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How to get my Doctor to prescribe cytomel with synthroid

I had a tt in nov due to thyroid cancer, had rai done in dec. My endo had me on 137 snythroid. My tsh was 0.39. He said it wasn't low enough. He put me on synthroid 150 then my tsh was 0.04. He said it was to hyper, he put me back to synthroid 137. I still don't feel well. I have all kind of symtoms, tired all the time, pain in knees, hair falling out, headaches, gaining weight, can,t sleep, sometimes cold sometimes hot, brain fog. I went to his office after going online. I asked him if my t3 levels were ok. He said that he didn,t check them because t4 converts to t3. He said I  just had to give the synthroid a chance to work. I insisted that the next time he checks my levels that I wanted all t3 checked to. I want to know if I am correct in this. I just want to feel good again. I would appreciate any advice you might have. Thanks
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393685 tn?1425812522
We must of been posting together - I just read your response to Barb.

Hate to say it but Jeannie - you were kinda all over the baord with demanding those tests.

Here is where knowledge will save you that embarrasement.

TSH - Thyroid Stimulating Hormone - + Pitutiary sending signal to thyroid - or meds working to either release or hold FT4 - and some FT3 hormone. Essential test with TSH to maintain suppression on thyroid cancer. A must test for that and should be leveled below a 0.1 for you

FT4 is the conversion hormone to create FT3 - for the majority of conversation to allow DIRECT FREE T3 to release into the body to :

1. suppress the TSH
2. to generate into the cells the thyroid FT3 hormone needed to stabalize the system to rid hypothyroidism - keep cardiac heart issue regular - digestive system and metobolism regular. - ALONG with keeping the other essential hormones we have to stay balanced.

The total testing is really not a priority - maybe do them - not don't USE them in determining the real issues.

Why would you request an uptake? are you referring to the T3 uptake lab? - don't bother on that either. and DO NOT request a TSH - 3rd generation either for the record.

does that help? It was the "quick 101 on thyroid labs I suppose...






Helpful - 0
393685 tn?1425812522
That is an absolute shame that you - who had cancer for heaven's sake - Can't get a dam T3 test  to see where that level is at.

Barb says.... quote> "You do have to give the synthroid a chance, but if he keeps reducing your dosage based only on TSH, you will soon have a disaster on your hands......my TSH runs only 0.01 and my endo doesn't worry about it because he *does* test FT3 and FT4 and as long as those levels are good, I'm fine.

This is all good information and stuff Barb...

This is classic modern - endo medicine.... To be soley looked at with the stupid TSH and basing your whole life and wellness around that "number" for you. - This my friend - is an abolute shame and idiotic and your doctor should re - exam his training to see how to maintain good thyroid health...

Geez - as a person ( me) who has been here on this board now for years and the SAME comment from endos keeps coming up ..............time and time again.. I have to step back and really ask>>>..

Aren't these endos sick of ALL these patients ...............coming in ALL THE TIME.................... saying the EXACT SAME thing .....................over and over -

ALL THE TIME?    

Its obvious "something" in this system (or learned) in thyroid  is broken - when there are SOOOOOOO many thyroid patients in the horrible shape they are in when their "specialists " endos base everything on that lousy
T S H !!!

Well.............We all can't be crack pots - drama queens - depressed - just "fat and lazy or anxious... can we??

( NO way) - Wake the heck up !!!! - most of you endos???

Jeanne, Please make one thing stick in your mind.. You "may" have worded your T3 comment incorrectly to your doctor.

You MUST - repeat - MUST clarify FREE T3 - FREE T4 testing. If you only say T3 - that would mean you are requesting a Total T3 test which would be just as useless as what you are getting with the TSH lab.

Another tip - If your endo has really come out and said NO T3 testing and T4 ALWAYS converts to T3... you may be up for a huge battle. Even if you get this endo to run the correct labs - chances are - HE/SHE will have NO clue how to interrpt them.. So there you are with the "right" labs done - but again - you will be poorly managed with medication.

YOU - with the history of Cancer - can not afford to gamble like that. Hypothyroidism WILL effect every cell and organ of the human body. You have already been stricken with cancer which your body WILL recover from.. Add Hypothyroidism and low Free T3 - that could be a slow lethal situation in my eyes.

You need to be "On the Ball" yourself -  with cracking this thyroid level stuff quickly or it could be a long haul for you to get totally well again.

The cancer is the least of your issues now sicne the removal and RAI and the TSH test WILL  play a role in maintaining suppression. however - the real thyroid hormones FT3 and FT4 need to be stabilized for the rest of your body to fight and maintain wellness.

If you need or want additional information - if you feel your doctor is and will not provide you with ALL the thyroid testings and medication tweeking available, please message me with your location and I will try to help you find someone better.
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Avatar universal
My Ft4 was 1.09 the range was 0.61-1.12 ng/dl. My tsh was 0.39 with range 0.34-5.60. The next lab he had raised synthroid to 150 but he only checked my tsh and it was 0.04 with a range as stated above 0.34-5.60. He now lowered my dose back to 137. I don't go for labs again until for 8 weeks. I insisted he start to check  free t4,freet3,total 4.tsh, t3 uptake,t3 total. He looked at me like I was crazy. He said that all that was needed was t4 and tsh but went along with it. I told him of all the symptoms that I was having and that I just want to feel good again.I had antibodies checked before they found the cancer and they said that was not a problem for me. They didn't find the cancer until afer I had my thyroid removed. The fine needle didn't show the cancer but I had thyroid removed anyway because I had 4 very large nodules that were hurting me. I'm so glad I did since it turned out to be follicular cancer in the right side.
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
What are your FT4 levels, along with the lab's reference ranges?  

Each time you have blood work done, you need to have FT4, FT3 and TSH done.  I know you had thyca, but do you know if you have ever had antibody testing done to see if you also have autoimmune hypothyroidism?  

You do have to give the synthroid a chance, but if he keeps reducing your dosage based only on TSH, you will soon have a disaster on your hands......my TSH runs only 0.01 and my endo doesn't worry about it because he *does* test FT3 and FT4 and as long as those levels are good, I'm fine.

I do have an appt on 2/8 with my pcp, who *loves* to change dosage based on TSH -- I'll have an argument on my hands then, but I'm not letting him change my dose.  He did that back in Dec and sent me to hypo he// in just a short time........Thank goodness for my endo -- he put me back up....and it didn't take long to return to the "land of the living".........

If you can't get your endo to adjust your meds based on FT3 and FT4, you need to look for a different one.  You may not need cytomel -- you just might need a higher dose of synthroid or maybe even a different med, altogether.  My pcp started me on synthroid and I didn't do well at all, but when I started seeing my endo and he approved the use of generic levothyroxine, I began doing much better.......

You might also want to consider the use of natural dessicated hormone.  I have never used it, but I know there are quite a few on this forum who do and they do very well on it.  I would never rule it out.  My endo suggested it at one time, but I felt that I had more control over my levels using the synthetic and he agreed, so that's what we've stayed with.  I'm on 88 mcg generic levo and 5 mcg liothyronine (generic cytomel).  

Now that I've rambled on so much, you've probably forgotten that I asked for you to post your FT4 results, along with the lab's reference ranges.........that will help some for members to comment.


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