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Old 08-26-2009, 06:33 AM   #1
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Help with TSH please

Hi.
I had a routine blood test during a physical and it showed an elevated TSH of 6.76. My physician wrote a note on the results which recommended retesting in 3 months. I did that and the TSH was 9.75. He advised waiting 4-6 weeks and testing again. I did that and it was down a bit to 7.75.
He now says I should retest in 3 months and evaluate then
Do these numbers seem reasonably low? Should I be pushing for a T4 or other test?
What are common ranges for hypothyroidism.

Last edited by M3lmims; 08-26-2009 at 08:29 AM.

 
Old 08-26-2009, 07:29 AM   #2
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Re: Help with TSH please

My TSH was just tested at 8.64 and I am hypo and had to increase my meds.
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Dx Grave's 10/2005 (High TSI level)
PTU Meds started 1/2007
Dx Toxic multinodular goiter 7/2009
Total Thyroidectomy 7/10/2009 (Benign)

 
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Old 08-26-2009, 07:40 AM   #3
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Re: Help with TSH please

If you have symptoms, you should be pushing for treatment.
Healthy people without thyroid disease have TSH of about 1 - 1.5.

There is absolutely no reason to do all that waiting and thumb-twiddling if you feel bad. You have hypothyroid-level TSH.

 
Old 08-26-2009, 07:53 AM   #4
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Re: Help with TSH please

Thanks for the advice.
Should I ask for additional testing?
A referral to a specialist?
I am pretty clueless when it comes to docs and I was raised to think they are one step below priests in infallibility... So I am slightly reluctant to question them, but I feel like I am going through this a little slowly.

 
Old 08-26-2009, 08:06 AM   #5
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Re: Help with TSH please

Is this dr a endocrinologist? If so I am really surprised he isn't checking your free T4 and T3 as well.. I would in all honesty just go to another endo that is going to check everything out for you.. My level is lower than yours and I feel awful! No sense you having to go around all these months like this..

If I were you I'd either ask them to check your free T4 level in conjunction with the TSH or just go to someone else altogether. You definitely have something going on here that needs to be treated.
__________________
Dx Grave's 10/2005 (High TSI level)
PTU Meds started 1/2007
Dx Toxic multinodular goiter 7/2009
Total Thyroidectomy 7/10/2009 (Benign)

 
Old 08-26-2009, 08:22 AM   #6
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Re: Help with TSH please

No he is not an endo, just my primary care physician. I just went in for a physical and got these results. I have not seen him since the physical, I go in for the labs, and he writes notes on the results of my labs.
I may ask him for a referral to an endocrinologist or a T4.
Again thanks.
PS I do feel like poo... I thought is was just me pushin' 50. In a weird way, I am somewhat relieved to possibly have a reason I feel this way other than weltschmerz..

Last edited by M3lmims; 08-26-2009 at 08:24 AM.

 
Old 08-26-2009, 08:41 AM   #7
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Re: Help with TSH please

I will never understand why primary drs don't refer to the specialists, especially with numbers like yours.. I would RUN to an endocrinologist.. Don't even ask this dr to do the T4, I would get completely out from under him and see an endo asap. I know many people say you need to look at more than just the TSH, but I can tell you from that number on the TSH alone there is clearly a problem with hypothyroidism.. the normal range is about 0.5-5.0 with most people feeling their best about 1.0 .. you are way too high. I am just perplexed as to why this physician would let you go this long like this. Please update when you can..
__________________
Dx Grave's 10/2005 (High TSI level)
PTU Meds started 1/2007
Dx Toxic multinodular goiter 7/2009
Total Thyroidectomy 7/10/2009 (Benign)

 
Old 08-26-2009, 10:32 AM   #8
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Re: Help with TSH please

I don't think you necessarily need a specialist. You just need a primary who isn't living in the dark ages when it comes to TSH. It appears he's one of the dinosaurs left who thinks that TSH below 10 never needs treatment. Ten was the standard to treat not all that long ago.

You need to point him in the direction of the American Assn of Clinical Endo's 2002 statement that says the current typical lab ranges are too broad and that TSH above 3 is hypothyroid for most of the population. It's pretty easy info to find, if you want to do that yourself and print it for him. That's not to say it'll definitely convince him, but you can always seek your diagnosis from someone else if it doesn't.

