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Thyroid Results
I've been having a lot of hypo symptoms & went to a dr. at the beginning of the week who tested me & said I was normal (not sure results other than 4.17 TSH and 1.06 Free T4). I went to another doc to get a 2nd opinion and he gave me Levothyroxine (.025 mg or 25 mcg) to start. He wants me back mid-February to re-evaluate.
I am wondering if this is too long to wait & if I should possible take the medicine for a month & call to get an appointment then and ask them to re-do a test for TSH, etc. What all should I ask them to test me for?
Also, anyone know if it is better to have your test done in the morning or later in the day - I've heard morning but not sure if that is just a myth or what?
THANK YOU!
I am wondering if this is too long to wait & if I should possible take the medicine for a month & call to get an appointment then and ask them to re-do a test for TSH, etc. What all should I ask them to test me for?
Also, anyone know if it is better to have your test done in the morning or later in the day - I've heard morning but not sure if that is just a myth or what?
THANK YOU!
Yes I did - Thank you!!! My cousin has been seeing one that I may go check out and if I don't like them I will probably go see that one - he's almost an hour away from where I am so if I can find something closer it would be great, but I really don't want to settle for a doctor either so if I don't find one I love soon I will driving the hour and checking out that doctor!
I feel the same way - I've been dealing with the symptoms for a while but by the time I went to the doctor a few weeks ago I went because I was going to have a breakdown if something didn't change quick. I should have went sooner, but either way I really don't want to wait that long just to see if anything has changed and if we need to up the dose. I wouldn't mind waiting that long once we figure out if it is working & what dose is right etc but I'm not very patient and want some results yesterday - ha!
Thank you again for all of your help - you have NO IDEA how much I appreciate it!
I feel the same way - I've been dealing with the symptoms for a while but by the time I went to the doctor a few weeks ago I went because I was going to have a breakdown if something didn't change quick. I should have went sooner, but either way I really don't want to wait that long just to see if anything has changed and if we need to up the dose. I wouldn't mind waiting that long once we figure out if it is working & what dose is right etc but I'm not very patient and want some results yesterday - ha!
Thank you again for all of your help - you have NO IDEA how much I appreciate it!
With those symptoms, you should continue with the starter dose of thyroid med and get in to see a doctor soon. Mid Feb is too long to wait around. Did you get the info I sent by PM on the member recommended doctor in your area?
I had one at about 2 or 3pm and that was the 4.17 - then I went to a new doctor and he wanted to retest just so he had the record there and then it showed 3.04 (around 4pm). So I guess I will try to get in first thing in the morning on my next test and see what the results are - then I will post and we can see which research is right - ha! Of course my doctor said there was no difference in morning or afternoon tests. I really think I might go see a specialist, I liked this new doctor but the idea of having someone who deals with a lot of patients going through the things I am going through and having more experience in this area sounds like it might put my mind at ease a little more. Thanks a ton both of you for responding and all your help!!!
Thanks for the input on TSH variability. Looking at the graph of TSH in Fig. 1 of this link, I think you should have gotten up earlier for the test. LOL
http://jcem.endojournals.org/content/93/6/2300.full.pdf
http://jcem.endojournals.org/content/93/6/2300.full.pdf
The TSH is higher in the morning and that is the only reason will I get out of bed at the crack of dawn to have a thyroid blood test. LOL I'm not a morning person!
An August 2012 study "Clinical Significance of TSH Circadian Variability in Patients with Hypothyroidism" (Sviridonova MA, et. al) results...
"The morning median TSH value in the patients with subclinical hypothyroidism was 5.83 mU/L; in the afternoon, it was 3.79 mU/L. The range of TSH circadian variability reached the level of 73%. According to the current TSH reference interval, hypothyroidism was not diagnosed in about 50% of the cases in the afternoon. The morning median TSH value in the patients taking l-thyroxine was 3.27 mU/L; it decreased to the value of 2.18 mU/L in the afternoon. The range of TSH circadian variability reached the level of 64.7%."
An August 2012 study "Clinical Significance of TSH Circadian Variability in Patients with Hypothyroidism" (Sviridonova MA, et. al) results...
"The morning median TSH value in the patients with subclinical hypothyroidism was 5.83 mU/L; in the afternoon, it was 3.79 mU/L. The range of TSH circadian variability reached the level of 73%. According to the current TSH reference interval, hypothyroidism was not diagnosed in about 50% of the cases in the afternoon. The morning median TSH value in the patients taking l-thyroxine was 3.27 mU/L; it decreased to the value of 2.18 mU/L in the afternoon. The range of TSH circadian variability reached the level of 64.7%."
Sent PM with doctor info. Just click on you name and that takes you to personal page. Then click on messages.
Yes! I would love their info. I know someone that goes to the Health Spot in Sandy & says they've changed their life with the hypothyroid/Hashimotos treatment they've received. SO I'm considering switching to their too. I think I will call & see what my doctor says about me coming back in 3-4 weeks to be retested vs. the 2-3 months he stated. If he doesn't think that is wise I think I will just switch. I am just SO READY for these symptoms to be gone & me to feel like myself again!
Lots of hypo symptoms.
When you go in for tests, I'd even make sure the lab people know you are to be tested for Free T3 and Free T4. Otherwise they often operate on auto pilot and do their usual, which does not include Free T3. Since hypo patients are frequently too low in the rnages for Vitamin D, B12 and ferritin, I also suggest getting those tested.
