Just curious, thought I'd ask....

Everyone talks about T3 & T4 levels being just as important as the TSH levels... But when I bring it up with my Doctor, or show her info related to testing.

1. She will not even look or doesn't care to treat me by testing my T3/ T4 levels, since after taking the iodine 131 and being on Levoxyl (Levothyroxine), since being diagnosed with Graves disease a few years now. Including being on several dosage since after taking the radiation, since she can't never seem to get my levels correct.

The Doctor states that there is no science to proof these are of any importance, and that Denver Health will not do a complete thyroid blood test. Who knows maybe it's because I'm on the Colorado Indigent Program.

2. Another thing the westside clinic for almost 5 weeks pulled my prescription, so  I just got back on my pills again, today.

-- But after reading no pills could eventually = death. Kinda, got worried. So could anyone tell me what the long term damage might have been or could still be? When I asked where I pick up my medication, they acted like it's no big deal, and the only side effects I'll have if I miss a pill is hypothyroidism symptoms again, no mention of death. Same symptoms I've had since I was diagnosed.  

Yes! these are health professionals too. They seem ignorant or just don't care.... What are they thinking????

[goolarra]

FT3 and FT4 levels are MORE important than TSH.  TSH is a pituitary hormone, and its level can be affected by any number of factors.  Once on thyroid meds, TSH often becomes totally unreliable.

"...she can never seem to get my levels correct."  That's because she's adjusting your meds based on TSH alone.  TSH varies a lot and can even vary with the time of day the blood was drawn.  

How long were you off meds?  If you only missed a (1) pill, it's really not a problem at all, and you probably won't feel any effects of it at all.  However, habitually missing your dose or missing if for longer periods of time could make your hypo symptoms return.  

They're not...thinking, that is...  

[gimel]

Since your doctor thinks there is no proof that Free T3 is important, give her a copy of this scientific study.  It concludes that Free T3 correlated best with a composite score of 8 major hypothyroid symptoms, subjectively rated by the participants themselves.  They also concluded that Free T4 and TSH did not correlate at all.  

TSH is supposed to accurately reflect the levels of the actual thyroid hormones, but in reality does not,   The doctor cannot show you a scientific study in which TSH correlates well with either Free T3 or free T4, much less with symptoms, which are more important.  

You could give a copy of Fig. 2 in this link and tell her this is the best correlation of TSH to Free T3 and Free T4 that has been found in scientific studies, and you can see how poor the correlation is.

http://www.clinchem.org/content/55/7/1380.full

TSH serves no function other than signalling to the thyroid gland to produce thyroid hormone.  Since the really important thing to the patient is symptoms, and since Free T3 correlates best with symptoms, why would you ever want to rely on a test that does not correlate well with either Free T3 or free T4 or symptoms.  

If the doctor continues to insist that TSH tells all she needs to know, ask her to show you some scientific data, like you gave her, that proves it is worthy of being the sole diagnostic for thyroid.  She can't.  She will only fall back on the fact that TSH was taught in med school as being the only diagnostic needed for thyroid.  There is no adequate scientific evidence to prove that.  

[gimel]

Sorry, forgot the first link.

http://www.ingentaconnect.com/content/routledg/cjne/2000/00000010/00000002/art00002

[TT29]

Thanks for the reply... I was off my medication over 30 days. Today I got a message from the doctor that due to not taking a pill for a while and the TSH blood-test came back low. To call back...

Now this is a drag, because I'll be given several different doses to correct my TSH levels, which I have never had a normal reading since taking the radiation pill.  

