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Old 01-02-2012, 08:33 PM   #1
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Do I need a new doctor for my hypothyroid condition?

I was officially diagnosed as being hypothyroid in July 2011 when my lab TSH reading was 5.47. I almost cried with relief when I saw the test results because it explained why I'd been gaining weight rapidly over the past year (40 pounds), had issues with constipation that never existed before, couldn't lower my cholesterol levels despite going on statins (& then doubling the dosage), couldn't sweat while exercising (I even stopped getting hot flashes), and was always feeling "blah".

Now, when I look back on my old TSH test results I see the following:

June 2009 - 2.24
June 2010 - 2.44
Sept 2010 - 4.04
July 2011 - 5.47

My doctor started treating me with 25mg of levothyroxine in July of 2011 after the 5.47 TSH reading even though he said that my TSH was only "slightly above normal". Two months after treatment in Sept 2011 my TSH was retested and it was 3.16. I had also asked him to test my T4 and that was normal. There was a little improvement in my energy level and I even started to sweat a little while exercising. I asked my doctor then if we shouldn't try to get my TSH levels down to the 2.2-2.4 levels that I'd had when feeling well and he told me that we should wait because the lab results have a lot of variability.

So... 3 months later in December of 2011 my retest showed a TSH of 4.4 and he tells me that I'm still "normal" (anything under 5.0 is normal for him). I told him that I've again stopped sweating while exercising and that I've started to feel "blah" but he repeats that the test results have a lot of variability and that I'm within the "normal" range.

I asked my doctor to check my TPO levels this past month to find out if I have Hashimoto's (I don't). I asked him if it's important to find out the underlying cause of my hypothyroidism but he said that it's probably just an inflammation of my thyroid gland.

This past weekend I started to feel like there's a little pressure around my lower throat. Swallowing feels odd and I've woken up a couple of times gasping for breath. That has scared me a lot. Which brings me to...

I want to find out if everything that I've been told by my internist is accurate. It kind of bothers me that a lab test has so much error or variability built in that a 100% increase in a result means nothing (going from 2.2 to 4.0). It also bothers me that I'm the one who has to request diagnostic tests to find the root cause of my hypothyroidism. But in the back of my mind I also wonder if I'm being ridiculous since my TSH numbers aren't horribly high. Should I get a consultation from another doctor?

 
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Old 01-03-2012, 12:31 AM   #2
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Re: Do I need a new doctor for my hypothyroid condition?

Absolutely, find a better doctor! That one doesn't know beans about hypothyroidism.

Healthy people have average TSH of about 1, no more than 2. It has been proven that the "normal" ranges for TSH include people with occult thyroid disease and are too broad to catch everyone who is afflicted. Current recommendations are that the ranges should be no higher than 3. (Your MD doesn't read much 'new' literature, does he? This recommendation was made in 2002.)

The levels that matter more are those for free T4 and free T3. The fact that your MD refuses you those all-important tests is another huge mark against him.

Here's another mark against him: A "dose" of 25 mcgs is never a true therapeutic dose. It's only enough to lower TSH without raising free T4/3 at all. It will further hamper natural thyroid production, so all in all, it has the effect of making you even more thyroid deficient than you are already. If that "doctor" refuses to raise your dose to 50 mcgs immediately, cut bait and go fish for a smarter MD. You will get nowhere with him.

In actuality, it isn't really too important to find the cause of your hypothyroidism. The treatment is the same no matter the cause. Just out of curiosity, though, exactly which tests did this "doctor" use to check for Hashimoto's? Both TPO and Tg antibody tests? Even if so, the tests are not infallible, have an error rate of up to 20%.

What you're feeling in your throat is thyroid inflammation. The gland is likely swelling, possibly even forming nodules. Clearly, you don't want that to happen, but it can when a gland is struggling like a trooper to produce enough hormone for your body's needs. Find proper treatment soon.

Oh... and the thing about levels within "normal" range. You have only one place within a range that's right for YOU as an individual. Saying that everything is fine just because a level is in "normal" range is like saying that you can wear any shoe within the typical women's size range. See how absurd that sounds?

