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TSH/Hypothyroidism...what?
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TSH/Hypothyroidism...what?

I had a blood screening on a few weeks ago at my job (health initiative...).  Expecting perfect results with no concerns....I tested with a TSH level of 7.96.

Do I have hypothyroidism?

Could I have been "hypo" for years and not known it? (I've been in treatment for depression/bulimia with medication and therapy for 13 years...) I've always lost a lot of hair...have weird skin (too many skin cells...)

Could it have been a fluke that I got this number?

Why do some people have levels like 200?!?! Does that mean they have it worse?

My test was at 6:15 am...are TSH levels higher in the am...at a certain time of the month?

Help, I'm clueless....

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Avatar_f_tn
Your TSH would be considered moderately high and within recommended diagnose range.
TSH 7.96 is on the hypo side of recommended diagnose range.  In other words you are not full blown hypothyroid, yet.

With your TSH  in the recommended diagnose range, a "fluke" or error would be irrelevant.  If TSH was abnormal then a second test 6 weeks after the first test would be warranted to rule out  a "fluke" or error.

People with higher TSH levels are probably more sever hypothyroid and perhaps longer.

Some medicals say AM test thyroid is more active with secretion of thyroid hormones and PM thyroid is less active secreting less thyroid hormones. Other medicals say it doesn't make a difference what time of day test is done - level is a level.

I think all your questions were answered and hope it brought more light to you on the subject.




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213044_tn?1236531060
You need to have more thyroid blood tests run, including a test for antibodies.

TSH (again)
free T4
free T3
Antibodies

Those tests will give a clearer picture than just the TSH.
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213044_tn?1236531060
Your TSH is abnormal. If it was 1.5, then it would be "normal", maybe.

7.96 is not normal. It falls way outside the average norm of a large healthy poulation.
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314276_tn?1235084823
Mine is 10.9. is that high? is it the reason for my hair lost?would it improve?what can i take to improve?
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Avatar_f_tn
Your TSH level is going into overt hypothyroidism.  Yes your TSH is getting high. Although some doctors say between 10 and 20 is considered high.

Was the FT-4 and FT-3 done?  They can relate to autoimmune thyroid antibodies and other thyroid or non-thyroid issues.

Is doctor going to treat you with thyroid meds. That is the only way to replace lost thyroid hormone and improve the thyroid function.

Hope you get treatment.



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213044_tn?1236531060
When are you going to get into the twenty first century?

The new recommended range is 0.3 to 3.0. Dump all that old info you have saved up to cut and paste and go read some new literature.

And skip the speach about 0.5 to 5.0 is the target range for people being treated, but 9.5 is fine for people not being treated. Most doctors don't buy it, because it doesn't make any sense. If my doctor wants my TSH at 1.0 to 2.0, then it is because that is where it is supposed to be, not because he picked a number out of a hat.

If the lab test comes back 5.2 with a big H for high next to it, that's because it is TOO HIGH. Which means it needs to be treated.
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Avatar_f_tn
So as you will have a better understanding  to a possible reason why your doctor may not treat you.

PER:

AACE - American Association of Clinical Endocrinologists  2006 amended guidelines.
US Government 2004 Guidelines
UK 2006 Guidelines,  
American Thyroid Association
The Endocrine Society -  Albert Einstein College of Medicine, New York. September 23, 2004 .  
The Johns Hopkins University School of Medicine and
Sinai Hospital of Baltimore, David S. Cooper April 20, 2004
"(the panel concluded that the upper limit of normal for serum TSH should remain at 4·5 or 5 mU/l, and not be lowered to 3 or 3·5 mU/l as had been advocated by some professional organizations (Baloch et al., 2003))". Medscape Today
Thyyro Link, Merck KGaA, Darmstadt, Germany 02.02.2005
American Family Physician  May 1, 2005
The National Academy of Clinical Biochemistry hypothyroid 2006 guidelines

quote - TSH 2.5 - 4.5: May be due to minor technical problems in the TSH assay, circulating abnormal TSH isoforms, or heterophilic antibodies; normal individuals with serum TSH concentrations in this range would be misidentified as having hypothyroidism

TSH of 4.5 to 10:  No routine levothyroxine treatment for patients with TSH levels between 4.5 and 10 mIU/L, but thyroid function tests should be repeated at 6- to 12-month intervals to monitor for improvement or worsening in TSH level. Early levothyroxine therapy does not alter the natural history of the disease,.........

TSH Higher Than 10 mIU/L Hypothyroidism Levothyroxine therapy is reasonable.

