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Old 11-11-2008, 07:18 PM   #1
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Exclamation Pregnant, hypothyroid in San Francisco Bay Area... NEED MD HELP!

Hi all,

I'm 9 weeks pregnant and being undertreated for hypothyroidism. My primary care MD and OBGYN will not increase my medication so that I am in an optimal range. I still have symptoms and I am worried about the baby. I don't know what to do-I have Kaiser, my primary Dr won't refer me to an endo, and the docs I see cost $800 out of pocket for a consult, $400 for follow ups. I'm considering paying that, but it seems crazy because I have health insurance. If you have Dr recommendations or any other ideas, PLEASE HELP. The best thing would be if I could go through Kaiser, especially if there is a primary care MD through Kaiser who will be understanding and helpful with thyroid issues.

Thanks so much,
willismoonis

 
Old 11-11-2008, 08:28 PM   #2
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Re: Pregnant, hypothyroid in San Francisco Bay Area... NEED MD HELP!

Thank you so much. I actually saw some of these names. Dr. Becker was the one I'd called who I had gotten the $800 quote from. Yikes. I really want to get treated, but I don't know if I can afford to spend so much money.

Last edited by moderator2; 11-12-2008 at 07:32 PM. Reason: posted disallowed website(s)

 
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Old 11-12-2008, 03:17 AM   #3
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Re: Pregnant, hypothyroid in San Francisco Bay Area... NEED MD HELP!

Hi....

I too have hypothyroid and am also a Kaiser patient. I don't live in the Bay area, but I do go to the Kaiser Vacaville clinic, [which is actually not far from the Bay area] and see an excellent endocrinologist there. [she is the only one there] I've been under her care now since Dec. of '03, and I tell you, once I learned to speak up for myself and became more assertive with what I expected and wanted, everything changed and my care went from bad to excellent. Once she could see that I was educated about this disease, and that I was being sensible about my treatment, she became a very cool [good] Dr. I am on Levothroid and she even was cool about giving me Cytomel, [I was originally on Armour, after I asked for it, but I did poorly on it], and she has given Cytomel to another girlfriend of mine too, without any problems.

Another thing though that you may not know about Kasier, is that if you are not satisfied with your treatment, and you are not being helped, still feeling ill, etc, and your Dr's are denying your request to see a specialist... you need to just go over to the members [ ? something...I can't remember at the moment...it's late], office and let them know how unsatisfied you are, and that they denied your request to see a specialist, and believe me,..they WILL do something about it. I have a large circle of friends and we are all Kaiser patients, so I know many who have done this.

Or...your could also make an appt. with a Kaiser GP, [in Vacaville or Fairfield] and try again...ask to see the endocrinologist over there. I would try the above first though...it works. [I also have a girlfriend, [my hair stylist], who sees her endo at the Fairfield clinic, and has had good results as well]

I have gone through many dose increases, most at my request with my endo, as long as my TSH stays within the range. Actually I have fallen outside of the range this summer [too low] and she is still letting me stay on this dose. I am now requesting to decrease my dose. She is pretty much letting me decide on what dose I need, as she says, "you seem to know your body and symptoms well and recognize if you're getting too much or too little". I really like and respect this Dr. She has turned out to be a wonderful Dr. and has really helped bring me to wellness.

You should be able to go to the members office right there at your own clinic and put in a complaint, and see results happen real soon. One of my girlfriends, [a heart patient] did this...went in to complain as her own Dr. [GP] wouldn't let her go see a specialist, [for something...I can't remember], and in a few short days she had received an appt. card in the mail with an appt. to see the specialist.

Try it...it really works. Then when you see the endo, you insist on an increase, and tell them what I told them... "I want this da_ _ TSH to go down to a 1!" ..while I tapped my finger on the table. [I was so ****** at the time!] I told them that as they were telling me my levels were "fine" with a TSH of 4.4, and I felt like death was approaching. What are your levels by the way...do you know? I know Kaiser is good about sending us our results, or posting them on the website. I just checked mine today and they were already posted, and i just took my bloodtests yesterday.

