It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Thyroid Disorders Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 07-08-2007, 08:36 AM   #1
Member
(female)
 
Join Date: Jun 2007
Location: texas
Posts: 51
lemondrop26 HB User
What to do next?

My family doctor tested my TSH (4.44) and Total T4 (12.4). He can't understand why both are elevated. I now read that protein in the blood and the birthcontrol pills I am on can up the Total T4 and that is why I need the FreeT4. His advice since the results confused him was to up my Prozac and see how I feel in 2 weeks.

Of course I need another doctor.

But, I am trying to decide what to do next. Make the 40 minute drive back to him and demand a Free T4 and T3 . Even though I don't plan on going to him for the condition - atleast I will have the results for myself probably by Wed.

or just continue to look for a new doctor. I was thinking an Internist. See if I can get them to run the tests? And it might be a few weeks before I can get into them.

Also what does Protein in the blood mean? Are we talking about the same protein we get when we eat meat? Thanks

 
Sponsors Lightbulb
   
Old 07-08-2007, 10:17 AM   #2
Senior Veteran
(female)
 
Join Date: Jan 2003
Location: Missouri, USA
Posts: 12,333
midwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB User
Re: What to do next?

No, the protein isn't meat protein. It's probably thyroglobulin, one of many proteins that are found in normal physiology. Thyroglobulin "traps" thyroid hormone in storage and carries it through the bloodstream. The protein must be stripped away, releasing the stored T4 which then is converted to T3, rendering it active to be used by the cells for carrying out body functions. Birth control pills, or any other estrogen med, creates more of this protein which then binds up more thyroid hormone in storage, unusable by the body in that form. That's why the measurement of total T4 isn't a useful level to know if you're using estrogen.

It's been my experience, similar to that of many who've reported here, that you can't "demand" anything of any doctor. Polite insistence might (or might not) get you somewhere, but aggressive demands aren't likely ever to. For example, if you went back to him and said something like, "Doctor, I've done a bit of reading up on the subject and found that my BC pills might be the reason my total T4 is high while my TSH is higher. I've learned that a free T4 test might be a more accurate measurement of how much thyroid hormone is available for my body to use. Would you mind doing that test instead? And while you're at it, how about a free T3 and thyroid antibodies tests, too?" It can't hurt to try. If it works, it's easier than finding a new doctor; if it doesn't, c'est la vie. Write him off at that point, because he isn't interested in learning anything he doesn't know, especially from a lowly patient.

 
Sponsors Lightbulb
   
Old 07-08-2007, 01:55 PM   #3
Senior Veteran
(female)
 
Join Date: Aug 2006
Location: U.S.A.
Posts: 731
ErinBeth HB User
Re: What to do next?

lemondrop, midwest1 just gave you some awesomely good advice. Questions and polite requests are often well received. Demands will raise caution flags and won't serve you well with any doctor. You want the doctor to look at you as a patient he wants to help, not as a probable liability.

I would like to add just one more thought. When getting information from my doctor, I want to make absolutely certain I get what he says correct, so I write it down. If necessary, I ask him to slow down or repeat. If I am not sure about the terminology, I ask him to spell it or write it down for me. I am careful to get it right, even reading it back to him to make sure. It is too easy to get it wrong trying to remember later what was said.

Last edited by ErinBeth; 07-08-2007 at 02:50 PM.

 
Old 07-08-2007, 02:39 PM   #4
Member
(female)
 
Join Date: Jun 2007
Location: texas
Posts: 51
lemondrop26 HB User
Re: What to do next?

you guys are sweet. I am getting very stressed and I KNOW it is because I am reading everybodies stories about how no-one would listen and how hard it was to get treated or sometimes even tested.

I am so polite and nice and quiet (even when I am mad) that I get walked over alot. I am honestly nervous to ask my doctor for anything. Or anybody for anything for that fact. So I am just trying to prepare myself to stand up for my health. Didn't mean to come across as a demanding b**** -- I just feel like my overly nice people pleasing atitude is going to get me blown off in this situation. thanks for the advice.

 
Old 07-08-2007, 02:46 PM   #5
Senior Veteran
(female)
 
Join Date: Aug 2006
Location: U.S.A.
Posts: 731
ErinBeth HB User
Re: What to do next?

Just a thought here, but it has worked for particularly non-assertive females at times.

If you feel you can't have the courage to be heard, find a male relative (husband, son, uncle, nephew or?) and coach him on the issues, somebody who knows how to negotiate without coming across in a threateningly aggressive manner. Take him with you as backup. You can speak until/unless it appears you will get the brushoff and that could be his cue to step in with some gentle, but firm, reinforcement?

 
Old 07-09-2007, 01:37 AM   #6
Member
(female)
 
Join Date: Jun 2007
Location: texas
Posts: 51
lemondrop26 HB User
Re: What to do next?