Data do not confirm clear-cut benefits for early therapy compared with treatment when......... or overt hypothyroidism develop. - unquote

AACE Thyroid Task Force - "2006 AMENDED VERSION"
"....TSH level should be measured in 6 to 8 weeks, and the levothyroxine dose should be adjusted as necessary.  The target TSH level should be between 0.3 and 3.0.....  Once a stable TSH level is achieved, annual examination is appropriate."


The Johns Hopkins University School of Medicine and
Sinai Hospital of Baltimore, David S. Cooper April 20, 2004
"(the panel concluded that the upper limit of normal for serum TSH should remain at 4·5 or 5 mU/l, and not be lowered to 3 or 3·5 mU/l as had been advocated by some professional organizations (Baloch et al., 2003))". Medscape Today


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Avatar_f_tn
So as you will have a better understanding  to a possible reason why your doctor only tested TSH.  

Unless there is warrant, some doctors do what is called "Thyroid Testing Cascade" .

Thyroid Testing Cascade is for the evaluation of primary thyroid dysfunction. This test cascade will allow clinicians to use reflex ordering of thyroid function tests in order to provide more timely and cost effective laboratory diagnosis of common thyroid function disorders.
The cascade is performed only if the physician specifically orders it. Patients are charged only for the tests that are performed. Monitoring thyroid hormone replacement can be done with TSH alone and does not require the test cascade.
The basis for the cascade is the TSH. Recent improvements in testing have made TSH the most sensitive indicator of primary hyper/hypothyroidism. A normal TSH effectively excludes primary thyroid dysfunction.


The Thyroid Test Cascade starts with a TSH. If the TSH result is abnormal, a free T4 is performed. Relates to hypothyroid.

In cases where a TSH is suppressed and the free T4 is low or normal, a total T3 is done to test for T3 toxicosis.  Relates to hyperthyroid.
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213044_tn?1236531060
I stand by every word I posted in this thread.

Both parties enquiring should have follow up tests with their Primary Care Physician, including all the tests I listed. And when their TSH comes back over lab norms and has an H next to it, and their other T's look a little low or maybe even have a capital L next them, they will be treated.

If their antithyroid peroxidase AB count comes back high, they will be diagnosed with Hashimoto's, even if their TSH is 5.9.

Using TSH alone to treat a diagnosed patient is not good medicine either. There is a reason some people do better on Armour rather than Synthroid.

There are other instances of illogical thinking in that official statement from the two sources you quoted, but I tire of this.
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314892_tn?1264627503
Once and for all: concerning the 2006 amended guidelines, the article was written in 2002. The word "amended" in this article ( at the top of the publication) only refers to the following quoted from that passage:

  "2006 amended version reflects a clarification to specify pertechnetate as the compound attached to 99mTc."

It does not amend the TSH reference range. This article from 2002 does list the old, higher reference range. The 2003 recommended reference range updates this guideline.

I just corresponded with the AACE via e-mail about this. New guidelines will be published in mid-late 2008 and co-sponsored by the American Thyroid Assn.

Until that happens- the correct guidelines are 2002, with the 2003 change to the recommended reference range of 0.3-3.0.

I also await further replies from the AACE on other questions I have asked of them. The people there have been very helpful.
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209384_tn?1231171906
Standing Ovation for you!!!!!

Hang tough, Bryan and continue to fight the good fight!!!

Dac
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Avatar_n_tn
You're right kitty9309, forget these old guidelines, go with your doctor's advice over that, and if you don't trust it get another one.  My first test not too long ago was 7.39 and my doctor immediately put my on Levothyroxine, I would hope yours would do the same.  I didn't even realize that this condition was hurting me physically and mentally until I felt the difference.  Whether this helps your depression you won't know until you try, it definitely has been linked.  
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314276_tn?1235084823
Yes he tested for t4 that was 1.22 and i went to another doctor that tested for those anitbodies that attact the thyroid or soemthing like that he said it was positive. ive been on treatment since october 26 this year. but i need something for my hair.
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97628_tn?1204465633

Dr Lupo on this forum who is pretty well "up" on the guidelines has stated more than once and very recently (but I don't have time to waste searching for the one a few weeks ago)that it is not mandatory to treat a TSH below 10. He does give trial doses for people who are subclincial who have antibodies, but acknowledges there is not proven benefit to this for people who ar within normal range.

The treatment guidelines for subclincial  I read whe dxd last spring have something like TSH over a certain level PLUS other indications, like antibodies out of range.

http://www.medhelp.org/forums/Thyroid/messages/1481.html

http://www.medhelp.org/forums/Thyroid/messages/689.html

http://www.medhelp.org/forums/Thyroid/messages/1245.html



An amendment is an addition to change/update something
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213044_tn?1236531060
That is why I assert that all four blood tests need to be requested and performed.

