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    Old 08-14-2007, 09:53 PM   #1
    Tip'sfriend
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    Please help me figure out test results

    I am wandering if anyone had any advice on what my results mean? I have Tricare (military insurance). I battled my doctor to get some tests done because I have every symptom of hypothyroid. The doctor said I was being ridiculous--"I need to take long walks, vitamins, and fiber".--His words. According to him "results are normal and he does not want to hear any more talk about thyroid".
    My results were:
    ESR 26 (0-20 range)
    TSH Ultra 4.21 (0.35-5.5 range)
    FT4 0.890 (0.64-1.85)
    Please! Any help would be so appreciated--
    Thank you in advance!

     
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    Old 08-14-2007, 11:35 PM   #2
    midwest1
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    Re: Please help me figure out test results

    Listen... Just smack him for me, then do it again for yourself. Feels good, doesn't it?

    According to data presented in he National Academy of Clinical Biochemistry's Laboratory Medicine Practice Guidelines, it is likely that the upper limit of the TSH reference range will eventually be reduced to 2.5 mIU/L because 95% of rigorously screened volunteers without any evidence of thyroid disease have serum TSH values between 0.4 and 2.5 mIU/L. Most are around 1.

    In 2002, a task force for the American Acad. of Clinical Endos updated their guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. They suggest that for patients on thyroxine replacement therapy, "The target TSH level should be between 0.3 and 3.0 uIU/mL". By inference this suggests that any patient not yet in treatment who has TSH outside this range has an "abnormal" level which should be "carefully followed but not necessarily treated". Some doctors, however, will go ahead and treat marginally abnormal TSH when coupled with positive TPO antibody titers because of the high progression rate to full-blown hypothyroidism. Other endocrine organizations such as The Endocrine Society and the American Thyroid Association are in agreement with this position.

    Bet your guy didn't even look for TPO or Tg antibodies, did he? Wouldn't even recognize them if they smacked him like you just did. Your free T4 level should be at least 1.2 - 1.3 to be adequate. I'd bet that your free T3 would be similarly low-normal if Dr. Smarty-Pants would bother to test it.

    You're hypothyroid, my dear. Please... please find a competent doctor who will recognize it and be willing to help.

     
    Old 08-15-2007, 08:21 AM   #3
    Tip'sfriend
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    Re: Please help me figure out test results

    Thank you so much for your reply. Just hearing from someone else makes me feel better! I fought hard to get those tests done. I will just have to pay out of pocket to go to someone else since I am pretty sure he won't talk about thyroid with me anymore. I made one last appt. and will push to get the other tests you mentioned. I don't understand why it is so hard for a doctor to let you at least try medication if you have the symptoms--it is not like I am asking them for painkillers! I also had told him that my mom had thyroid and parathyroid issues and he said that meant nothing hypothyroidism is not contagious--isn't family history important regarding thyriod issues? Again--thank you!

     
    Old 08-15-2007, 09:17 AM   #4
    midwest1
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    Re: Please help me figure out test results

    Family history is absolutely important! What an idiot!

    The most common cause of hypothyroidism is an autoimmune disease known as Hashimoto's thyroiditis. Up to 80% of people affected by hypoT have one or both antibodies associated with the disease... TPO and/or Tg antibodies. There are simple blood tests for both. About 10-20% of afflicted people don't test positive for these antibodies. If a biopsy of thyroid tissue were to be done, Hashi's would be revealed.

    Autoimmune disorders are very familial. My mother was hypo, as am I and my daughter. I tested positive for Hashi's, but neither mom nor daughter have had tests for it. It's reasonable to assume they had/have the antibodies as well.

    I wonder if your MD's degree came from a Cracker Jack box? Unfortunately, even the students who graduate at the very bottom of the class get the MD just like the aces at the top. And then, I have to wonder too... how many cheat their way to get even to the bottom?

     
    Old 08-15-2007, 11:09 AM   #5
    katkatdd
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    Re: Please help me figure out test results

    Ditto what everyone else said. Ugg.. How frustrating for you. Isn't it the worse when these dr's will not even recognize the symptoms you are having and indeed your labs show something is going on! Sheesh...

    Get to another dr ASAP!

    P.S. And slap that dr for me 2 ok? heehee..

     
    Old 08-15-2007, 01:56 PM   #6
    grace1908
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    Re: Please help me figure out test results

    Just because you have tricare doesn't mean that you have to put up with such an uncompassionate doctor. Is he your primary care doc or an Endocrinologist? If he is your primary, switch to another doc. If he treats you like that on an apparent hypothyroidism situation, who knows how he will treat you on any other medical concerns in the future. You need to be refered to an Endocrinologist (thyroid specialist) or at least a more knowledgeable doctor. You do not deserve to suffer when treatment is just around the corner. Also, I didn't like the word "contagious". He sounded very condescending. Yes thyroid issues can be heriditary or can be the first example in a family history. It all depends on the person.

    Hope you start feeling better soon.

    Grace

     
    Old 08-15-2007, 05:02 PM   #7
    Bran'sNana
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    Re: Please help me figure out test results

    and where did he graduate from IDIOT U???? Give him 3 slaps.What a JERK!!! It isn't contagious...poor people(women) that don't have a computer so they can be on these kind of boards for support...what the H did they do 20 years ago or MORE? How many women suffered needlessly???