Quote:
Originally Posted by ErinBeth View Post
Just a thought here, but it has worked for particularly non-assertive females at times.

If you feel you can't have the courage to be heard, find a male relative (husband, son, uncle, nephew or?) and coach him on the issues, somebody who knows how to negotiate without coming across in a threateningly aggressive manner. Take him with you as backup. You can speak until/unless it appears you will get the brushoff and that could be his cue to step in with some gentle, but firm, reinforcement?

I thought about this - taking in hubby. I also thought about asking my doctor if I could have the free t4 test and add in all the others because I am scared of needles and would like as much blood work as possible at once. (even though I am not scared at all)

I guess all this might seem silly. But so many times the words are in my head and I just literally cannot open my mouth to say them. I need to go to assertiveness training.

Last edited by lemondrop26; 07-09-2007 at 01:38 AM.

 
Old 07-09-2007, 01:59 AM   #7
Member
(female)
 
Join Date: Jun 2007
Location: texas
Posts: 51
lemondrop26 HB User
Re: What to do next?

Alright I am putting on my BIG Girl Panties !!!! I have printed off Mary S's very simple and straight forward info on the newer lab standards and the problems with the Total T4 test. I am going into my doctor this morning and even though he has told me he wants me to take prozac and wait 2 weeks I am going to nicely but firmly give him this information. If he refuses to run the tests or gets pissy ... well you know what ... see ya! Simple as that.

Maybe finding out I have thyroid issues will help me gain some assertiveness. I am scared to go in and tell him I don't want anymore prozac - I want the testing. But, it will also show me if he really wants to help me or is just full of himself. I have been on anti-anxiety and depression meds for 8 years. In about 2003 he even said to me, "You are on a laundry list of medications here. I can't help you. You need to go to a Psycahtrist." Maybe now he can help me.

 
Old 07-09-2007, 09:10 AM   #8
Veteran
(female)
 
Join Date: Apr 2005
Location: FL
Posts: 389
sparkles916 HB User
Re: What to do next?

Just remember...just because you understand that the literature out there supports you, and newer treatment protocols are being developed outside mainstream medicine which reflect this literature....the standard response to someone already on psych meds will be "you are imagining it" and "you need more meds"

Like I said somewhere in a thread, "experts" who don't put much stock in the complaints of patients related to thyroid disease advise practitioners to interpret complaints and "symptoms" of such patients as somatiform in kind - that is pyshcosomatic. And, the recommended treatment for this is......drumroll.....antidepressants.

I know from experience, having gone to new drs and some specialists, that once I put down on my forms that I am on pyshc meds, I am treated in an entirely different way. There is very little that is taken seriously. In the end, i know the look even if the words are not spoken, which they have been on occassion - you are depressed blah blah more meds, see pyshciatrist blah blah. ( I don't disclose my medication any more up front,needless to say)

You cannot convince a dr even with evidence in hand who believes that, even though you have been diagnosed as hypo, you need to increase your psych meds. Obviously, he has no understanding of the relationship of thyroid disease to your mood disorders (supposing you have some real problems).

You certainly cannot convince a dr of this (or maybe anything) when YOU are taking the meds. Your credibility has be irreparably undermined.

Add to this any hint of you telling your dr you will not comply with his wisdom in telling you to up your antidepressants - well, you have just drawn the line in the sand.

What you can do is this:

Your objective is to get the order for the tests from him. So, try to finesse him and present your evidence as nicely as possible.

Do not reveal anything about not upping your anti depressants. Try to avoid talking about it. You don't want to lie if you intend to have him treat you in future.

Ask him about what you have read, and is WIDELY accepted, about depression, mood disorders and thyroid disease, in your case hypo. Play dumb, like you are seeking his advice after you have just read something you can't understand. This way the subject has been put on the table, without you seeming confrontational and shoving information at him. Remember you are talking to an all knowing all seeing dr. Act accordingly.

Is this Dr a keeper?

If after tests, ect, he is willing to treat you according to what your understanding of treatment entails, AND he understands and is willing to discuss the relationship between depression etc and thyroid disease, then you may reveal you were holding off (said ever so nicely) on upping the anti depressants, cause you wanted to see how thyroid treatment worked out.

If your dr is not willing to work with you in this way, and accept the relationship between depression and thyroid disease, I think it is time to move on.

Alternative Solution

You know, you can order the tests online through one of those companies. The one I am thinkning about gives you an order to take to a reputable lab, near to your home. If I remember correctly, it includes a TSH, FT3, Ft4 and the antibodies tests.

This way, you have a baseline for treatment, and it is a good tool to look around for a dr with - he/she who responds well to it and has a good treatment plan, may be the keeper.

