Thyroid Disorders Community
Living without a thyroid
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This patient support community is for discussions relating to thyroid issues, goiter, Graves disease, Hashimoto's Thyroiditis, Human Growth Hormone (HGH), hyperthyroid, hypothyroid, metabolism, parathyroid, pituitary gland, thyroiditis, and thyroid Stimulating Hormone (TSH).

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Living without a thyroid

Why do we have to wait so long to get the thyroid levels checked?
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Avatar_m_tn
From that I assume the doctor is focused on TSH which is a pituitary hormone that is supposed to accurately reflect levels of the thyroid hormones: however it cannot be shown to actually correlate well with either of the biologically active thyroid hormones,  Free T3 or Free T4, much less correlate with symptoms, which are the most important consideration.  So TSH is totally inadequate as the sole diagnostic for thyroid status.

It would be far better to test for Free T3 and Free T4 (not the same as Total T3 and T4).  Free T3 is the most important because it largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  If your doctor resists testing for Free t3 and T4, then you should insist on it and don't take no for an answer.  Also, be aware that Free T3 and Free T4 levels in the low end of the range are frequently consistent with being hypothyroid.  

Since Hashimoto's Thyroiditis is the most common cause for diagnosed hypothyroidism, your should also test for the thyroid antibodies of Hashi's.  Those tests are TPO ab and TG ab.  While you are at it, you might as well also test for Vitamin D, B12 and ferritin.  Each of those need to be well up into their ranges for best results.

So, in view of your symptoms and status,  I see no reason to wait around for followup testing.  I would call and ask to have all these tests done now.
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Avatar_m_tn
Are you talking about the time after a thyroidectomy, or RAI?  Or are you talking about the time interval between tests?
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Avatar_f_tn
I am talking about the time between tests my doctor said according to my blood levels my pituitary glad says I am starved for thyroid chemicals (not sure if that is the right terminology) but I have to wait 25 days to do another blood test so he can tell if it is true or a false reading. Meanwhile I am tired, low and want to fall asleep a lot. Also my scar aches quite a bit. I have to take a lot of ibupofrin to get relief from that. Any words of wisdom?
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Avatar_m_tn
From that I assume the doctor is focused on TSH which is a pituitary hormone that is supposed to accurately reflect levels of the thyroid hormones: however it cannot be shown to actually correlate well with either of the biologically active thyroid hormones,  Free T3 or Free T4, much less correlate with symptoms, which are the most important consideration.  So TSH is totally inadequate as the sole diagnostic for thyroid status.

It would be far better to test for Free T3 and Free T4 (not the same as Total T3 and T4).  Free T3 is the most important because it largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  If your doctor resists testing for Free t3 and T4, then you should insist on it and don't take no for an answer.  Also, be aware that Free T3 and Free T4 levels in the low end of the range are frequently consistent with being hypothyroid.  

Since Hashimoto's Thyroiditis is the most common cause for diagnosed hypothyroidism, your should also test for the thyroid antibodies of Hashi's.  Those tests are TPO ab and TG ab.  While you are at it, you might as well also test for Vitamin D, B12 and ferritin.  Each of those need to be well up into their ranges for best results.

So, in view of your symptoms and status,  I see no reason to wait around for followup testing.  I would call and ask to have all these tests done now.
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Avatar_m_tn
What's the study correlating FT3 with symptoms please?
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Avatar_m_tn
In this study the researchers got the participants to rate their hypo symptoms for severity.  Of course such ratings are very subjective in nature, as opposed to being objective measures.  Then they used a composite of the total score of the top 8 typical hypo symptoms and ran a regression analysis to determine the correlation of all the normal thyroid tests against the composite scores.  

Free T3 correlated best with the hypo symptoms score, while Free T4 and TSH did not correlate at all.  The degree of correlation was amazing to me when considering the subjective nature of the scoring of hypo symptoms.

This is only logical when you consider that Free T3 is the one that regulates metabolism and so many other body functions.  Conversely, even though doctors like to say that TSH is the most sensitive measure of thyroid status, they cannot show that TSH correlates well with either Free T3 or Free T4, much less correlate with symptoms.

http://www.ingentaconnect.com/content/routledg/cjne/2000/00000010/00000002/art00002
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Avatar_m_tn
OK thanks, I took a look.
There's a cracking quote:
" For practical reasons we considered women over 18 and men over 21 years of age as mature adults"

Apart from this, it seems medline don't index this journal (ie don't trust it).  As a retrospective study without a convincing explanation of how the symptom scores were taken and how if at all the blinding was done I somehow doubt it myself.  Pity really
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Avatar_m_tn
You said, "Apart from this, it seems medline don't index this journal (ie don't trust it).  As a retrospective study without a convincing explanation of how the symptom scores were taken and how if at all the blinding was done I somehow doubt it myself.  Pity really."

Couple of followup questions.  Who or what is medline and what is the relevance of that?   Also, did you get into the full text of the experiment?  If not, how can you conclude there was no convincing explanation and decide whether researchers knew what they were doing when they designed the experiment?    

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Avatar_f_tn
thanks i will call
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Avatar_m_tn
Medline = pubmed, http://www.ncbi.nlm.nih.gov/pubmed

Yes I did find a full text version and read it
googling the title turns it up easily
Thyroid Insufficiency. Is TSH Measurement the Only Diagnostic Tool

I'm not claiming particular authority in being able to judge the quality of scientific studies.  But I do know to look at the blinding, and here there isn't any I think.  I also look at it in pubmed, how many other studies cite it (eminence based medicine if you like), an imperfect method for sure, but the best I can manage.  You would also expect to see replication studies, and again I can't find any (I looked for Urine FT3 symptoms in pubmed).  It's a retrospective study, and it seems to me they probably knew the urinary FT3 figure even as the assessed the symptoms.  Sorry

Steve
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Avatar_m_tn
It has been a while since I read the full text of the experiment.  I tried googling for it unsuccessfully.  Please give me the link that allowed you to view the full text.
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Avatar_m_tn
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCEQFjAA&url=http%3A%2F%2Fli123-4.members.linode.com%2Ffiles%2FThyroid%2520Insufficiency.%2520Is%2520TSH%2520Measurement%2520the%2520Only%2520Diagnostic%2520Tool_0.pdf&ei=C5t4UL2HGoeo0QXr54CQDA&usg=AFQjCNE5Msccb3R45o2-rmk_K_F50Pe7ew&sig2=W12rLHz8-oLjzf1tqW0l3w
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