Sorry for mistakes, like I said, it's real late. I hope it works out for you. Let me know what happens, and best of luck to you. I will try to find out the name of that office I was telling you about and post it on here tomorrow, if I can get on computer later.

Deda

Last edited by Deda; 11-12-2008 at 03:18 AM.

 
Old 11-12-2008, 09:12 AM   #4
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Re: Pregnant, hypothyroid in San Francisco Bay Area... NEED MD HELP!

Hi willismoonis,

I'm a frequent lurker and rarely post, but since I actually know something about this, I wanted to share my experience. I'm in San Francisco, and I've recently started treatment for hypothyroidism, and I see Dr. Myers so I can give you some feedback on her. Dr. Myers is the first doctor I went to to be tested, and so far she's been great. I originally went in because my mom was diagnosed with Hashi's back in February, and I had a lot of the symptoms and was just feeling generally bad. I listed off all of my symptoms to her and she actually believed me and said there was no way I should be feeling so bad, and sent me in for a battery of blood tests. Everything came back in range, so she told me everything was "normal." Since I hadn't done much research at that point, I believed something else was to blame and made several lifestyle changes to try to feel better. None worked, and after six months I did more research to find out that my values really weren't in the new normal ranges, so I made another appointment. I told her how I still wasn't feeling well (and was actually feeling worse) and she agreed that my levels might not be optimal for me and started me on Levoxyl. I am supposed to go back for a follow-up in December and while I have seen improvement, I don't feel I'm optimized yet since I've recently gone back to being totally exhausted and having a lot of migraines, so I'll see what happens then, but she does treat to symptoms (at least a bit - as I said, I'll see what happens in December when I'm assuming my numbers will be lower, but I still feel bad) and does not rely exclusively on lab work. I did find out after I started seeing her, though, is that she's more specialized in diabetes than thyroid, but I'm happy with the way she's been treating me so far, so unless that changes, I'll continue seeing her. She also will run tests upon request. I think her waiting time for an appointment is about two weeks currently.

Dr. Becker is supposed to be the best thyroid specialist in San Francisco, but he does not take any insurance. I don't have Kaiser so I'm not sure how that will work with Dr. Myers' office, but it's worth checking into! When I got my EOB from Blue Cross her new patient appointment rate was about $250, which isn't nearly as bad as the $800 you've seen from others.

I hope this helps!

abby

 
Old 11-12-2008, 09:54 AM   #5
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Re: Pregnant, hypothyroid in San Francisco Bay Area... NEED MD HELP!

Willismoonis,

I was hoping you would get some hits. YEAH! I think either Myers or the other group might work for you. The sooner you get seen the better IMO. Call about and see what pans out. The first 12 weeks of pregnancy are the most important to keep your Ft4 levels up. The baby is solely dependent on your T4 for developement and growth at this time. Mucking about with it the way your current OB is.. well it is just poor practice IMO!

MG
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Old 11-12-2008, 09:45 PM   #6
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Re: Pregnant, hypothyroid in San Francisco Bay Area... NEED MD HELP!

Thanks so much, mkgbrook, and the others who have responded. I will be bookmarking this thread and referring back to it!

GREAT NEWS! I wrote my primary MD last night and told him that I was going to go to patient assistance (I think this is the same as member services) with documentation of current medical standards illustrating that I am being undertreated. I asked him to explain to me why, with a diagnosed thyroid disorder, he is refusing to refer me to an endo. He actually wrote me an email telling me that he had made the referral, and the endo's office called me immediately afterwards with an appointment for me next week! I'm going to bring in some articles and insist that I have my dose increased. If they say no, I will tell that that I will follow up with patient assistance and get a second opinion from another kaiser doctor.

