Conflicting diagnosis from dr re hypo

[hifsosjf]

Hi All,

I went to see regular dr today to see if he would write a prescription for Armour (my naturopath is writing them, but she does not have a DEA # so insurance won't cover cost).  Well, "normal" doctor told me to stop takin Armour and that I don't have a thyroid problem.  He said my TSH should be >20 to be treated.  I asked about my antibodies and he said they are always there and there is no real way to tell if they are attacking the thyroid.  Also, he said my FT's were fine even if they are on the low end.    

So, now what???  I think I am going to continue with Armour, get retested in another month or so and see if I feel better and am improving.  I guess a lot of dr's just treat solely based on TSH.  

Any advice is appreciated as I am sure a lot of you have dealt with this or are very familiar with labs and numbers.  What concerns me the most is the high antibodies - indication of Hashi.  Thanks so much :)  

Again, here are lab results for reference

Thyroid Antibody tests

Thyroglobulin AB 556 (should be 0 -40)
Thyroid Peroxid 63 (should be 0-34)

Other Thyroid tests:

TSH 4.52 (should be .25 - 2)
T3 Free 2.2 (should be 1.8 - 4.2)
T4 Free 1.17 (.8 -1.9)

[venora]

Is the "reg" doc just a pcp or an endocrinologist? Get an endo that specializes in Thyroids preferably.I am sure Graveslady can tell you better about your labs than I can.But definatly get an endo.PCP docs arent very up to date on the latest in thyroid medicine
Love Venora

[utahmomma]

I'm with venora on this - fire your doctor and get a good endo that specializes in thyroids.  Many of us on this forum have found it necessary to fire a doctor or two (or more) to get proper healthcare.  Don't feel bad about doing it - it's your body, your health, and your copayment!

[GravesLady]

You didn't ask, but here is my two cents worth - take it or leave it ;)

The high end of your TSH reference range looks off to me.  You stated doctor said 20, which probably is the Labs top reference range.  What's the scoop anyway?  If it is 20 as you say your doc stated no treatment unless over 20, then you are way within Labs reference range.  You can't go by others reference range because each Labs have their own way of testing therefore levels will vary from Lab to Lab as well as from country to country.  

In how your levels are relating to each other, suggest adrenal fatigue which is often confused with hypothyroidism (because of the low levels), allergies, hormonal imbalance, yeast problems.  This can be confusing for doctor and really needs thorough evaluation to determine the source of the problem.  

Playing with your meds. on your own is like playing Russian Roulette - dangerous.  You can go even lower than  your last TSH and can cause all sorts of other health issues - heart, osteoporosis, etc. and thyroid storm, ending up in the ER a very sick lady if you don't go into coma and die first.  This is a serious situation, play around with meds. is a no no!!

There is no cure or  treatment  for antibodies and they wax and wane for no known reason.
Antibody action can fluctuate up and down and  will  destroy portions of the thyroid as they attack.

Presence of  antibodies is not enough for a diagnosis and treatment of Hashimoto’s thyroiditis, because Antibodies are seen in other thyroid disorders, other autoimmune disorders and people with healthy thyroids:  they are seen in idiopathic thyroid atrophy, De Quervain's thyroiditis - transiently, Sjögren syndrome, lupus, rheumatoid arthritis, pernicious anemia, Addison's disease, type I diabetes mellitus , polyglandular endocrine failure syndromes, etc.

Doctors will treat by antibodies, symptoms and FTs if TSH warrants it - yours doesn't show warrant!  Your levels are in a good place for now, why fool with them!?  However this doesn't mean that sometime in the future  you won't become a thyroid issue, so have levels checked on a regular bases to stay ahead and on top of any thyroid issue.

[hifsosjf]

Thanks Graveslady

Well, I have 2 conflicting opinions and not sure what to believe.  The ref range for TSH for this lab is .25-4 and my TSH was 4.52.  GP said no need for treatment...he told me that his TSH was 5.5 the other week and his dad has Hashi's, but Dr himself said he is not concerned about his TSH being 5.5 so why should he be concerned if mine says 4.52?

Other Naturopath dr said yes, take 1 grain of Armour so we can get TSH down and FT's up (or where they are supposed to be). Yes, I do have the antibodies and I do have Hashimoto's and antibodies are slowly attacking my thyroid.  

