TSH question of the day

DebE13 · Post by **DebE13** » Wed Nov 19, 2014 5:00 pm

Previously I was taking 775 mcg of levothyroxine a week. The doses varied depending on the day so I'm sticking with the weekly dose in hopes that it is simpler. September 15th My dose was upped to 850mcg/wk. My labs are almost identical except for the TSH.

FT3 Nov. 17- 2.2
Oct. 13- 2.2
Sept. 11- 2.3 pg/mL

FT4 Nov. 17- 1.2
Oct. 13- 1.2
Sept. 11- 1.2 ng/dL

TSH Nov. 17- 0.69
Oct. 13- 1.16
Sept. 11- 4.91 uIU/mL

What does that mean? Throughout this time I continued to take 5mcg/day of liothyronine. I continue to feel run down and exhausted. I never wake feeling rested and look like hell. My endo said his goal for my TSH is between 0.35 and 2.5 and will not oblige my request to get my FT3 numbers in the higher range of his normal. He is very content with where I'm at. What I don't understand is how such a big increase in meds has no effect on my FT3&4 numbers. ???? Does it matter? It hasn't changed how I feel.

Post by **tex** » Wed Nov 19, 2014 8:38 pm

Deb wrote:What does that mean?

It means that you're using all of it and still being undertreated. Sure your Endo is happy — it's no hide off his butt, and he probably wakes up happy and refreshed every morning.

IMO, until your Free T4 increases (or you show signs of thyroid sufficiency), you're being undertreated, regardless of what your TSH does. If you still had a thyroid gland, the lower TSH would be a signal for it to produce less T4. But you don't have a thyroid, so it can't produce less.

If your supplementation rate was too high, then your Free T4 and/or your Free T3 should have increased, or you should be showing symptoms of hyperthyroidism. Since neither of those scenarios actually occurred, your dose is still too low.

At least that's the way I see it, but as we all know, I ain't no endo.

Tex

DebE13 · Post by **DebE13** » Wed Nov 19, 2014 8:57 pm

Thanks Tex. i wanted confirmation that I'm not off base. My only problem now is finding one who agrees. There aren't many in my area and they all fit the same mold of looking at their text book numbers and not listening to how I actually feel. Hmmm, it's a dilemma.

dfpowell · Post by **dfpowell** » Fri Nov 21, 2014 4:49 pm

Hi Deb,

Just a thought, have you had your adrenals checked? One of the first things my integrative medicine doctor ordered was an Adrenocortex Stress Profile before looking at thyroid function.

DebE13 · Post by **DebE13** » Sat Nov 22, 2014 1:32 pm

Thanks Donna,

I haven't. It's been a stuggle to get this far. My cancer dx was the only reason the Hashimotos was found. Since my numbers were always within the normal range I couldn't get anyone to address possible thyroid issues. I've had adrenals at the back of my mind but my brain fog has returned and it's slowing me down. I almost feel like I've had one too many to drink. It's the opening of deer hunting season here, which is huge in this area. All the boys are off in the woods and I should be having a productive day by myself but so far I've managed to take two naps and seem to just float from room to room. What I've actually accomplished...... Beats me. I would insert a haha face here but I'm totally disgusted with the situation. The real me that wants to get up and go is locked far away in a distant spot in my mind. Alert enough to be really t'd off.

Thanks for the reminder!

dfpowell · Post by **dfpowell** » Sat Nov 22, 2014 5:22 pm

Deb,

If you want to check adrenal levels on your own, you can order a test kit online or find a lab in your area. There are several labs in the MPLS area that provide services, without a MD order, tests cost about 120 dollars.

DebE13 · Post by **DebE13** » Sat Nov 22, 2014 6:01 pm

That's good to know, thank you. I would most likely schedule and appointment with my family doc to see if she would humor my request and have it covered under my insurance. I am fortunate to have all labwork paid at 100%.

dfpowell · Post by **dfpowell** » Sat Nov 22, 2014 7:07 pm

Deb,

Good idea to use your resources. Stop the Thyroid Madness probably has some supporting information you could present to your doctor when you make the request. Your adrenal status may put some light on your thyroid issue. The 2 integrative MDs I saw this past year were interested in knowing what my adrenal status was before changing thyroid medication. Good Luck!

DebE13 · Post by **DebE13** » Sun Nov 23, 2014 5:34 am

Thanks Donna. The only thing I wonder is if I am being under treated, then does it make a difference chasing other potential problems until that is addressed? But then again, a problem is a problem. Nothing like riding the fence, huh? I know I need to do something but paying to see someone so I can just hit a brick wall is something I'd like to avoid. Been there, done that too many times. But I know doing nothing won't get me anywhere either.

I have the Stop the Madness book- good info there too.

The following links were provided to me from a thyroid cancer survivor's forum. It was useful but discouraging at the same time. There aren't many close to me and the few that are would be out of network with no guarantees of their take on my treatment. One I found had litigation against him for treating a patient for thyroid issues when their numbers were within the normal range. Sigh. I didn't read that far into it when I found the "quack" alert from googling his name so I could be totally off base with the details of the lawsuit but that caught my eye. I remember my own endo citing doctrine from the holy outdated medical texts referring to doing no harm...... I understand the lawsuit happy world we live in but I wish there was a waiver I could sign relinquishing him from responsibility for getting my numbers where I would like to see them, which would still be in his normal range, just on the higher end. I feel a rant creeping up on me so I will end it there, haha.

My fear is the doctor appointment will play out as it has in the past with an offer of antidepressants and and a referral to a rhuematologist (and an offer of more drugs I won't take). It sure is difficult situation that shouldn't be.....I can understand their frustration with me because I shut down every option they are trained to offer. When will health insurance start covering visits to more useful practitioners?
----
Links to doctor lists

When you get to the actual physician list click on a heading like "state" to sort by state or province, etc
http://www.thyroidchange.org/list-of-doctors.html

finding docs by prescribers:
http://projects.propublica.org/checkup/
One way to make it work is go to say "Armour" or "Liothyronine" in the "Top Drugs" list, then go into that by clicking into it, then click on your state on the left and it shows the most to least prescribing doctors of that exact thing. So if you want Armour in your state you have a list of docs that do it. But they have to do at least 50 prescriptions of it I guess.

Slightly older and no longer updated, but still valuable:
http://thyroid.about.com/cs/doctors/a/topdocs.htm

Some osteopathic physicians will look more into T3 and T4, some but not all
http://www.osteopathic.org/osteopathic- ... earch.aspx

Naturopaths in some states can give prescriptions, select Adrenal/endocrinology disorders and enter zip code
http://www.naturopathic.org/AF_MemberDi ... ?version=2

Post by **tex** » Sun Nov 23, 2014 10:20 am

Deb wrote:The only thing I wonder is if I am being under treated, then does it make a difference chasing other potential problems until that is addressed?

It's possible that the reason why you are undertreated is because of adrenal issues. Adrenal issues trump thyroid problems, because the adrenals are farther up the command chain in the hormonal system. Until any existing adrenal issues are addressed, it's not possible to obtain an optimal thyroid solution.

But that's just my opinion, and I could be all wet.

Tex

DebE13 · Post by **DebE13** » Fri Nov 28, 2014 5:14 pm

Then it would be worth it to make an appointment with my PCP and see what she has to say since my endo made it clear I don't need to be seen until spring. Thanks all for the insight.