Questions I should ask the endocrinologist?

[jena64]

My doctor is going to refer me to a endocrinologist.  I have been reading a lot of your questions and answers and I read that you should ask the doctor what he perscribes.  I'm very confused about what I'm reading.  

My TSH is 1.150, FT3 is 123, FT4 is 1.08.  What should I ask about?  I did read somewhere that you should take a combination T3/T4.  I don't want to take a medication that is going to cause more hair loss.  I would rather go the natural route.

My symptoms are hair loss, can't sleep, constipation, hungry all of the time, weight gain, puffy face, brain fog really bad, high cholesterol 263, husky voice, dizzy, aches.

I should mention I do have an appointment with a dematoligist in September because of my hair loss.  

[ChitChatNine]

Hi and welcome.

I pulled some posts from the community search.  I'd write down all your history, symptoms and concerns in a little book and bring with you

http://www.medhelp.org/forums/search/73?query=questions+to+ask+at+appointment

WELCOME!

C~

[gimel]

What were the reference ranges for the FT3 and FT4 test results?  Also, are you on any meds now?

[jena64]

I'm very new to all of this.  One week ago I did not realize that I might have hypothroidism.  My docotor said my throid reading was fine.
I didn't know the reference range meant anything.

FT3   123           85 - 205
FT4   1.08         .61 - 1.76
TSH   1.150      .450 - 4.500

I'm taking Aciphex for a stomach ulcer
Flonase and sudefed for allergies

I stopped taking Cholesterol, depression, and sleeping meds because I thought my hair loss might be from one of them.  I don't take any meds for thyroid.  

I'm taking many vitamins multiple, kelp, selenium, saw palmetto, biotin, fish oil, flax seed oil,  B-Complex and more.  I started all of these because of the hair loss.  My hairloss has slowed down some.

[jena64]

Thanks for the posts from the community search.  I will read over them.  

[gimel]

To me, your symptoms and thyroid hormone test results look like hypothyroidism.  Although the TSH result is not consistent with that, TSH is a pituitary hormone that is affected by many variables and does not correlate well with hypo symptoms.  Dependent on the doctor that you end up with, they sometimes rely so heavily on TSH that they would consider you "normal" and not recommend anything further.  

If the doctor is a good thyroid doctor that listens to symptoms and tests and adjusts FT3 and FT4 with meds, as required to alleviate symptoms, then you might be successful at getting at least a therapeutic dose of thyroid med, to evaluate the effect on your symptoms. I believe this would be in order, based on those symptoms and the relatively low levels for the FT4 and, I believe TT3 results.  I believe the doctor might also do some further evaluation for possible causes for the TSH level not relating to your symptoms.

I mention TT3, because that range you gave looks like TT3, not FT3.  If that is correct, then you will want to insist that they test for FT3 in the future.  It is the most important and potent thyroid hormone and it correlates best with hypo symptoms.  

I think you can better prepare yourself for your next doctor appointment by reading this link.

http://www.hormonerestoration.com/Thyroid.html

[jena64]

My doctor didn't suggest to have my TT3 and FT4 done.  I went to a compound pharmacy and they suggested I get my FreeT3 and Free T4 tested.
She suggested this because in Jan 2009 my THS was .77.  But she said to have the others done too.

So I asked for Free T3 is this not correct is it TT3.? There is so much more involved but right now I have to leave to go away for a few days.  I'll be back on when I get back.

[Fuel1212]

Gimel -
Hi there welcome, I have a lot of the same symptoms you have. I would suggest that you also get an antibodies test done. It appeared all your numbers are within range, however I know that you can still have symptoms with this. I am just letting you know, because I was in the same boat and no one would listen to me. At least finding antibodies could give you more ammo to seek treatment. EX. (Thyroid peroxidase antibody (TPOAb); Thyroglobulin antibody (TgAb); Thyroid stimulating hormone receptor antibody (TRAb)

There are a ton of very knowledgeable people in the forum that are great helping, trust me I would know.

Thanks Fuel

[jena64]

I'm back, This is what my thyroid report says

Thyroxine (T4) Free (Direct)         1.00              ng/dL          0.61     1.76
TSH                                        1.150             uIU/mL       0.450 -  4.500
Triiodothyroninr (T3)                     123              ng/dL            85 -     205

I just found out that my cousin takes Synthyroid 150 MCG.  She doesn't have any idea what her test results are.  And I know she doesn't feel well.  She is depressed, achy, fatigue, she is almost bald, overweight, brain fog but I think she has dementia. She is 85 years old so its hard to talk to her about all her symptoms.