The whole "thyroid testing cascade" is stupid and unnecessarily time consuming. Why mess around for weeks or months and three office visits doing one test at a time when you need ALL the test results to get a true picture of what your hormones are doing and possibly why?

My first GP never ran an antibodies test. I was on thyroid meds for 18 months for a "slow thyroid" before a different GP ran an antibodies test and diagnosed me with Hashimoto's.

Had the first GP done that, he may have had some forewarning when my TSH would not stabilize, and probably would have tested my blood more often. But he didn't. My care suffered because of that.

My insurance company paid a couple thousand dollars for an emergency room visit, an ambulance ride, a stay in the hospital, and an angiogram because I flipped from hypo to hyper. If the ER people knew I had Hashimoto's and not a "lazy thyroid", they may have looked at my possible heart attack a little harder and found my TSH was very low. But my first GP saved everybody sixty bucks by not running an antibodies test.

If your TSH is between 5.0 and 10.0 and your T4 and T3 are out of range, you should be treated. Waiting until your TSH goes above ten is not justified if you are not producing or utilizing thyroid hormones properly. To me that is the same as a dentist finding a cavity and waiting to treat it until an infection occurs.


If the AACE asserts that treating a thyroid patient using just TSH levels and ignoring actual hormone levels is proper, that is irresponsible. There are several forms of Hypothroidism and many things can happen between the time the pituitary produces TSH and the body absorbs T3 hormones.

The guidelines as laid out in Graves Lady's posts may be official, but they don't make sense.
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314892_tn?1264627503
In reading Dr. Lupo's responses, he has many responses worded similar to this answer he posted on 9/30/07:
You likely have mild hypothyroidism from Hashimoto's -- would test antibodies but most of my patients with TSH levels that go from 2.5-5.0 like this are antibody positive and many (but not all) benefit from thyroid hormone treatment.  

This persons TSH levels were: 3.083, 4.065, 2.983.
No antibody results listed.
Dr. Lupo knows that you can prob call most cases of even mild hypothyroidism Hashimoto's w/o even testing antibodies because it is the most common form of hypothyroidism.



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Avatar_n_tn
thanks!  

One of my questions that didn't get answered is....could people be hypo for a LONG time and not even know it and could it trigger depression or bulimia...(what I've been treated for for FOREVER)?
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Avatar_n_tn
to give a better picture...my free t4 was .98...(TSH 7.96)

I've got an appointment on the 5th of dec. but i will spend this week freaking out and researching everything...
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Avatar_n_tn
Yes, you could be Hypothyroid for years and not realize it. The symptoms are very broad, lengthy and they are shared by other medical issues as well.

Mild depression is definitely a symptom - I have seen many leading phyicians say a thorough Thyroid screen is warranted in EVERY case of depression.

I would NOT freak out if I was you. I would be just the opposite - I would feel relief that you may finally have the reason that you have been feeling the way you do. The treatment is very easy and most have success with it. Depending on how knowledgeable your dr. is, he may push Synthroid which many do NOT have success with. If that is the case do a search for Armour "friendly" doctors and go see him/her.

Take control of you care, but again I would feel good about likely finding the root cause of your ailments.
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Avatar_n_tn
I strongly agree with your post!!!!! Anyone w/ tsh out of the normal range should be carefully monitored and have T3, T4 and antibodies tested! Once a patient starts to feel hypo, it takes MUCH longer to recover, and get of the hypo symptoms. You will feel sick when your tsh hits 10 (I can vouch for that!!!!!) so why let that happen?!!!  Every MD I've seen as told me that if you're hypo and on treatment, you don't want tsh over 3, and tsh of 1 (or close to 1) is where most hypos feel "best" and what most endocrinologists aim for w/ treatment. AR-10, you are right!!
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21352_tn?1196466338
Personally, with a TSH of 10 I'd feel DEAD!!  On medication at 5 I'm a mess.  Even at mid 3 I feel awful.  All go THIS far......at 1.7 on 125mcg of Levothyroxine I STILL don't feel great.  Don't let it get worse~~Feel better soon!! :)
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314892_tn?1264627503
Yes, people can be hypo for a while and not be diagnosed. Many people on this forum will attest to that.
I know depression can be related to depression. And while bulimia is now considered a psychiatric disorder, I just don't know enough about bulimia. Try doing a search, especially in mental health sites. You can message me if you want some articles referencing mental health and thyroid disorders.
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209384_tn?1231171906
If you go through all of the AACE precious cr@p you will also see much info on the damage being even slightly hypo (over 3.0 according to THEM) causes your body.  It raises the cholesterol, enlarges the heart, causes fatique (which can hinder abiliity to maintain a normal life style), and as even GL has said thyroid affects EVERY cell in your body.  So if it is even the least little bit high it affects you.