If I have to, I will drive to a Vacaville endo that the other person mentioned, or go to another private endo and pay. But first, I will play hardball with the endo that I have the appointment with.

mkgbrook, I am so paranoid right now that the baby has already been irreparably damaged by this-please talk me down a little! I know you can't promise me that it's fine, but...I'm so scared!

 
Old 11-13-2008, 01:19 AM   #7
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Re: Pregnant, hypothyroid in San Francisco Bay Area... NEED MD HELP!

Way to go! You did the right thing,..and the very best of luck to you. It takes some guts and perseverance, but you're on your way...keep up the fight. By the way, my endo's name is Dr. Che. So glad you're getting to see the endo soon. Let us know how it goes.
Hugs...
Deda

 
Old 11-13-2008, 06:24 AM   #8
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Re: Pregnant, hypothyroid in San Francisco Bay Area... NEED MD HELP!

Willis,

What was your last Ft4 level? You can look really hypoT on paper and it be due to LOW T3 values while your Ft4 levels are just fine. Now my MFM and OBs tell me that the fetus gets the cream off the top. Basically it is going to take as much T4 out of your system as it needs and you are left with the left overs. So I was told many people with 25-40% range FT4 have babies that come out just fine. THE patient is the one that gets the hypoT brunt. NOW when you look at even lower levels of T4 concentration there is just an INCREASED chance of cognitive developmental issues. The most common of which is a depressed IQ. Now this increased chance is not even 50%.. it is 20-25% chance.

So with all this in mind you know and you can still fix things. First you are only on 75 mcgs of T4 correct? Your TSH is 3.7 correct? Am I remembering it correctly? If so in preparation for your Endo. I would increase your dosage and tell your Endo why you did it when you go to see them and ask for a new script for a higher dosage. Now I would just take 1 and a half tablets right now. Add the half tablet in the evening about an hour before supper. This will reduce the absorption but get your intake closer to 100 mcgs versus 112 mcgs. The Endo may jump you right to 125 mcgs of T4 if you go in with out having any hyperT symptoms.

Stress can be worse on you than anything else right now. You got into an Endo. hopefully they will be a bit more agressive with treatment especially if you stress you want your Ft4 level in the 50-80% range of normal and an optimal TSH near 1! Go in and ask up front if they know what the latest NORMAL TSH range is according to their own medical society (A A C E). If the given you .3-3.0 then they are a little behind the times, but you can work with this.. Let them know you read the announced recommendation of the A A C E to refine the normal range to .35-2.5. Ask why the other MDs are so far behind the times. Plead for help, stroke the Endo's ego.. they should still treat you you have a valid documented arguement for treatment by your TSH alone. Push them to get more T4 in you for the sake of your child. Tell them that the you are desperate.. if it is a guy SOMETIMES crying will help. You are still in the 12 -22 week recovery period. If you can get your levels up quickly with in this period any issue that may be present now should be reversible. Even with a perfectly functioning thyroid and perfect hormone levels there is a 2.5% chance of the fetus developing an issue. So number wise you are not that bad off and the fetus will be getting the majority of your T4. The little guy/gal right now has MUCH lower T4 demands than you. They take between 30-50% of your T4 depending on the phase of development. You would both benefit from an increase now when brain development is occuring, that is the only reason I would even recommend boosting your T4 medication. SO that it is noted I would call and ask your GP if they think given known pregnancy demands require an increase in thyroid medication by 30-50%, if they thought taking 1.5 75 mcg tablets would harm you given your current TSH of 3.7 and hypothyroid state and your concern for the impact on your developing fetus. I would bet the nurse will call you back SOON and say go ahead let the Endo know when you see him.

It looks like you are getting a grip on your situation and things will be just fine. Since the GP was so responsive, when you call to ask about increasing your dosage you should also request a referral to an Maternal Fetal Medicine specialist to insure that you and your fetus are getting the best OB-thyroid care. Let him know that your OB is the main MD dropping the ball and that you would be very appreciative of any help that your GP provided at this point.

Good luck and keep us posted.
MG
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