     
    Old 08-15-2007, 07:03 PM   #8
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    Re: Please help me figure out test results

    Tricare Prime or Tricare Standard? Are you being seen at an MTF or civilian provider? I have Tricare. I have absolutely no problem getting tests I need. They haven't quibbled once. They also have a very effective greivance procedure that actually works. The only problem I've run into is with idiot doctors who don't know what tests to order.

     
    Old 08-15-2007, 10:01 PM   #9
    Tip'sfriend
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    Re: Please help me figure out test results

    Thank you so much for everyone's post! I have Tricare Prime--I think I may have to switch to Tricare Standard that allows me to see civilian doctors with a higher cost share. I get nothing but a lot of runaround from the military treatment facility that I have to go to currently. I plan on pleading my case one more time at my next appt and then just paying out of pocket to see a civilian doctor. I am amazed that I have come across so many doctors who flat out just did not care about the patient. Any tips on how you got Tricare to cover thyroid--my doctor said they are not going to cover meds if I am in the normal TSH range--even high normal. Were you out of the range before treatment could start? Thank you for any advice! ps--I had to contact the patient affairs dept to get my next appt--is this the grievance procedure you mean?

    Last edited by Tip'sfriend; 08-15-2007 at 10:12 PM. Reason: another question to add.

     
    Old 08-16-2007, 05:22 AM   #10
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    Re: Please help me figure out test results

    I have prime but I'm lucky enough to live out in the middle of nowhere. 300 miles to an MTF. I've got a civilian PCM. I only switched to prime cause the only local doc happened to be a PCM and it would save me oodles of $$$'s. When my thyroid was first diagnosed, I was on standard. I had a alot more flexability. If you could drop prime at the renewal, you'd be much better off and won't be locked out from going back on for a year or whatever it is. Get you a civilian doc and get your diagnosis. Then go back on prime.

    My thyroid labs were "in range" when I first was diagnosed. Not much else was though.

    Tricare will cover anything as long as the diagnosis code is coded properly. Tests must be appropriate for the condition that you have or they suspect you have. The pharmacy benefit will fill any prescription written by a doctor. They don't ask for a diagnosis. You can have prescriptions filled thru mail order or a local pharmacy for a small copay. You are not required to have them filled on base.

    Get a copy of the manual. They are available online. Lot's in there about the benefits. It's good insurance if you know what they offer and how to use it right. The grievance procedure's in the back of the manual.

    Good luck.

    Helen

     
    Old 08-16-2007, 05:26 PM   #11
    Tip'sfriend
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    Re: Please help me figure out test results

    I just went and picked up more lab results that had not come back when I got my TSh results. Does this support hypothyroidism or make it less likely hypothyriodism? I have been prowling around the internet and am confused by all the thyriod tests and what exactly they mean. Does anyone understand what the tests I had done measure or mean? I appreciate any help more than you know!!

    Thyroglobulin Antibodies 33.4 (0-60)
    Thyroid Pero Antibodies <15 (0-60

    TSH ultra 4.21 (0.35-5.5)
    FT4 0.89 (0.64-1.85)

     
    Old 08-17-2007, 03:57 AM   #12
    accessn12
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    Re: Please help me figure out test results

    Midwest, you got a comment on these? Sure looks like it needs a closer look to me. I'm going to let her explain it cause she does it so well.

    Those done at the MTF? They're still using the old ranges. When does your prime come up for renewal? I think you're going to need a civilian doc on this one. At least to get you started.

     
    Old 08-17-2007, 05:42 AM   #13
    GCC
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    Re: Please help me figure out test results

    Even doctors from the ivy league schools, like my last endocrinologist (who was a Harvard undergraduate and med school graduate) don't have a full understanding of what it takes to feel normal.

    They are taught that all they have to do is get your TSH in "normal range" and they have done all they need to do. A few years ago they did finally realize that the "nornal range" of TSH was way too high (and lots of Gp's still don't know this). These same experts still don't think our quality of life is affected by a low Free T3. I know it is.

    But they often still ignore free T3 levels. When that is low, you are likely to feel hypo symptoms no matter what your TSH (pitutary hormone) is.

    Do what ever you have to do to find a doctor who will treat your problems so you will have the quality of life you were meant to. Don't give up and best wishes.
    __________________
    25 years feeling worse every year on Synthroid & 13 months feel good on Armour Thyroid.

     
    Old 08-17-2007, 09:39 AM   #14
    midwest1
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    Re: Please help me figure out test results

    I have seen at least 2 members on the board diagnosed with Hashimoto's disease based on positive thyroglobulin (Tg) antibodies and negative thyroperoxidase (TPO) antibodies. Some MDs only test for TPOs, so at least some cases of Hashi's are missed due to their ignorance.

    You aren't exactly positive for anti-Tgs, but you aren't negative either. IMO, even though they're still in range, they aren't at 0-2, which IMO would be "negative".

    I think you're definitely hypothyroid, based on the TSH and FT4 alone. The "not exactly negative" anti-Tgs explain why you are.

    Pursue this. I think if you an locate the right MD, you'll get treated.

    Last edited by midwest1; 08-17-2007 at 09:41 AM.

     
    Old 08-20-2007, 06:38 AM   #15
    Tip'sfriend
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    Re: Please help me figure out test results

    I am hopeful for the first time, after posting here, that if I just keep pursueing this issue I might get treated. If doctors know that you do best with tsh 1-2 why do they make you go out of normal range before bringing you back down to the 'optimum'? Is there a legitimate reason to wait to treat that anyone knows about? Everyone's help here has been wonderful--thank you for your time spent helping me decipher lab work.

     
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