Hypothyroidism is also listed in their material as the #1 cause of heart attacks among American women.  

But then they turn around and talk out of the other side of their mouth about it being subclinical at 10.  They need to get their info straight.  And if some one is going to quote them like the Bible for thyroid they need to be quoting it all and not just the part that happens to suit them.

And personally, if you ask me, they would be much better off if THEY quit doing the assuming on their own and let all of us who are veterans of the diseases of thyroid tell them how it really is.  No guess work needed!

Dac
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Avatar_n_tn
i agree. the "good" tsh range (what most of would consider livable) should be under 2.5. once my tsh goes above that i feel terrible (it could also vary from person to person, which most docs do not even consider, irrelevantly of how symptomatic you might be). i had a specialist once tell me (after he saw my bloodwork and my thyroid ab in 100s/1000s) that "we all have antibodies, and it should not worry me, and that it was normal." i had a hard time getting anyone to prescribe synthroid. eventually, i got it and it did make me feel better (not great, but i was ok). until recently, when my tsh blew up again. i was so fatigued i could not walk! after doing the research on my own, i learned that you have to be very persistent to get proper treatment. i was a classic case of hypothyroidism, and it took them over a year to start taking me seriously.  
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My TSH did get to 10 point something and I felt very horrible!!!!! I couldn't think/mind fog, aching muscles, tingling sensations all over, constipation, heart palps, dry eyes, dry skin, hair shedding, I couldn't get out of bed in the morning (felt like I was on sleeping pills, but I wasn't), carpal tunnel and numb hands, etc, etc. I wish my MD had run more extensive thyroid tests sooner, so I could have started treatment sooner and NOT developed to so many miserable hypo symptoms!  I'm a PERFECT EXAMPLE of what AR-10's post is addressing!!!!! I still felt bad when tsh dropped to 5 point something. Now my tsh is 2.5 and I'm much better, but I'm still not my 100% myself yet. MDs must run FULL RANGE of thyroid blood labs to get the FULL picture, not just look at tsh number!!!  I'm speaking from experience.
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Yes, you can be hypo for a long time, even for YEARS and go undiagnosed and untreated!!! That is what happened to me!!!! It wasn't until my TSH was over 10 and I began to develop many awful symptoms that MD ran the full range of thyroid tests and took my symptoms seriously!!!! He discovered then that I had thyroid antibodies/hashimotos and sent me to an endocrinologist who told me that I probably had it for YEARS but was undiagnosed and thus untreated!  If you read more about hypo on this forum and elsewhere, you'll see that it can cause depression!!!!! And also hair loss/shedding. I don't know if hypo has been lineked to bulimia, but bulimia can also aggravate hair loss.
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125112_tn?1217277462
Per your first post, I don't know how you can justify it.

Re (hyperthyroid): "Normally, trestment is suggested with TSH below 0.1, unless have Graves or nodule, and agree."  Your words.

Of a person who is out of range (hypo side) and being Hashimotos is well known to be common amongst hypothyroids-how is it that you will acknowledge this amongst Graves but not Hashi? I think BOTH are bad news and have empathy for both.

If it makes sense to treat Graves, who are borderline/out of range...it certainly makes sense to apply that to Hashi, who are borderline/out of range. With or without goiter.
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97628_tn?1204465633
AR- There clearly is a controversy and either viewpoint is worthy of respect when it is expressed.

I know you have suffered from your levels being unstable and I am very sorry for that.  BUT, just so you know, they saw my mildly elevated TSH (6) and antibodies and immediately put me on meds (they didn't spare any time- did ALL the tests right away) and they checked me every 6 weeks. Guess what?
I got and still have thyrotoxicosis (last test less than 0.04). Have been off meds for many weeks now.  I am as thin as reed, my HR has been irregular I have horrible digestive problems and rarely sleep more than a few hours a night.  Treating people at low levels of elevation CAN cause real harm. The speed of the testing certainly contributed to harming me.

We are all entitled to our opinion about treatment and should be able to express it without attacking people who have perfectly justified points of view as if they have dared to attack motherhood, God and apple pie.

I think a great many subclincial people are  looking for a simple answer to more complex issues  that they may have and that is why, even at a TSH of 1, many people  are still complaining of the same problems.
In many cases it's simply not their thyroid.