You aren't being ridiculous. You're hypothyroid.

Last edited by midwest1; 01-03-2012 at 12:34 AM.

 
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Old 01-03-2012, 08:52 AM   #3
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Re: Do I need a new doctor for my hypothyroid condition?

Thank you so much for your response, Midwest1! In regards to your questions/comments... my doctor started testing my Free T4 back in September when I first asked him if we shouldn't be checking both my T3 and T4. My Free T4 is inside the normal range (1.28 in Sept and 1.32 in Dec with "normal" being .82-1.77). He never did test my Free T3.

For the Hashimoto's tests, he only gave me the test that I asked for which was the TPO test. I didn't know about the Tg antibody test. But then, isn't the doctor supposed to know that??? ;-)

Just curious as to why it's not important to determine the underlying cause of the disease... I've read that under certain circumstances the condition can be reversible and won't require medication for a lifetime. But I also know that that window of opportunity is closing quickly on me.

Will call a new doctor this week to make an appointment. More than anything, it really makes me uncomfortable that my doctor doesn't seem to know the proper tests to run. He should be recommending the tests... not me!

Thanks again for the advice!

 
Old 01-03-2012, 09:29 AM   #4
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Re: Do I need a new doctor for my hypothyroid condition?

Your December FT4 was exactly at range median. That's the bare minimum the majority of people need to function without symptoms. You have symptoms, so apparently, you're in the majority of people who need that level to be upwards of 70% of the range.

FT4 is a storage hormone that's supposed to be converted to the active hormone, T3. If you are a poor converter, as many women are, a low FT3 would contribute to symptoms as well. You wouldn't know this important fact if your FT3 were never tested.

Almost all hypothyroidism in North America (and other places) is caused by Hashimoto's disease. There are alternative practitioners who believe this can be reversed, and perhaps it can... I won't judge. But, IMO, once symptoms present, the damage to the gland has already been done. That damage is irreversible. That gland cannot be resurrected to a great enough degree that it will ever again produce enough hormone for your body to function normally. This is why I say it doesn't matter very much what is causing the hypoT.

There are a few instances where it might be reversed when the cause is corrected. Iodine deficiency would be one; diet high in soy and other goitrogens would be another. Iodine deficiency severe enough to cause hypoT is rare in the US, and a person would need to eat huge amounts of raw goitrogens daily to suppress thyroid function. With Hashi's, there isn't much that can be done except to replace the hormone in a sufficient amount to replace what your body made when it had normal thyroid function.

Please understand that your doctor is not unusual at all - (my bashing of him aside). One article by an MD I once read said that it takes an average of six consultations before a woman gets her hypoT diagnosis. I went through three MDs before I found a diagnosis and optimal treatment. This is a very subjective condition, which can't be diagnosed from black and white lab sheets. Most MDs don't even know which tests are best; they still use the ones they heard about in med school 30 years ago. Often they misinterpret the results even when they happen to order the right tests. This is why it pays to shop around for more knowledgeable ones even when you meet resistance from others.

Please let us know what happens next. Those of us who are being successfully treated stick around here because we genuinely care about those of you who are struggling.

ETA: Oops... Forgot to comment on the antibody tests. Anti-Tg (thyroglobulin) is as important a factor as anti-TPO. I've seen several cases here on the board where someone tested negative for TPO but was positive for Tg. That's Hashi's, too.

Last edited by midwest1; 01-03-2012 at 09:34 AM.

 
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Old 01-03-2012, 09:50 AM   #5
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Re: Do I need a new doctor for my hypothyroid condition?

After reading some more posts here I'm beginning to wonder if the heart palpitations that I started having back in 2009 might not be related to the thyroid problems. My doctor put me on a beta blocker in April of 2010 which now suppresses the palpitations. I kept asking him if the beta blocker was causing my metabolism to slow down but guess that was just the hypoT. Live and learn...

Thanks once more. You're awesome!

 
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hypothyroid, thyroid blood tests, tsh levels, tsh testing?



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