Do i question my doctors treatment plan

[svgegrdn]

44 yo female with long history of hashimotos and thyroiditis. On 150 levo current tsh .61 antibodies high at thyroglobulin 745 and thyroid peroxidase over 900. 4 years of compressive symptoms of throat/neck. Mother had thyroid cancer and thyroidectomy. My recent ultrasound showed several 2-6mm densely calcified nodules and one larger 1.2cm complex cystic nodule. My doctor says everything is stable and fine and is sending me to a gastro for the compression symptoms. Couldn't my symptoms be my thyroid? Should i second guess her opinion? Not sure what my next step should be. Other issues are high bp, myoclonus, essential tremor and heart valve issues

[gimel]

I am not interested in TSH.  Please post your test result for FT4, along with reference range shown on the lab report.  Also, pleae post your Vitamin D and B12 test results.  

[svgegrdn]

No b12 done with last testing
No t3
No t4
Vit d 42 reference range 30-100

[gimel]

Unfortunately your doctor is just followig the unwarranted standard of  care that resulted from the ATA/AACE/Guiodelines for Hypothyroidism.  The Guidelines warned against their becoming the standard of care; however, it is so quick and expedient to just use TSH for diagnosis and treatment,  the negative effects are ignored.  

What you need is a doctor that is willing to pay attention to your symptoms that are typical of hypothyroidism, and also test for both Free T4 and Free T3 (not the same as Total T4 and T3)  It is also important to test  for  Vitamin D, B12 and ferritin since they can affect symptoms.  You can read about all this, along with supporting scientific evidence, in a paper I co-authored, listed in the following link.  

https://thyroiduk.org/wp-content/uploads/2023/10/A-Patients-Guide-to-the-Diagnosis-and-Treatment-of-Hypothyroidism-V5.pdf

I suggest giving a copy of the paper to your doctor and ask if he is willing to treat clinically, for symptoms, and FT4 and FT3, as described in the paper.  If unwilling, then you are wasting your time there and should find a good thyroid doctor that will do so.  

[svgegrdn]

Thank you for your insight it is exactly what i suspected. Sometimes you just need confirmation. I will be looking for a new doctor.

[gimel]

Good thyroid doctors are hard to find.  Make sure they are willing to treat for symptoms by adjusting Free T4 and Free T3 levels.  And dont forget  that Vitamin D should be at least 50, B12 in the upper part of its range, and ferritin should be at least 100.  If you have difficulty locating a good thyroid doctor, let us know and perhaps we can help.

[gimel]

TSH is basically useless for determining a hypothyroid patient's med dosage.  This is because TSH has only a weak correlation with the actual thyroid hormones, and a negligible correlation with symptoms typical of hypothyroidism.   The best way to treat is to raise the thyroid med until Free T4 and Free T3 are high enough to relieve hypo symptoms, without regard for TSH.   There is much to discuss, but first please look at the following list of symptoms typical of hypothyroidism and tell us which ones you have.

Tiredness.
More sensitivity to cold.
Constipation.  (need to use laxative or fiber)
Dry skin.  (have to use skin creme)
Weight gain.
Puffy face.
Hoarse voice.
Coarse hair and skin.
Muscle weakness.
Muscle aches, tenderness and stiffness.
Menstrual cycles that are heavier than usual or irregular.
Thinning hair.
Slowed heart rate, also called bradycardia.
Depression.
Memory problems.

Also have you even been tested for Free T4 and Frree T3, Vitamin D, B12 and ferritin?

[svgegrdn]

The recent tsh was TSH W/REFLEX TO FT4
I am on a vitamin d supplement due to chronic low vit d. Currently normal
B12 normal
No free t3 or ferritin

Tiredness.
More sensitive to cold
Dry skin.  (have to use skin creme)
Weight gain.
Puffy face.
Hoarse voice. Losing voice
Muscle weakness.
Muscle aches, tenderness and stiffness.
Menstrual cycles that are heavier than usual or irregular..
Memory problems.
Also have difficulty breathing (episodes of gasping for air)

[svgegrdn]

Tsh reference range is .40-4.50