I will call naturopath dr tomorrow and discuss with her.

No, I am not "playing" with my meds, I am simply following the advice of the first dr who put me on 1 grain Armour in the first place.  

Also, if you read my post that says "tid bit of info" it explains the school of thought for treating somewhat "normal" thyroid numbers with antibodies.

[hifsosjf]

In regards to treatment with high antibodies and TSH around 4

"Your internist is patently wrong about the thyroid peroxidase (anti-microsomal) antibodies—they do indeed impair thyroid gland function. The antibodies are considered "cytotoxic,"meaning they’re damaging to thyroid gland cells. The antibodies interfere with the activity of the enzyme "thyroid peroxidase," and the interference impairs function of the thyroid gland. Your elevated levels of antibodies indicate that you have "autoimmune thyroiditis," and that is clearly a process destructive to the thyroid gland.

Your TSH level also suggests that the function of your thyroid gland is impaired. A few years ago, clinicians would’ve considered your TSH level of 4.15 "normal." Based on recent evidence, however, a TSH level that high suggests impaired thyroid gland function—especially in someone with elevated thyroid peroxidase antibodies. So your TSH, like your antibody titer, indicates hypothyroidism. Treatment with thyroid hormone usually suppresses anti-thyroid antibodies and slows or stops the process of autoimmune thyroiditis. Based on your symptoms and your lab results, I have no doubt that you are hypothyroid and need treatment."

[GravesLady]

I am a little confused. You yourself gave three different TSH reference range - which is the correct? and not the one that fits your agenda.

The only active roll of antibodies is that they wi.ll distroy parts of thyroid in which thyroid meds will be needed or adjusted, and the TSH is the indicator of this.  
Antibodies can damage the thyroid gland and affect its function, so what, you can't stop them from damaging the thyroid - there is no direct cure or treatrment for  antibodies.  Its the thyroid that is treated from the damages of the antibodies.

Who's school of thought anyway?


http://www.rlbuht.nhs.uk/jps/antithyroidthyroglobinperoxidase__i.htm
N.B. Requests for autoantibodies should be selective and relevant to the clinical circumstances. There is rarely any merit in requesting a particular autoantibody if there is no clinical evidence of the disease(s) with which it is associated .

http://www.endocrineweb.com/thyroiditis.html
Thyroid antibodies may remain for years after the disease has been adequately treated and the patient is on thyroid hormone replacement

http://www.mythyroid.com/Blood%20tests.htm
Thyroid stimulating immunoglobulins may be measured in patients with Grave's disease, but are not required to make a clinical diagnosis. The presence or absence of these  

PubMed.gov
Thyroid antibodies may be ordered to search for evidence of autoimmune thyroid diseases, such as Hashimoto's or Grave's disease. Thyroid antibodies may remain positive for years, and do not provide an indication of whether the person has normal or abnormal thyroid function. Furthermore, some patients with Hashimoto's disease may have negative levels of circulating antibodies, and conversely, patients with positive levels of thyroid antibodies may never develop thyroid disease during their lifetime. It is generally not useful to repeatedly measure levels of thyroid antibodies in the blood. Although the presence of antibodies predicts a slightly higher rate of progression to hypothyroidism, some studies suggest that a slightly higher TSH in the mid upper normal range might convey the same prognostic information. See            


http://www.labtestsonline.org/understanding/analytes/thyroid_antibodies/faq.html
What can be done to prevent, lower, or get rid of thyroid antibodies?
There are not really any lifestyle changes or therapies that can prevent or eliminate thyroid antibodies. It is important for patients and their doctors to be aware of them when they are present and to work to minimize their effect on thyroid function.

