What is the The best way to “fire” my current endocrinologist?

[40mills]

This doctor  has consistently kept my thyroid levels so low that I feel very
Hypo. Also he will not listen when I try to explain. He talks over interrupting me
And only treats by the TSH, never considering the actual thyroid levels.
Do I just cancel my next appointment and never call back, or just say I won’t
Be back?

[gimel]

Very glad to hear that you are making some progress.  Please keep in touch and let us know how you are doing.

[gimel]

With that result I suggest that you should request from the doctor a full iron test panel: serum iron, TIBC, UIBC, % saturation, and ferritin.  

Have you been supplementing with any form of iron?  

[40mills]

I have never taken any iron supplements in my life.
But I do take other supplements.
I will be sure to get all of the tests you suggested.

[40mills]

I was diagnosed with NAFLD several years ago.

[40mills]

Gomel:
Thank you so much for pointing me in the right direction.
All of those tests that you suggested turned out abnormal & now I’m under the care of my liver Doc specialist. He Dxd NAFLD in 99. Now it has progressed to NASH.  The Fibrosure serum test
Showed low-moderate fibrosis which motivates me even more to lose those last 10 pounds.

[gimel]

Good.  Please let us know how you are progressing.

[40mills]

Hi Gimel
I ordered my ferritin online. I will see my PCP
Next Monday.

Results were:  218   (15-150)

[gimel]

Is the new doctor who doesn't care about TSH willing to treat clinically, as described?  

[40mills]

Yes. He is  a preventive medicine
Functional medicine MD

[40mills]

Gimel
His special focus is on all hormones

[40mills]

Gimel: currently m being treated for a bladder infection .
Could this  be the cause of higher rt3?

[gimel]

For the saliva cortisol, did you have test for the early morning also?  If so, what was the result and range?  

[40mills]

That test was 2 yrs ago so dont remember
But ive been taking a pharmaceutical grade of bovine glandular off and on lately.

[40mills]

But i do recall everything was good until 3pm

[40mills]

R

[gimel]

Your FT4 of 1.38 is 59% of its range.  Your FT3 of 3.5 is 62% of its range.  Your Reverse T3 is also high in range.  The FT3 to RT3 ratio is 1.6, which is lower than optimal.  Those levels are a bit unusual when taking NDT type med.  Due to the ratio of T4 to T3 the FT3 is usually quite a bit higher in range than FT4.   Which leads me to question  your ferritin level.   Hypothyroid patients are frequently deficient in Vitamin D, B12 and ferritin.   Low ferritin levels adversely affect the conversion of T4 to T3.  Low ferritin, along with low Vitamin D and B12  are also some of the variables that can cause higher levels of Reverse T3.  So I think it is very important for you to get tested for ferritin, Vitamin D, B12 and I would also suggest a saliva cortisol (free cortisol) test panel taken at 4 times during the day.

You may be getting close to your optimal dose of NDT, so it is very important that you test and supplement as needed to optimize  Vitamin D, B12 and ferritin.  Vitamin D should be at least 50 ng/mL, B12 in the upper part of its range, and ferritin should be at least 100.  The cortisol test is needed to make sure it is optimal also.   Females with hypothyroidism are frequently too low in cortisol.  Doctors will usually only order a morning serum cortisol test (total cortisol), which is not nearly as useful as the saliva cortisol test.  If you want to pursue that, here is a link where you can order a test kit.

https://livewelltesting.com/healthconfirm-zrt-stress-hormone-plus-full-day-cortisol-saliva-home-test-kit/

[40mills]

Wow. Thanks for the info.
I know my D is 72;  i am taking  b12 sublingual,,
My 8 am cortisol is 18.  In the past my ferritin has been good. I eat an iron rich diet. Grass fed meat all organic diet.

[40mills]

Also, I did a saliva cortisol last year. About 3 pm it dipped lower and into evening also.

[40mills]

My new doc says:
I  DONT CARE ABOUT THE TSH

[40mills]

BTW
My new Dr. Says......

I DONT CARE ABOUT THE TSH

[40mills]

Gimel. Another question

Could the higher RT3 be because
I am being treated for a bladder infection?

[gimel]

Can't say for sure.  The best info I have found stated that:  Other postulated causes of reverse T3 dominance include a broad spectrum of abnormalities such as: “Leptin resistance; Inflammation (NF kappa-B); Dieting; Nutrient deficiencies such as low iron, selenium, zinc, chromium, vitamin B6 and B12, vitamin D and iodine; low testosterone; low human growth hormone; Insulin dependent diabetes; pain; stress; environmental toxins; free radical load; haemorrhagic shock; liver disease;
kidney disease; severe or systemic illness; severe injury‟, surgery; toxic metal exposure”

[40mills]

I will have to go and look at the latest labs

[40mills]

FT 4  1.38 (0.82-1.77)
TSH. <0.006
FT3  3.5.  (2.0-4.4)

Reverse T3   21.5    9.2-241

[40mills]

I was on 165 mcg for 8 weeks at this blood draw

[40mills]

I take my 165 mcg NP thyroid after blood draw

[40mills]

The dose he gave me is only 135 mcg

[40mills]

Right now on the 165 mcg...it’s not the best I have felt. But I’m willing to live with it.

[gimel]

I also meant to also ask what is the dosage of thyroid med?   Did you take it the morning before the  blood draw for those tests?

[gimel]

What symptoms do you have?  What are the results from your thyroid related test results and reference ranges shown on the lab report?

[gimel]

I have a better idea.  Click on my name and then on my personal page, scroll down to my Journal and read the 2 page Overview of a paper on Diagnosis and Treatment of Hypothyroidism:  A Patient's Perspective.   The Overview explains that dosing a hypothyroid patient based on TSH doesn't work and that thyroid med dosage should be increased enough to relieve hypo symptoms without creating any hyper symptoms.  Also important to optimize Vitamin D, B12 and ferritin.  

I would give the doctor a copy of the Overview and ask to be treated clinically, as described, rather than just based on TSH.  If he bothers to read the paper and look at some of the listed references, he can learn that your treatment based on TSH is inadequate.    if he refuses to reconsider, then you have good reason to tell him you are going to find a good thyroid doctor that will treat clinically, as described.  

[40mills]

I have decided to move on.  He is always in a rush. I know he wouldnt read it. I once tried to show him my low dose acth stimulation test that i failed & he just wouldnt even look at it.

[40mills]

So according to the  loe dose acth stim test  i have central hypothyroidism