Concerned. Looking for input on my labs.

[JMoses82]

I want to start off by saying that until the end of 2016, my thyroid disease was managed flawlessly by the most amazing Endo that anyone could ask for. Then new insurance took over and I was unable to see him and that is when it all went down hill.  My previous pcp that I had all of 2016 was trying to take me off my thyroid medication after I was successfully able to start losing weight.  The more weight I lost, she would try to decrease my thyroid meds. Luckily I was still under the care of my endo so that did not happen.  I told her I did not need her to manage my thyroid because I already had a doctor for that. When it came time to get a new referral to see my specialist, she refused and said I did not need to see him any longer as my condition was vastly improving. The only thing that was improving was my weight, my labs stayed within normal range, with the occasional spike to which my endo would add additional dose to even things out. This doctor treated my thyroid condition based on my weight and not my actual need. I had to get rid of her, and start with a new physician. Eventually, I ended up losing my endo altogether and went through a slew of doctors that obviously don't know how to treat. I am finally in a position where I can go back to my endo, but that appointment is still about a month out.

I recently had lab work done, 3 months apart with a new PCP and would like some input.  I will be seeing her on Thursday and we are going to work on a care plan until I can get in with my endo. I would feel more comfortable going into this appointment with more knowledge.  Any input would be greatly appreciated.

Results from 9/17.  This was a full blood test and I wasn't sure what else to pull from it.

TSH, High Sensitivity 2.97 0.45 ­ 4.50 mU/L     
T4 Free Non­Dialysis 0.9 0.8 ­ 1.7 ng/dL  

December 6th 2017 I had new lab work done.  My PCP added to my through medication. My endo had me on 65mg of Armour Monday-Saturday and 90mg on Sunday.  PCP changed it to 90mg 3 days a week and 65mg the other 4 days. These are the new labs.

T3 Uptake 20.8  L   23.4 ­ 42.7 %     
Thyroxine (T4) 6.7 4.5 ­ 12.5 ug/dL     
T7 Index 1.4 1.2 ­ 4.3      
TSH, High Sensitivity 4.47 0.45 ­ 4.50 mU/L     
T4 Free Non­Dialysis 0.9 0.8 ­ 1.7 ng/dL  

After seeing these she suggested I try to get into my endo sooner.  But there is a significant wait period on appointments and I had already had my Jan appointment since September.

I tried to dig up lab results from when I was under the care of my endo, and these were the last results I had when he had adjusted to the 90mg on Sunday.  This was in 2016

TSH, High Sensitivity 3.30 0.45 ­ 4.50 mU/L   CG

As you can see it was improving, then not.  I don't know whats happening. I feel like garbage and that wonderful 100 pounds I was able to lose is back and then some.

[gimel]

For some reason the last part of the link sometimes gets cut off.  Just be sure the link ends with this.

%20%20Update.pdf

[gimel]

Even though you made progress with the Endo, I am not convinced that you were being adequately treated even then.  And now it is worse.  A good thyroid doctor will treat a hypothyroid patient clinically, by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels.  Symptom relief should be all important, not just test results.  I say that about TSH because studies have shown that most patients taking thyroid med adequate to relieve symptoms find that their TSH becomes suppressed below range.  That does not mean hyperthyroidism unless there are hyper symptoms due to excessive levels of Free T4 and Free T3.  So TSH should NEVER be relied on to determine thyroid med dosage.  

Many of us have found that we needed Free T4 at least at mid-range, and Free T3 in the upper third of its range, and adjusted from there as needed to relieve symptoms.  In addition hypo patients are frequently deficient in Vitamin D, B12 and ferritin.  So  if not tested for those you should do so and then supplement as needed to optimize.  D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.  All 3 are very important for a hypo patient.

You can read all about this in the following link.  I highly recommend reading at least the first two pages, and more, if you want to get into the discussion and scientific evidence for all that is recommended.  You can also make good use of the link with any doctor that doesn't want to treat clinically.  Note especially rec. 13 on page 13 dealing with suppressed TSH.

http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf

[JMoses82]

I cannot tell you the last time anyone tested my B12 or Ferrritin, so I will request those.  I could probably use another check on my D as that seems to be an issue for me, even living in Arizona.  I was on 50000 UI a week for 6 months, then supplementing with 3k daily.

As for my endo, he has always treated me pretty well as far as listening and treating my symptoms as well. I am going to bring up what you have mentioned and I am certain he will check EVERYTHING since it's been some time since I have been able to see him.  If nothing, I guess changes will have to be made.  I guess because I didn't know any better, I thought he was doing an outstanding job compared to the ones in the past.

Thank you for your input and I will be checking out the link right now.