Are thyroid antibodies part of routine testing?
No, they are usually only indicated when a patient has an enlarged thyroid or symptoms suggesting thyroid dysfunction. Routine screening of the thyroid is usually accomplished using thyroid tests such as TSH and T4.

    
http://autoimmune.pathology.jhmi.edu/diseases.cfm?systemID=3&DiseaseID=22
Johns Hopkins Autoimmune Disease Research Center
Currently, there is no treatment capable of stopping the autoimmune process leading to Hashimoto's thyroiditis.
Presence of these antibodies is not enough for a diagnosis of Hashimoto’s thyroiditis, since 10 percent of women in the population have these antibodies.

http://www.thyroidmanager.org/Chapter8/8_clinical.htm
A % of most populations have positive TG and TPO antibody test results(35-37) in the apparent absence of thyroid disease by physical examination.

http://www.necla.org/Education/disease_mgmt_dtl_4_7975_21912.html
Thyroid Testing Cascade for the evaluation of primary thyroid dysfunction
The basis for the cascade is the TSH. Recent improvements in testing have made TSH the most sensitive indicator of primary hyper/hypothyroidism. A normal TSH effectively excludes primary thyroid dysfunction. It is not sensitive for cases in which pituitary or hypothalamic etiologies are suspected. In those cases a TSH and free T4 should be ordered

http://72.14.253.104/search?q=cache:Q4AFp9dA42YJ:www.aace.com/pub/pdf/guidelines/hypo_hyper.pdf+AACE+position+statement+on+hypo+treatment&hl=en&gl=us&ct=clnk&cd=1
AACE positition statement on hypo treatment
AACE clinical practice. guidelines for the evaluation and treatment
Treatment of subclinical hypothyroidism remainscontroversial, and recent arguments for and against treat-ment have been proposed (19,21). We believe that treat-ment is indicated in patients with TSH levels >10 µIU/mLor in patients with TSH levels between 5 and 10 µIU/mLin conjunction with goiter or positive anti-thyroid peroxi-dase antibodies (or both). These patients have the highestrates of progression to overt hypothyroidism. An initialdosage of levothyroxine of 25 to 50 µg/day can be used,the serum TSH level should be measured in 6 to 8 weeks,and the levothyroxine dose should be adjusted as neces-sary. The target TSH level should be between 0.3 and 3.0µIU/mL. Once a stable TSH level is achieved, annualSubclinical hypothyriodism treatment is indicated with TSH  10
In conjunction with a goiter or positive anti-thyroid peroxidase antibodies or both TSH between 5 and 10.
The target TSH level between 0.3 and 3.0
Subclinical hyperthyroidism TSH 0.3 and 3.0

The TSH test is a reflection of thyroid balance. It is accurate in most patients with auto-immune thyroid disease - including "hashitoxicosis".
TSH is not "skewed" by antibodies unless there are anti-TSH antibodies that interfere with the assay (blood test). The anti-TSH antibodies  are rare ones that interfere with the assay.


TSH and thyroid hormone levels vary during the day and from day-to-day during the week. It’s possible that when a person is tested,  TSH and T4 levels were within the normal range, but that the levels are abnormal at other times. It is suggested that for hypothyroidism a person be tested as late in the day as possible for thyroid levels will be in highest.  For hyper be teasted early in the AM as possible for thyroid levels are the highest in the AM.
Also  person might have central hypothyroidism in which the thyroid gland is underactive where  the blood level of thyroid hormone is too low, at least part of the time. But the cause of the underactive thyroid gland and low thyroid hormone level is not an abnormality of the thyroid gland. Instead, the cause is a dysfunction of the pituitary gland or hypothalamus.

If your thyroid test results are normal you and the doctor might consider doing a TRH stimulation test.

[hifsosjf]

Ok, I am just getting really confused and hearing different opinions regarding everything.

Sorry for the TSH range confusion the range is .25 - 4.   My doctor told me that ideally it should be bt .25 - 2 not the lab range.  Sorry about that.  

Initially I went to the doctor bc I felt like **** - no motivation, apathetic, lethargic, depressed, felt bloated, had gained a few pounds despite lack of appetite and decrease in food consumption.  My periods have been off track and I have horrendous spotting.  So dr ordered thyroid tests and when they came back she was concerned about low FT's and high TSH.  She put me on 1/2 grain Armour and then ordered the antibody tests to see if this could be autoimmune.  After those came in, she said it looks like I have Hashimoto's and to increase to 1 grain Armour so that is what I have been doing.  I will see her again in 2 weeks, but will give her a call tomorrow to make sure I should be on the Armour etc...

In addition my mom and grandpa both have/had thyroid issues so that was another reason she was concerned

Please keep in mind that I am new to all of this