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Old 05-16-2012, 06:32 AM   #1
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What on earth is my doc talking about?

Here is the latest email I got from my doc after requesting a med raise:

"I definitely understand your concerns and so I would like for us to get a second opinion from an Endocrinologist who is very accomplished with thyroid treatment as well. Whenever the treatment causes a suppressed TSH despite normal levels of T4/T3 I always like to get another opinion on this."

A suppressed TSH DESPITE normal levels? Huh?

Background: My docs for years have been treating me so that my Frees are always and forever below midrange, and sometimes my FT4 has even dropped OFF the radar (too low). Until I took my health in my own hands from feeling awful so long, I didn't ever request labs or understand them. NOW I get it.

My labs two months ago were FT3 at 46% of the range and FT4 at 5% of the range, with TSH <.006 on 3.5 grains Armour. He switched me then to 2 grains Armour plus 112mcg Synthroid.

Latest labs show my FT3 at 36% of the range and my FT4 at 20% of the range, but bc my TSH is still <.006 he doesn't want to up my dose. I feel horrible. AND I'm 17 wks pregnant. I feel like I have only enough to survive each day and no more.

I begged for a raise, quoting studies about TSH, telling him it is not MY normal, etc, asking just to introduce 15mg Armour and see where that takes me.

His response is above. I'm crushed. The endo is out of network and costs money I don't have, so I've just been adding the 15mg Armour myself.

Can someone help me understand?

is my TSH really that scary that he only wants to see that and ignore my Frees?

Last edited by Camirae; 05-16-2012 at 06:36 AM.

 
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Old 05-16-2012, 07:38 AM   #2
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Re: What on earth is my doc talking about?

TSH is scary because clueless doctors haven't kept up with things and those same doctors make their dosing decisions based upon pituitary hormone TSH.

Studies have shown that a low/suppressed TSH is of no concern as long as the actual thyroid hormone levels (FreeT4 and FreeT3) are within the normal range (or even slightly above-range) *and* the patient doesn't have any symptoms.

Do yourself a favor and go to the treatment section of the Armour website - you'll see that paragraph 2 shows that Armour is indicated as a pituitary TSH suppressant. It doesn't seem like your doctor is aware of the prescribing information.
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Old 05-16-2012, 07:56 AM   #3
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Re: What on earth is my doc talking about?

Good to know, but what if I don't convince him? What would you do? I'm running out of docs.

I did go ahead and raise anyway. Sigh.

 
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Old 05-16-2012, 08:31 AM   #4
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Re: What on earth is my doc talking about?

what about your gyn? since you're pregnant can he/she do the thyroid follow up?

Last edited by lisa789; 05-16-2012 at 08:32 AM.

 
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Old 05-16-2012, 08:57 AM   #5
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Re: What on earth is my doc talking about?

My OBGYN wanted to lower my dose to something minuscule bc all he knows is TSH.

 
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Old 05-16-2012, 09:06 AM   #6
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Re: What on earth is my doc talking about?

Why is there so much conflicting info, even on thyroid forums? Another place I asked this question to said normal TSH should be 1. It should not be suppressed. That I'm going to get osteoporosis. Sigh. Yet if I back off on my meds to get that TSH to 1, I won't even have enough meds in my body to survive!

 
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Old 05-16-2012, 09:09 AM   #7
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Re: What on earth is my doc talking about?

I'm sorry my little "hint" didn't get you the dose increase you need. It's amazing how a doctor who prescribes Armour doesn't understand how it works. But then, doctors never cease to amaze me with what they don't know.


Yes, do try to enlist your GYN's help with this. Being hypothyroid does increase the risks to a successful pregnancy. Do be pro-active, but please don't stress. The stress is worse than the hypoT for a pregnant mom.
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Old 05-16-2012, 09:13 AM   #8
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Re: What on earth is my doc talking about?

Oops. I missed your followups while composing my last answer.

T4 therapy - aka Synthroid and other levothyroxines - entails a target TSH of 1. Natural thyroid products are very different. They contain T3, which always suppresses TSH well to near zero. The problem is, so few MDs are willing to prescribe T3, the others don't understand this effect. Again... It's amazing that one who does prescribe it doesn't understand.

Don't worry about your bones with low TSH. They don't need TSH. They need optimal amounts of T4 and T3.
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Old 05-16-2012, 09:14 AM   #9
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Re: What on earth is my doc talking about?

Midwest, thanks.

Yeah. Bummed that it didn't work.

My OBGYN is of no help. He wanted me to drop my dose IN HALF bc all he knows is TSH.

If you don't mind, can you answer my question above yours? Osteoporosis? Normal TSH is supposed to be ONE? Huh?

 
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Old 05-16-2012, 09:16 AM   #10
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Re: What on earth is my doc talking about?

HEY, you already replied! You're awesome!

Also, this is my sixth child and all were conceived while my Frees have been miserable. Ive not been able to find ANY doc who will look beyond my TSH. I'm even going out of state now to a "top thyroid doc" and he doesn't get it, either.....which make me really panic that there IS something wrong with my TSH.

 
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Old 05-16-2012, 09:17 AM   #11
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Re: What on earth is my doc talking about?

Quote:
Originally Posted by Camirae View Post
If you don't mind, can you answer my question above yours? Osteoporosis? Normal TSH is supposed to be ONE? Huh?
I addressed it in my previous answer.
I'm out of time now, but sometime in the next day or two, I'll elaborate on the osteoP issue and hypoT treatment.
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Old 05-16-2012, 09:18 AM   #12
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Re: What on earth is my doc talking about?

thanks! I'll be patient!

 
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Old 05-16-2012, 11:37 AM   #13
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Re: What on earth is my doc talking about?

A thyroid expert summarized a large, recent British Study that confirmed low TSH is of no concern..

You can find the article by searching for its title: A Low TSH Doesn't Increase Morbidity.

The study only addressed TSH as low as .04 but:

"The authors of the new study did however emphasize the need to correlate thyroid hormone levels with TSH. This would help in determining a TSH level that’s truly low (accompanied by high thyroid hormone levels) as opposed to a TSH level that’s falsely decreased."

TSH is falsely decreased when the patient takes T3.

A person taking proper amounts of thyroid hormone will not have "high" (over-range) thyroid hormone levels.

These are logical conclusions that many doctors fail to reach.

Thank goodness my doctor isn't one of them.


PS
I, too, take T3 and, on a "good" day, my TSH is .011
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Last edited by sammy64; 05-16-2012 at 11:42 AM.

 
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Old 05-16-2012, 04:13 PM   #14
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Re: What on earth is my doc talking about?

I just went back and looked through three years of labs. My TSH doesn't correlate with a darn thing. it just does what it wants, apparently.

For instance:
FT4 out of the range low, FT3 low range, TSH .05
OR
FT4 low range, FT3 above range, TSH 3.25 (I believe I also took meds before this lab draw, though)

Apparently my brain is confused. LOL.

Last edited by Camirae; 05-16-2012 at 04:15 PM.

 
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Old 05-16-2012, 04:51 PM   #15
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Re: What on earth is my doc talking about?

Quote:
Originally Posted by Camirae View Post
My TSH doesn't correlate with a darn thing. it just does what it wants, apparently.
This is why thyroid-savvy doctors treat based upon the actual thyroid hormone levels - FreeT4 and FreeT3 - and not pituitary hormone TSH.
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