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  • Lab Results vs Symtpoms vs Small town doctor

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    Old 04-23-2016, 11:26 AM   #1
    Heather7204
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    Smile Lab Results vs Symtpoms vs Small town doctor

    Hello all,

    I have suspected I have a thyroid issue for a while, mainly from the fatigue, 20 pound weight gain this last year, my eyebrows falling out, horribly dry skin.

    I just got insurance again after a couple of years without it and started with a new doctor. I talked about all my 'on going' issues from before but noted that I am sincerely interested to know about my thyroid because I feel like I might have an issue.

    I was able to see online that she only ordered TSH and FT4 in the blood work. My TSH was 1.48 and the FT4 was 1.07. According to the Mayo clinic that 1.07 FT4 is enough combined with symptoms to warrant treatment. I also read that some endo's now say even 1.5 on the TSH is where hypo should be at. So a 1.48 and a 1.07 plus symptoms seems like it should be a flag.

    I stumbled upon the classic symptoms list of Hashsimoto's during my reading and I literally have -every- symptom, down to the 'especially hip and shoulder pain' that only began in the last year.

    I can see what 'current diagnosis' the medical professional listed and nothing to do with my thyroid is on the plan of treatment, so I know when I go back she is going to tell me 'you were perfectly normal' and do nothing.

    Should I push for more? I'm so tired of being sick. How do I push for a full panel or a referral to an endo without ticking her off for daring to question her?

    Thank you so much for your help..

     
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    Old 04-23-2016, 11:55 AM   #2
    mmp463
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    Talking Re: Lab Results vs Symtpoms vs Small town doctor

    Quote:
    Originally Posted by Heather7204 View Post
    Hello all,

    I have suspected I have a thyroid issue for a while, mainly from the fatigue, 20 pound weight gain this last year, my eyebrows falling out, horribly dry skin.

    I just got insurance again after a couple of years without it and started with a new doctor. I talked about all my 'on going' issues from before but noted that I am sincerely interested to know about my thyroid because I feel like I might have an issue.

    I was able to see online that she only ordered TSH and FT4 in the blood work. My TSH was 1.48 and the FT4 was 1.07. According to the Mayo clinic that 1.07 FT4 is enough combined with symptoms to warrant treatment. I also read that some endo's now say even 1.5 on the TSH is where hypo should be at. So a 1.48 and a 1.07 plus symptoms seems like it should be a flag.

    I stumbled upon the classic symptoms list of Hashsimoto's during my reading and I literally have -every- symptom, down to the 'especially hip and shoulder pain' that only began in the last year.

    I can see what 'current diagnosis' the medical professional listed and nothing to do with my thyroid is on the plan of treatment, so I know when I go back she is going to tell me 'you were perfectly normal' and do nothing.

    Should I push for more? I'm so tired of being sick. How do I push for a full panel or a referral to an endo without ticking her off for daring to question her?

    Thank you so much for your help..

     
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    Old 04-23-2016, 12:03 PM   #3
    mmp463
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    Re: Lab Results vs Symtpoms vs Small town doctor

    Sometimes finding a good doctor is the key to feeling better. When a doctor submits labs every 6 months to determine where you are and listens to you to describe how you feel, you will end up feeling better. My doctor submitted a requisition to the lab to see where all of my hormone levels were. Now I am on 2 gm. of Armour thyroid and compounded progesterone and compounded Bi-Est. Along wth medications, I am taking numerous vitamins and minerals to help my thyroid do its job.

     
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    Old 04-23-2016, 11:08 PM   #4
    Harri3t
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    Re: Lab Results vs Symtpoms vs Small town doctor

    I have to agree with mmp though FWIW- your small town doc probably did better than average ordering a FT4 with a TSH. Many conventional docs, endocrinologists included, even in larger cities, just order a TSH and base their diagnosis on that alone. Also FWIW, thyroid symptoms tend to be nonspecific and are shared by many other conditions.

    I couldn't find the reference you did on the mayo clinic site though I can tell you it's at odds with the joint 2012 guidelines of the ATA/AACE (american thyroid association and the american assoc. of clinical endocrinologists) for hypothyroidism. Their recommendation is TSH screening alone with FT4 added only in some instances. Treatment is suggested for TSH >10 with or without symptoms and >4.5-5.0 with symptoms. You can google the complete guidelines in pdf format.

    The reason for cautious treatment is related to concerns about cardiac effects and osteoporosis when need for thyroid replacement isn't measurably clear cut. In that light, it might be easier to understand why some doctors are unwilling to treat a TSH in your range.

    And THAT said, there are more than a few thyroid sufferers and less conventional practitioners that think these guidelines are misguided and that more than tsh and FT4 testing is needed. If you're convinced you're hypoT and your current doctor is unwilling to explore other reasons for your symptoms then it might be worth your while to find another doctor who will also test free t3 levels. Thyroid antibodies are also sometimes recommended especially for women in their child bearing years as they can affect the outcome of pregnancy. But here again, I'd caution you not to be so married to hypoT as a cause of your symptoms that other processes or conditions aren't also explored.

    Wishing you all the best getting your issues sorted out. There is a lot of disagreement even among doctors on when, what, and how to treat. And not all thyroid sufferers respond equally to the same treatment. Educating yourself on thyroid issues is a good place to start and many resources exist on the net that address all treatment approaches. One source that I think midwest, a frequent forum poster here, often suggests is a book called “Thyroid for Dummies”. It explains the basics in understandable terms at least from the viewpoint of more conventional approaches to treatment and imho is also worth a look.

     
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    Old 04-24-2016, 12:36 PM   #5
    levo
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    Re: Lab Results vs Symtpoms vs Small town doctor

    "In the United States, about 90 percent of hypothyroidism cases are due to Hashimoto's. Of the more than 1,500 patients with autoimmune thyroiditis (Hashimoto's) who were included in the study, 16 percent were found to have an additional autoimmune disease."

    Hashimoto's is easily tested with 2 antibody tests, TPOAb and TGAb. It would be great if you could test for that, free T3, and a whole bunch of other things connected to hypothyroidism like b12, vit d, iron panel, etc.

     
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