 
Old 08-27-2009, 05:17 AM   #9
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Re: Help with TSH please

Again thanks for the help.
At least I have a few options.
I will probably go talk with my primary care guy and use the endo option as a fallback if he proves too reluctant.

 
Old 08-27-2009, 07:05 AM   #10
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Re: Help with TSH please

That TSH sounds way out of range to be feeling normal, I would think.

sorry, but don't just rely on the Primary Physician. My internist always sends me to specialists.

Part of the job of an internist is to KNOW when to refer you to someone in that specialty.
.That is their job.

They treat infections and illnesses but if you have a heart condition you don't stick with him --you go to a cardiologist and if you have Thyroid disease you go to an Endo.

After surgery for removal of a nodule and one lobe, my lab test results showed a high TSH --I was gaining weight, couldn't walk, night sweats, chills, muscle and joint aches...That should not be happening to a healthy person.

If your TSH is high, thyroid blood level is LOW.

I thought I was having new menopause symptoms! My gyno was very perplexed.

What are your symptoms?
Why would your TSH be so high? That is the question.

Last edited by golfhat; 08-27-2009 at 07:18 AM.

 
Old 08-27-2009, 07:42 AM   #11
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Re: Help with TSH please

I'm with Midwest here. I've seen more specialists than you can shake a stick at and I didn't get good thyroid care until I found a family medicine doc who had an interest in thyroid disease and was wiling to listen to ME.

The problem with many endocrinologists is they are for the most part, practicing hypothyroidism guidelines that are stuck in the 70s or 80s. They seem to have no interest in treating by anything but numbers and have a dismal record when it comes to listening to patients. I agree that with serious thyroid conditions like large nodules and cancer detection they do have their place, but they seem to be geared only towards these more serious conditions and this leaves those of us with more typical and harder to detect thyroid conditions left behind and not treated. I was treated very rudely by the one endo I saw, he basically asked my why I was wasting his time with my "normal" labs and sent me on my way. This was over 15 years ago and I suffered ever since.

In your case, M3L, with a high TSH it is very important that you find good treatment and you need a much better work-up. Obviously the doc you are currently seeing is dropping the ball big-time. And it's very likely an endo would probably order the right tests and treat based on your numbers. But the key is to find a practitioner who will continue to treat by symptom relief and not just by the TSH. Also to find someone who is open to the two big treatment options for hypothyroidism, natural thyriod hormones vs synthetics. That is where it gets very difficult to find a good specialist, they do exist but they are a tiny minority. They also tend to be much harder to get into and more expensive so good follow-up and the frequent testing that is necessary for tracking treatment can be more difficult. So I'm in the camp that says find a good doctor or practitioner who will do the right testing and if your labs, ultrasound results or exam points to something that really needs specialized attention, then go to the specialist. But for regular hypothyroidism I don't think a specialist is mandatory.

Just my two cents worth!

 
Old 08-27-2009, 08:29 AM   #12
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Re: Help with TSH please

Sorry for the naive nature of my questions, but I am very new to this and again, thanks to ALL for the considerate replies.

Do you have any suggestions about how to go about finding a good doc? Is it just persistence and shoe leather?
Can one post a thread here asking for specific advice (i.e. "Can anyone recommend a good doc in Winston-Salem, NC) or are things like that against the rules here?

 
Old 08-27-2009, 09:04 AM   #13
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Re: Help with TSH please

You said a routine blood test. But routine blood work does not look for Thyroid levels. so your doc must have thought something was wrong with You.

So do you have symptoms at all? Or was this just a total shock?

I forgot to tell you...My surgeon had to recommend me to an Endo in order for them to even look at my records.
I could not make my appt without the surgeon saying to. I have a PPO and can see anyone I want except this Endo office will not just see anyone off the street just cause they think they are sick.

So you are doing the right thing by going to your ENT or Primary first.

A second opinion wouldn't hurt and then you will have something to take back to your primary if you want to stick with him for this treatment.

Last edited by golfhat; 08-27-2009 at 09:46 AM.

 
Old 08-27-2009, 10:50 AM   #14
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Re: Help with TSH please

Interesting Golfhat. I had assumed it was a routine blood test as it was take at a routine physical. I did say on my intake form that I felt tired and blue. So maybe my doc is more on the case than I realized.
The endos affiliated with my doc need a referral to be seen. Additionally it is more to see a specialist than a GP with my medical insurance. So I will probably pursue my current doc for the time being.
Thanks

 
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