Finally how is your hubby in all this? Has he seen some of the postings and info here on this board and elsewhere on the web? It sounds like he is supporting you in this

 
Old 07-09-2007, 11:58 AM   #9
Senior Veteran
(female)
 
Join Date: Aug 2006
Location: U.S.A.
Posts: 731
ErinBeth HB User
Re: What to do next?

Quote:
Originally Posted by lemondrop26 View Post
I am getting very stressed and I KNOW it is because I am reading everybodies stories about how no-one would listen and how hard it was to get treated or sometimes even tested.
I meant to respond to this earlier. There are pros and cons to reading these message boards, especially for those new to the subject, not yet having received solid knowledge of how the thyroid works, what actually happens when it stops functioning correctly, etc. When you ask questions here, you are not getting solid medical advice, based on proven practices and with your particulars in mind.

You have to take with a grain of salt everything anyone says here because our testimonies are based on our layman understanding of whatever it is we have chosen to read, our layman understanding of what our chosen medical professionals have told us ... all that coupled with whatever other issues we may have which we may or may not mention in the process of giving our own biased (sorry, but it's true) opinions.

It would be difficult to find anyone here with all the possible experiences, anyone who has fully tried all the possible treatment approaches and none of us have exactly the same combination of medical history, family history, personality, or even ability to comprehend what we are told or read. You just can't seriously apply everything any of us say to yourself.

Given that you keep all that in mind and don't let anything anyone says get you worked up, you definitely can find food for thought here. You can find support from a variety of people who care because we have been there or somewhere similar. You can get leads for further investigation. But when it comes down to you and medical care of you, the decisions must be made by you with the guidance of a doctor or doctors you personally trust for that.


 
Old 07-09-2007, 03:13 PM   #10
Senior Member
(female)
 
Join Date: Apr 2006
Location: Iowa
Posts: 218
boata HB User
Re: What to do next?

Lemondrop26 - I just wanted to jump in here and let you know that with treatment for hypo, my psycho symptoms were the first symptoms to dramatically improve. I have been on anti-depressants several times over the years (before being diagnosed hypo) and they just didn't help me. My doctor has been amazed at the improvement - he did not expect those symptoms to be addressed. There is hope. Now go on out there and put on your BIG girl panties... LOL!

 
Old 07-10-2007, 10:50 AM   #11
Member
(female)
 
Join Date: Jun 2007
Location: texas
Posts: 51
lemondrop26 HB User
Re: What to do next?

Well I got my results in. And they are normal. I mean the TSH is a little high. But, my doc made a strong case for the other side of this health issue. So I'm back to feeling hopeless - sorry to say.

He said there is a reason Endo's won't treat patients with my labs and that is because we don't need treatment. He said that I could go around until I find an Internist who would treat me. And when I finally found one - I would feel justified b/c I had found someone to back up my claim. They would give me meds and in the beginning I would feel better but then my body would adjust and everything would return to it's original state.

What I don't understand is every other test he ran came back normal. Every body function came back fine. The one that is off -- doesn't seem off enough to look into anymore. And I have a ton of symptoms that indicate something is wrong with me. So since it isn't off enough I must need more anti-depressants.

Why can we try anti-depressants to see if they work. But we can't try thyroid meds to see if they work. Why is trying one ok and the other not?

Oh well here are my test results.
TSH 4.44
Free T4 1.2
Free T3 285

 
Old 07-10-2007, 01:11 PM   #12
Senior Veteran
(female)
 
Join Date: Jan 2003
Location: Missouri, USA
Posts: 12,333
midwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB User
Re: What to do next?

We need to have the reference ranges for those tests to tell you exactly what the results mean. Do you have them?

Your TSH continues to be well above the level now named by a large US endo society as suspicious for hypothyroidism. The FT3 appears low by typical ranges. Most ranges start at 230 and go to 420. Your 285 is well below median range, which is too low for the majority of people. Your FT4, although not quite as deficient, is also below its usual median range. These levels are worrisome enough to warrant antibody testing - TPO and Tg. If antibodies are present, my former endo would have treated you. She's more forward-thinking than most, but she can't be the only one.

It all depends on how strong you are to pursue this. You can get treated if you go to the effort of finding a doctor who is willing to try for you.

 
Old 07-10-2007, 02:57 PM   #13
Member
(female)
 
Join Date: Jun 2007
Location: texas
Posts: 51
lemondrop26 HB User
Re: What to do next?

Thank you Midwest. My T4 was 1.2 and the range was 0.8 to 1.8
My T3 was 285 on a range of 230 - 425

I want to pursue it. And now that I look at it 285 isn't really in the middle like he said.

 
Old 07-10-2007, 06:04 PM   #14
Senior Veteran
(female)
 
Join Date: Aug 2006
Location: U.S.A.
Posts: 731
ErinBeth HB User
Re: What to do next?