[TT29]

Thanks for the reply back. I'll try to pass this information on to her but all she'll tell me is you can't believe everything you read on the internet and these studies are not from the medical field. I even tried to share with her a power-point that was shared with me from a lecture given to federal employee in Washington DC. by Dr. Robert A Rifkin and she had no interest in looking at the documentation.

link: www.heal-naturally.com

[TwinMama36]

I hope I am in the right section.  I'll be as brief as possible.  Age 36 y/o female with 2 bio kids (5 year old twins, b/g) and stepdaughter and stepson are 14 and 9.  All decent, good kids.  We have counted in the past 2 years how often I just CANNOT get out of bed.  It is not because I am depressed....I am just TOOOO tired and utterly exhausted.  Even if I've slept for 14 hours the night before!  So my psych. ordered tests.  Everything came back pretty normal except a T3 level of 266???  Is that free t3....I don't know.  So that got the docs looking and 3 blood tests later, I land at an end's office that was personally recommended to me.  She did an u/s of thyroid, clear.  She looked at my numbers.....my TSH is usually 2.17 or so.  In one of the 4 tests, it was 4.35 (I am thinking just a fluke)  I have HYPERthyroid symptoms like you wouldn't believe.  She didn't explain the high t3, other than that I am on Yaz for birth control, which can make that higher.  I have been on that same pill for 3 1/2 years or so.   Next call came back with more results.  Oh!  Everything is fine but wait, you have a high calcium level in your blood.  That should never happen.  She proceeded to tell me it was parathyroidism.  It matched my symptoms, but most importantly my fatigue and the way it ebbs and flows........got an MRI today.  I think it will be clear because though b/c I am starting to wonder if I am going crazy!  Any insight or similarities, please write!!!!

[Barb135]

You're in the right place, but in order to prevent hijacking this thread, why not start another of your own, listing your symptoms and lab results, with reference ranges..

The 266 on the T3 may or may not be high, depending on the reference range, which varies lab to lab, so must come from your own report. Whether or not it's Free T3 or Total T3 will make a huge difference.  We'd also need to see a TSH and Free T4 result and reference range.

Fatigue such as you describe can be attributable to several different conditions, so we need to work through a lot of things.  

High calcium levels do indicate hyperparathyroidism....... keep in mind that your parathyroids have nothing to do with your thyroid, other than their location in the body; they serve totally different functions.

To start your own thread, you can click the orange "Post a Question" button at the top of this page, type in your info, then click the green "Post a Comment" button.

Be sure to include whatever lab results you have, along with the reference ranges........  

Rest assured; you aren't going crazy!!  

[gimel]

Those studies I gave you links for are absolutely scientific studies.  The only relation to the internet is that's where I found the info.  

The first study was done by researchers at the "Division of Endocrinology and Metabolism, Georgetown University Hospital.

The second study came from the Journal of  Nutritional and Environmental Medicine.

Ask your doctor for a copy of her scientific study that shows that TSH correlates well with either Free T3 or Free T4, or even more importantly with hypo symptoms.  She can't show you any such info.

I expect that your doctor's mind is totally closed on the subject.  She sounds like she is so arrogant that she could never consider being wrong, and changing her mind.  So, do you have the freedom to go to other doctors in your area?  If so, I have a doctor in your area that was recommended by a fellow member.  

[TT29]

I totally agree with you. I have to see her in six weeks for another blood test, so I'll bring this up again... Also, when I questioned and wanted to make a complaint about who was responsible for stopping my thyroid medication for over a month, I was called by the supervisor of the clinic and told that during my next appointment I have to sign medical discipline form, since I told the doc that her and the clinic didn't care about my well being/ health and that I could have died. NO PILLS = DEATH!! I have no thyroid, so I need the pill everyday to help produce thyroid.  

I don't think I have the opportunity to switch providers, since Denver Health is the only provider for indigent patients, which they base on your income level  and according to my doctor they all only test TSH levels. T3/T4 no proven science............

[AJWS6]

Hello friend, at first my physician was only testing TSH, many physicians only go by TSH.  Sad truth !  

Here's what I shared/asked my physician.  FT3/FT4 are produced by the thyroid, If these levels are not important, then why do labs have test for them?  Aftwards on my lab reports, noticed my physician began to test FT3/FT4 along with TSH.  He's still clueless as to balancing hormonal levels, but at least I made alittle progress.  