[gimel]

So it was total T3, not free T3.  In future testing, you should insist on both FT3 and FT4, along with TSH.  FT3 and FT4 are the actual, biologically active thyroid hormones that largely regulate metabolism and many other body functions.
Another thought for you to consider is that just because a doctor is an endocrinologist doesn't mean that he is a good thyroid doctor or that he will be willing to treat you as I suggested in my 8/15 post, as follows.   "If the doctor is a good thyroid doctor that listens to symptoms and tests and adjusts FT3 and FT4 with meds, as required to alleviate symptoms, then you might be successful at getting at least a therapeutic dose of thyroid med, to evaluate the effect on your symptoms. I believe this would be in order, based on those symptoms and the relatively low levels for the FT4 and, I believe TT3 results.  I believe the doctor might also do some further evaluation for possible causes for the TSH level not relating to your symptoms."

You might be well served by basically interviewing any potential thyroid doctor by calling his office and telling them you have some questions you need answered before making an appointment.  You should ask if the doctor usually checks for FT3 and FT4, or does he primarily rely on TSH in determining a patients thyroid status and the need for medication.   If that answer is okay, then ask if the doctor would be willing to treat a patient based on testing and adjusting FT3 and FT4 within the reference ranges, with medication as required to alleviate symptoms.   If that answer is okay, then also ask if the doctor prescribes medication other than T4 types, such as a T4/T3 combo, or T3 only.

If the doctor does not ascribe to these ideas, then I wouldn't  have a lot of confidence that you will get the treatment response you want.  

[jena64]

I did ask my family doctor for Free T3 testing.  So the test result is for T3 not Free T3?  I do not have confidence in my doctor but she is the only doctor within a 50 mile radius that will take my medical card. I have complained about my symptoms for years and they are ignored.  I know the same is going to happen with the endocrinologist.  I will call today to make an appointment and I will ask the questions you mentioned.  But I do know the doctors that take my medical are far from the best.  

You are so knowledgeable.  I thank you so much for all of this info you are giving me.  I'm just feeling so sick all of the time, and the brain fog is horrible.  I'm having trouble writing this post.  

The reason I mentioned my cousin taking synthyroid, is because isn't hypothyroid hereditary.  I never knew until Monday that anyone in my family had a thyroid problem.

[gimel]

Yes, hypothyroidism has a tendency to be hereditary.  You know, I was just thinking about your doctor situation.  With only the one doctor taking your medical card, that makes it even more difficult to get to a good thyroid doctor.  Do you think that your doctor might be open minded enough to read some articles, such as the link I gave you on Hormone Restoration, and reconsider giving you a therapeutic trial of meds?   The article clearly spells out the fallacy of relying on TSH, and it talks about treating symptoms, by testing and adjusting the real thyroid hormones, FT3 and FT4, with at least a therapeutic trial of meds to evaluate the effect.  Do you think that seeing it in writing might make the doctor reevaluate his approach?  I really don't see how this could hurt anything.  Right now I think the doctor is just looking at your lab test results and the reference ranges and saying that everything's "normal", and is not willing to go outside his comfort zone.   Yet you don't feel normal.

Another thing you could point out to him is that the AACE recommended over 6 years ago that the reference range for TSH be changed to .3-3.0, yet his lab is still using the old range.  Also, you could mention that the reason the range was changed was that the Endocrinologists decided that the old range included a lot of people who were hypo.  When the suspect hypo patients were excluded, the range went down drastically.  Yet, in spite of that finding and that change,  the reference ranges for FT3 and FT4 have not been revised like the TSH range.  They should be, for the same reason.  To me this explains why so many patients still show hypo symptoms even when their FT3 and FT4 results are in the lower end of their ranges, and this is further reason to at least try a therapeutic dose of meds for you.

What do you think?

[gimel]

Herfe's another good article that you might consider giving to your doctor.

http://www.altsupportthyroid.org/tsh/tshmedrefs2.php

[jena64]

Thanks again for all of the advice.  I finally got the number for a endocrinoligist.  I plan to call tomorrow to make an appointment.  I printed out the articles that you suggested.  I plan to take your advice on the questions you said to ask and also mention to the doctor that the range for TSH has changed.  

Most likely my appointment won't be for months from past experience, seeing a new doctor.  I'll let you know.  

[jena64]

I have an appointment to see a endocrinoligist on Tuesday August 25.  Was shocked to get an appointment so quickly.  I did ask some questions, but the the person I spoke to didn't seem too happy about all of the questions.  She said they would test TSH first and go from there.  I told her I already had the testing done.  She said, we will see when you come in.  Doesn't sound good that I got an appointment so quick and the way she answered my questions.  But we will see.  As I told you before I don't have a choice in doctors.  I will take all the information with me, symptoms, test results, articles that I printed out, and other meds I'm taking.

Thanks so much again.  I'm so much more educated about this than I was 2 weeks ago.  I'm so glad I found this forum.