I know lots of people who are hypo, they take a pill each day and they lead normal lives. I had no idea they were hypo until I  told them I was.

kitty- Dr Lupo flat out said there is no compelling data that treating a TSH below 10 is necessary.
If people are complaining of symptoms or have other indicators of disease yes, he puts them on the med. He says that frequently as well.  

  If they are subclincial, not complaining and simply don't want meds he tells them the truth- they don't need it.  It's not currently considered medically necessary before a TSH of 10. He has suggested that people at 8 or 9 go ahead and start because they will be 10 soon anyway, but still stated it was not necessary. I can remember that one without looking ;-)

If people are at normal TSH and they write him asking " why can't I have meds?" he also often says his opinion is that a trial  of meds "wouldn't hurt".

That is not the same as them being needed and he has also occasionally implied that there may be a certain placebo effect involved. I've read him regularly since May.

It is my opinion and only hard scientific data that is successfully replicated and implemented as professional policy will affect it.

I don't personally care if people take treatment prior to 10, I merely maintain it's not necessary and the professional guidelines not only here, but all over the world back that up.

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97628_tn?1204465633
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314892_tn?1264627503
But there are just as many articles wriiten for changing the reference range as there are for keeping the higher level.

We are talking about people who complain of symptoms, have every other test in the book and have seen a number of specialists who say they are in perfect health. Then their TSH tests mildly high, have + antibodies, family history. This has to mean something.

I have read at least a few articles that say that our personal TSH remains within 0.75, which is a very narrow window. When you see results of TSH that bounce from 4.7 to 3.5 to 6.0 to 4.5( this is chronologically), they are not within that narrow range and this signifies a problem- at least according to the experts that wrote the articles.

There is nothing I can do to prove it, but I believe it will eventually be the accepted view.

I am sorry that you had the bad experience you are going through. Would you mind sharing the dose you started out on and how you progressed to being hyper? Do you know why it happened? Maybe it would help others who may wind up like you.

Wishing you well.
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97628_tn?1204465633
Hey Kitty. I have to go to work now, but will try to answer your question when I get home. I work at a museum and we have an "Open House" tonight so I have no idea how long I'll be there this evening, Santa is coming to Old Town LOLOLOL
If not this evening, I'll write it up tomorrow morning.
It's a long story.
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Avatar_n_tn
I'm hypo w/ hashimotos. My primary care doctor didn't start treatment until my tsh was 10 AND I began to develop many hypo symptoms, unpleasant symptoms! He waited because even through my tsh was over the normal level, I stll felt fine and had good/normal energy!  He didn't want to make my hyper, But what happened was I developed miserable hypo symptoms, that I might have been able to AVOID if treatment was started sooner AND if he did a full thyroid blood panel sooner!!!  I'm sure deciding when to start treatment can be a hard call for doctors, but I'm an example of what can happen if a doctors waits too long, lets the patient get to tsh of 10, waits for symptoms to develop, and doesn't run full thryoid labs! Now my tsh is 2.5 and I still don't completely feel well yet. I really wish my doctor had started treatment SOONER or sent me to an endocrinologist sooner for a second opinion. I've been sick of hypo symptoms for most of 2007 as a result of delayed treatment.
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314276_tn?1235084823
When I was diagnosed with a level of 10.9 TSH. The only symptom that made me go to the docotr was the hair loss....Anything out there to help that symptom?
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314892_tn?1264627503
Check your ferritin. A low ferritin ( which is the iron storage protein) can cause hair loss according to dermatologists.
What is your TSH now? Once my TSH was below 2, my hair loss is better. I have lots of new "baby hair" growing in. It is thicker and easier to style without using volumizing mousse!
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314276_tn?1235084823
Well thats the thing-I havn't gone in to check it again.  It's been since late October 2007
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314892_tn?1264627503
After diagnosis, you should be checked every 6-8 weeks until stable.
Call the office and ask for a lab slip. You may still be hypo. What is your dose of thyroid med? Symptoms should begin to abate in several weeks on the RIGHT dose for you.
Some docs think every 6 months to 1 year is okay. NOT!!!
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Avatar_f_tn
Interesting that even those living with the same illness have such different experiences and information.  Based on my experience, I now do my own research, first, and then discuss with an endo and a gp - the forums help, and while sometimes helpful, always validating and less isolating, also remind me that I am my own best advocate for me.  

My experience with hypothyroidism was that while I complained for years about all the classical symptoms, when my gp finally did test my tsh, at 6.5, he did not prescribe treatment.  I developed a huge goiter and now have no thyroid.  

Now I have an endo who listens to me but only because I push the information I gather.  I also have a new GP and an NP who thinks about other contributing factors not just the Thyroid and, yet directly related, like Ferritin levels (thanks Kitty).
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