It's easy for physicians to view TSH, increase/decrease FT4 meds.  Testing is very easy for most physicians, balancing hormone levels is rocket science to majority.    

Also lot's of hospitals & health insurance providers are the reason physicians do not test beyond TSH, to cut medical cost.  Nearly every health plan has max limit, that can be spent on a patient each yr, including prescriptions.  

Another way you can try is, next time you visit your physician ask them if they would test your for FT3/FT4.  If they decline, tell them you will pay for the test yourself, if you can afford to do so.  All they have to do is request the test.  How can they say no.  Wishing you well :)  

[TT29]

Thanks! I never thought of that, but I do think it is due to medical cost....

Great idea, I think I'll ask if I can pay for the test, if I can afford them.
The medical cost can be outrageous.

Another, is that she doesn't believe in the alternative medicine approaches for thyroid diseases, which she thinks is the reason that everyone all interested in the T3/T4 levels.  To her this area is not scientifically proven according to the doc.

[gimel]

Tell the doctor that you can provide scientific studies that show that Free T3 correlated best with 8 major hypothyroid symptoms, while Free T4 and TSH did not correlate at all.  Also tell the doc that there is no valid scientific study data that shows that TSH correlates well with either Free T3 or Free T4, much less with symptoms, which are more important.  If the doctor disagrees with this, ask for a reference to data that would prove otherwise.  She won't be able to provide such data.

Since Free T3 is the test that is most important, followed by Free T4, then you need to know those levels to determine what kind of med is needed and approximately what the dosage needs to be.  This is not alternative medicine, it is just that so many doctors were mistakenly taught that TSH is the gold standard and they don't realize the limitations of using TSH to diagnose and medicate a hypo patient.

[AJWS6]

Hello friend, physicians that work in hospitals have to abide by rules of hospital or health care providers, which evolves around money, not patient treatment.  Oprah Winfrey has money, physicians have no problem testing/treating her health concerns.

It's possible your physician believes in alternative medicine, but can do anything about it.  

Here's a good example.  A salesperson working for a car dealership has to abide by rules of the dealership, while an independant business owner can do whatever they choose to do.  

Health care system sux ! in the US and many other countries.  Truth is money = good health.  

Take notice many health care providers state which physicians patients use to be covered.  Go elsewhere, pay out of pocket.  

Health care is all about limit on expenses.  Although patient pay monthly, health care providers put stipulations on what is covered, what is not.  So physicians learn to make excuses.  I could write a book about this topic, Lol !!!  Wishing you well :)  

[Barb135]

AJWS6 is right about the guidelines doctors have to follow, in certain programs, whether it be Colorado indigent, military, some insurance companies, etc.  If the guidelines are for TSH only, that's what you're going to get and no amount of insistence or scientific study will make them change, unless the guidelines change.

Rarely, there may a doctor who is willing to test against the guidelines, but I don't think that will happen real often.

TT29 - another option that might be less expensive for you is to go to an online company to get the thyroid panel.  There's one that I've used (as have others) and  had good luck with.  It's healthcheckusa -- the price may have changed, but when I used it, it cost $85 to get TSH, FT3 and FT4... you order the tests online, they e-mail you a lab order and tell you what lab to go to, in your area.  You take the lab order and get the blood draw, then in a couple of days, they e-mail you a report, followed up with a hard copy in the mail.  You can, then, take this report to your doctor and hope she will have some compassion.

Here's an eye opener for everyone when/if we get a national health care program in place -- since TSH is the "gold standard", will we all be back to TSH only testing and what will that do to those of us whose TSH is out of the ordinary, but normal for us? I, for one, will probably not live long, because they will start taking away my med, in order to "normalize" my TSH.  When a previous doctor did this, I truly thought I would die.