Quote:
Originally Posted by lemondrop26 View Post
He said there is a reason Endo's won't treat patients with my labs and that is because we don't need treatment.
Now don't misunderstand me ... I am not saying you should not try to be treated ... but, technically, that is true. Your labs do tell you death and/or coma is not imminent from a hypothyroid condition.

That said, all three labs do agree your thyroid hormones appear to be low. If you feel bad with symptoms typical of hypothyroidism, I believe you can find a doctor who will look at both the labs and your symptoms and let you try treatment. It may be a difficult task, however, and you may need to try many doctors before finding one who will do that.


Quote:
Originally Posted by lemondrop26 View Post
They would give me meds and in the beginning I would feel better but then my body would adjust and everything would return to it's original state.
If you got what he said right, that's a puzzle. Trying to think what he may have meant, there are cases where women's labs indicate mild hypothyroidism for awhile and it later goes away for whatever reason. But if it does go away, you would discover that with monitoring and he should then decrease a prescription.

If you have Hashimoto's, that can cause the hormone levels to rise and fall, too. Treatment can be quite difficult and a doctor might want to see that stabilize before trying treatment because he/she would not want to introduce risks to you.

There are considerations and reasons why many doctors are conservative about treating until they are solidly convinced you are hypo and it's not a temporary situation.



Quote:
Originally Posted by lemondrop26 View Post
Why can we try anti-depressants to see if they work. But we can't try thyroid meds to see if they work. Why is trying one ok and the other not?
I have no reasonable answer for that one. Thankfully, I have never been offered those, perhaps because I didn't speak up enough to even have the labs done until I was nearly crawling? Even if you don't get treated immediately, if this is going the way it looks, you'll get it treated far sooner in the progression than I did 'cause you're on it now.

Whatever you decide, we're here to cheer you on to feeling better.

Last edited by ErinBeth; 07-10-2007 at 08:29 PM.

 
Old 07-10-2007, 10:11 PM   #15
Veteran
(female)
 
Join Date: Apr 2005
Location: FL
Posts: 389
sparkles916 HB User
Re: What to do next?

Quote:
Originally Posted by lemondrop26 View Post
He said that I could go around until I find an Internist who would treat me. And when I finally found one - I would feel justified b/c I had found someone to back up my claim.
Well, if your dr wants to say that you are not treatable for primary/clinical what about subclinical hypo as defined by that Endo Association and others in the medical literature? There is a strong body of evidence that supports treatment of subclinical hypo.

It is just not true that you will have to search high and low for someone to treat you the way he says it would be. There are more drs out there, esp in the integrative medical field, for instance, who would feel it was medically justified to treat you at your TSH level and free levels too. . And, i think it is rather insulting to call it "your claim". Rather, it is the claim of practiioners and researchers who consider the evidence on thyroid studies and treatment protocols to be different than he does. There are a number of differing views on treating a hypo condition = what TSH to use as the cut off, whether to use the free T4 as a test to evaluate a possible condition; the way to treat a hypo patient - down to 1.0 or so TSH or just to get them "in range"; whether to treat a hypo patient with just T4, thyroxine, or to add T3 as an adjunctive ; etc.

Don't give up.

I looked back at my old medical records from 1994, and saw that my tsh was 4 point something and my free T4 at .9 (bottom of range ) ( I don't have my records at hand). By this point I had been complaining year in and year out about being tired etc. I guess the dr gave me the test, but nothing was done. I never saw the results, becasue at that point, I was not a patient active in participating, like I am now.

By 1995, I was having full blown panic attacks- though I had no idea at the time what was happening to me. The rest of the story I have repeated elsewhere - bad bad and worse till I went to the ER and psych unit.

{I was finally diagnosed April 2006 as hypo)

I feel certain that had I been informed, and gone to different drs until someone did something other than record "anxierty" in their notations and send my on way, I would have been alot better off.

Bottom line, whether you are clinical or subclinical - it is worth the effort to find someone who will give you a trial of thyroid hormone.

 
Closed Thread

Similar Threads
Thread Thread Starter Board Replies Last Post
What to do about selling the house. Gabriel Alzheimer's Disease & Dementia 41 01-27-2009 09:26 PM
What do you think the next step will be and what to do about meds? eddieJ85 Back Problems 6 09-28-2008 12:30 PM
Post-Colon Resection - What to expect? resection Bowel Disorders 162 01-26-2008 09:21 AM
What is wrong with me???! mrschoppachop Rare Disorders 2 07-23-2007 10:09 AM
I don't know what I should title this... (long post.. =/) lr582 Mental Health 3 07-04-2007 01:22 PM




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Sign Up Today!

Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

I want my free account

All times are GMT -7. The time now is 11:34 AM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!