You can read through it and find some prospects in your area.  Be sure to read the patient feedback also.  It can give insight into whether the doctor treats clinically, or only uses TSH and other test results.  Also look for indications that the doctor will prescribe T3 meds.  

http://www.thyroid-info.com/topdrs/virginia.htm

[garnet31]

Labs this month are:
Free T4... 1.20
TSH.... 1.610
Also cholesterol panel, as my chol went up as a side effect of Hashimoto's but I'm now on a statin drug to help that. I'm more in a "maintenance" mode after 8 years rather than a diagnosis mode, but am considering to see if there is any new viewpoint. I've had two other docs in between (four docs total now) and they all believe I'm doing well. When I was diagnosed in 2003, my TSH was 10.0. Last I was tested for T3 was in 2006 with a level of 157 in a range of 60-181 ng/dL. That was a "T3,Total" score on T3 then.

[Barb135]

What tests is your doctor doing routinely, to keep tabs on thyroid function?

He should be doing a full thyroid panel, which includes Free T3, Free T4 and TSH.  Many doctors, including endos, think that TSH is the only test they have to run, in order to keep track of things, however, TSH is a pituitary hormone and does not tell the whole story.  

Free T3 and Free T4 are the actual thyroid hormones, with FT3 being the one used directly by the cells.  FT4 is not used directly, but is converted to FT3 for use.  Some of us don't convert properly; therefore, we need a medication that includes a T3 component; this can be added by using cytomel, which is a synthetic T3 medication, which is best started at a very low dosage and increased as needed, based on symptoms and labs. In addition to cytomel, there are the dessicated thyroid hormones, such as Armour, NatureThroid, Canadian ERFA and some others.  These are derived from porcine (pig) thyroid.  The T3 component in these medications is approximately 4 times higher than what the body normally produces.  Many people do very well on either a combination of synthetics or a dessicated.  

Many of us find that in order to be symptoms free, our Free T4 should be at least mid range, and Free T3 should be in the upper 1/3 of its range.  Once levels are adjusted to suit your individual needs, you should be able to lose weight.  Your weight gain is most likely a result of being under medicated.  Some people are lucky and the weight "falls off".  I've never been that lucky, but when my levels are right, I can lose if I work at it.

You can "pre-interview" doctors prior to making an appointment to find out how they test/treat thyroid patients.  Often, you can call and ask to speak to a nurse.  Ask if the doctor tests for Free T3 and Free T4 (make sure it's "FREE" and not TOTAL, as they aren't the same), along with TSH and if s/he is willing to treat with T3 medications, including dessicated.  If the answer to either of those questions is "no", don't waste your time with that doctor.   Some people have compiled a list of questions and e-mailed or faxed it to their doctors.  Of course, if you did that and a doctor didn't bother to respond, you'd know s/he's not for you........

If you have any recent labs, it would be helpful if you would post them here, along with their reference ranges, so members could help assess your treatment.