I really don't expect you will notice any improvement in symptoms for a while. First because it will take a while to get your Free T3 and Free T4 levels high enough to relieve symptoms. Second, symptom relief tends to lag somewhat behind changes in serum thyroid levels. So, patience is key.
Keep in mind that a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation. The letter is then sent to the participating doctor of the patient to help guide treatment. In the letter, please note the statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."
http://hormonerestoration.com/files/ThyroidPMD.pdf
So when you see your doctor next, it would be a good idea to find out if the doc is going to be willing to treat clinically, as described. If not, then you will need to find a good thyroid doctor that will do so. In that case I happen to have on my list of member recommended doctors one that is located in Salt Lake City. Are you interested?
When you go in for tests, I'd even make sure the lab people know you are to be tested for Free T3 and Free T4. Otherwise they often operate on auto pilot and do their usual, which does not include Free T3. Since hypo patients are frequently too low in the rnages for Vitamin D, B12 and ferritin, I also suggest getting those tested.
I really don't expect you will notice any improvement in symptoms for a while. First because it will take a while to get your Free T3 and Free T4 levels high enough to relieve symptoms. Second, symptom relief tends to lag somewhat behind changes in serum thyroid levels. So, patience is key.
Keep in mind that a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation. The letter is then sent to the participating doctor of the patient to help guide treatment. In the letter, please note the statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."
http://hormonerestoration.com/files/ThyroidPMD.pdf
So when you see your doctor next, it would be a good idea to find out if the doc is going to be willing to treat clinically, as described. If not, then you will need to find a good thyroid doctor that will do so. In that case I happen to have on my list of member recommended doctors one that is located in Salt Lake City. Are you interested?
Thank you so much for taking the time to answer :) I appreciate it! I think I will call and try to get an appt in about a month then and have them retested along with doing Free T3 and T4. I don't think they've even tested the Free T3.
Do you know does it take that 4 weeks to see improvement in symptoms? Or with such a small dose should I even expect to see improvement then?
Some of the symptoms are:
- EXTREMELY dry skin/hair (when I've usually had oily skin/hair)
- Not feeling like my self, feeling sad/down, can't remember things, no energy
- Menstruation cycles not normal
- Lactating for YEARS after I quit breastfeeding (when searching for why I found this could also be tied to the thyroid)
- Irritable, moody
- Hair Falling Out
- Short of breath even when I'm not doing anything that should make me out of breath
Thanks again!
Do you know does it take that 4 weeks to see improvement in symptoms? Or with such a small dose should I even expect to see improvement then?
Some of the symptoms are:
- EXTREMELY dry skin/hair (when I've usually had oily skin/hair)
- Not feeling like my self, feeling sad/down, can't remember things, no energy
- Menstruation cycles not normal
- Lactating for YEARS after I quit breastfeeding (when searching for why I found this could also be tied to the thyroid)
- Irritable, moody
- Hair Falling Out
- Short of breath even when I'm not doing anything that should make me out of breath
Thanks again!
Please tell us about the hypo symptoms you mentioned.
So far you have not been adequately tested to help confirm/rule out hypothyroidism. TSH is a pituitary hormone that supposedly reflects accurately levels of the thyroid hormones, but in reality it cannot be shown to correlate well with either Free T3 or Free T4, much less correlate with hypo symptoms. Free T3 is the most important test since 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. So every time you go in for tests you should insist on being tested for Free T3 and Free T4.
Since one doctor put you on 25 mcg of T4 med, it takes about 4 weeks for it to reach 90% of its effect on serum T4 levels. So, there is no need to wait until Feb. to evaluate the effect. Since 25 mcg is basically a starter dose, and your body may adjust to the med by reducing TSH and thus reducing production of natural thyroid hormone, most likely your levels won't increase and you will need to increase your dosage.
TSH does vary over the whole day, with lowest level in the morning and highest in the evening. But TSH is totally inadequate as a diagnostic by which to medicate a thyroid patient anyway. At best it is only an indicator to be considered along with more important indicators such as symptoms, and also levels of The biologically active thyroid hormones, Free T3 and Free T4.
So far you have not been adequately tested to help confirm/rule out hypothyroidism. TSH is a pituitary hormone that supposedly reflects accurately levels of the thyroid hormones, but in reality it cannot be shown to correlate well with either Free T3 or Free T4, much less correlate with hypo symptoms. Free T3 is the most important test since 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. So every time you go in for tests you should insist on being tested for Free T3 and Free T4.
Since one doctor put you on 25 mcg of T4 med, it takes about 4 weeks for it to reach 90% of its effect on serum T4 levels. So, there is no need to wait until Feb. to evaluate the effect. Since 25 mcg is basically a starter dose, and your body may adjust to the med by reducing TSH and thus reducing production of natural thyroid hormone, most likely your levels won't increase and you will need to increase your dosage.
TSH does vary over the whole day, with lowest level in the morning and highest in the evening. But TSH is totally inadequate as a diagnostic by which to medicate a thyroid patient anyway. At best it is only an indicator to be considered along with more important indicators such as symptoms, and also levels of The biologically active thyroid hormones, Free T3 and Free T4.
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