Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
Hi Dr. Lupo, question about labs
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Hi Dr. Lupo, question about labs

I am newly diagnosed with hypothyroidism and taking levothyroxine.  I feel confident in my doctor's protocol for treating me, however, I am confused by some support groups that suggest a number of lab tests that my doctor hasn't ordered, including but not limited to free t3 & 4, vitamins/minerals.  What's up with that?  Is that what is called integrative medicine?  As I said, I'm confident with my care, yet want to make certain I'm doing all I can to actively participate.  I would like to know  in addition to TSH,  what tests do you recommend to use as a guideline for treatment?  What additional testing do you recommend?

I rarely read medical sites on the internet, but do read Mayo clinic information and that site doesn't mention the other tests.  It does mention too much iodine can contribute to hypothyroidism, and to discuss if one consumes  significant amounts of iron, calcium and an ingredient in some antacids.  I doubt iodine is the culprit for me, as I do not salt anything nor do I eat very much prepackaged foods.  As far as iron, I take a multi-vitamin, but not a "plus iron" formulation.  In addition to the mulitvitamin, I take a calcium supplement and consume dairy regularly, hope that is ok.  I take those at night, the levothyroxine in the morning as directed.

Is it important to know if one's illness is due to autoimmune disorder?  I understand the treatment is the same, but wonder if I should know if this is perhaps the reason for my hypothyroidism.  I have first degree relatives (now deceased) who had SLE and RA.  A reason I am asking if it matters is because in addition to hypothyroidism, I do have some GI issues for which I see a gastroenterologist.  I wonder if perhaps I have some systemic inflammation that is causing some of the problems.  Obviously I will ask my GI but I do not go for a couple of months and thought I'd ask your opinion for now.

Thank you very much for your response.  I appreciate your availability through this site.
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TSH is the single best test.  There is not convincing data on routine use supplements for hypothyroidism.  The Mayo site you mentioned reflects best evidence and guidelines for the management hypothyroidism.  Clinically significant systemic inflammation is not thought to be common in hashimoto's (the most common cause of hypothyroidism)
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