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Old 08-29-2008, 06:40 AM   #1
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Question convincing Dr help needed

I have my first check-up since my Dr put me on Levothyroxine 25mcg. I am not entirely sure what to expect from her. The last labs she ran were going to be a "complete panel" yet when I got the results she hadn't run the Free t3 when I questioned her on it she said that it wasn't necessary, she could tell what was needed frotm the ones she did run.
What do you think, and what reasons could I give her for getting her to run the test? I would like to go in sounding a little more knowledgeable than last time and quite honestly I am still confused.
Am I wrong or wouldn't cytomel or another t3 med help with a little weightloss and more energy seeing the levothyroxine alone and diet/excercise is really doing nothing?

Here are my labs from last time

tsh is 6.93 with a range of .35-5.0
free t4 .9 with a range of .7-1.5
cholesterol 4.1 with a range of -<4.5
triglyceride 282 range -<150
ldl 96 range -<130
hdl 49 range -<39
any help would be greatly appreciated...

Kelly

Last edited by Kelly54115; 08-29-2008 at 06:41 AM.

 
Old 08-29-2008, 09:03 AM   #2
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Re: convincing Dr help needed

As you discovered, "complete panel" means different things to different MDs, and there's certainly no guarantee that any one of them will abandon their pet panel in favor of the one the patient wants.

In theory, the body is supposed to convert T4 into T3 at the proper rate for its needs. Good theory, but it doesn't hold up for a large part of the hypothyroid population; yet MDs hold steadfastly that nothing ever goes wrong with that part of the thyroid process... as if although the thyroid gland isn't doing its part, everything else in the feedback loop will still be completely hunky-dory. The true fact is that lots of things can affect that conversion rate, and someone with perfectly adequate free T4 can still be deficient in T3. In that case, added T3 medication fills the gap. Because MDs believe T3 can never be deficient, they believe T3 med is never needed.

You cannot know whether you need T3 unless your level of free T3 has been measured. Period. If you can't convince your MD to run the test, prepare yourself for the possibility that you will never feel as good as you might if you had an MD willing to do the test and prescribe T3 if needed.

There are no absolutes when it comes to weight loss for a hypothyroid person, and T3 is no magic bullet for that... especially if your FT3 level isn't low to start with. T3 will not cause weight loss for a person who doesn't need it. But having both FTs optimal - i.e. at least at the center of their ranges or above - is the best way to ensure that your weight loss playing field is leveled to the place where you could lose if you weren't hypoT.

 
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Old 08-29-2008, 09:15 AM   #3
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Re: convincing Dr help needed

YOu need an FT3 run. You do not know where that is given the panel run.

tsh is 6.93 with a range of .35-5.0 - This alone indicates you need more thyroid hormone. 25 mcg of T4 is a token dose. It barely dents the surface. I recommend you try and get your MD to bump you to 50 mcgs. Why?
free t4 .9 with a range of .7-1.5 This shows you are at 25&#37; of the normal range. This is well below the 50-80% optimal range 90% of the population resides in. You are still hypothyroid in T4.

Now you may be even worse in T3. We do not know, it was not tested. You may also have additional issues that a FT3 and Ft4 comparison can point to.. all in all you can not just toss in T3 with out testing to see if you need that T3. This is just my personal opinion of course.

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Old 08-29-2008, 09:32 AM   #4
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Re: convincing Dr help needed

your TSH is too high. how long have you been on the 25mcg? it was a good starting dose for me, but you'll need an increase.

your free T4 is too low. sure, its 'within normal ranges' and most doctors say that is good enough. most people on this board though will say that is too low.

free T3 testing is customary. i dont know why but your endo is mistaken on not having yours checked.

you might feel better on a T3 med, but even with your T4 so low you are not going to feel 100%. perhaps you will have to get aggressive with your doc and insist on a free T3 and medication increase, or find another doctor.

 
Old 08-30-2008, 06:38 AM   #5
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Re: convincing Dr help needed

I have my appt on Friday, I am going to insist that she runs the test.. she will have to do a draw anyhow to see where my levels are so I may as well get that one too....
When I had my levels tested in 2006 my ferritin was 19 and my tsh 4.28. She just wanted to wait the 4-6 months for the next draw to see what happens. I don't remember what the levels were the next time. It was about 7-8 weeks ago that she put me on the levothyroxine 25mcg. I did not have my ferritin levels checked this time. I will also ask for that.

I really appreciate the help given on this board... I will let you know my new results when I get them....

Thanks Kelly

 
Old 08-30-2008, 07:26 AM   #6
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Cool Re: convincing Dr help needed

Have to agree that 25 mcg's of Levothyroxine is "token" dose

And as mkgbrook states, your TSH is still high with your T4's barely IN range <<~ that ALONE indicates need for higher dose.
Quote:
in 2006 my ferritin was 19
Have you done anything to get that number UP ?? Because if ferritin & B12 are low that only adds to the fatigue we hypo patients feel. (may have something to do with HOW well we absorb our thy meds too,,)

Also, DO you GET COPIES of your lab work each & EVERY time? That is VITAL in my honest opinion. Doctors will tell you NORMAL, when often you're BARELY in range, therefore there *IS* room for improvement

 
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