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A TSHPituitary and tsh Tsh of 6.8 is typically just an indicator of the need to take a good look and evaluate what symptoms are being evidenced, and to do more testing, in preparationPreparation h hydrocortisone for medication, if required. Symptoms are really important in the decision making process here.
I just wanted to make a couple of suggestions that might help get you off in the right direction. Hopefully the doctor will want to do a full panel of thyroid tests, including free T3, free T4T4 test, TSHPituitary and tsh Tsh, and antibodies to determine potential cause for her elevated TSH. Many times doctors will include total T4, or sometimes free T4, but not free T3. If he includes free T3, that is usually a good sign that the doctor is knowledgeable about thyroid problems. Surprisingly, not even all Endos are. Many specialize in diabetes or other areas. If the doctor does not initially include free T3, I suggest that you request that it be included.
Free T3 and free T4 are very important because they are the active thyroid hormones that create biological activity in the body. Free T3 is the most important because it is four times as potent as free T4 and it correlates best with hypo symptoms. Many doctors depend primarily on TSH as the diagnostic for thyroid problems. TSH is a pituitary hormone that is affected by many variables. TSH does not correlate very well at all to patient symptoms. Doctors who regulate a patient's meds by just getting TSH down into the reference range, frequently leave a patient with lingering hypo symptoms.
In my opinion the most effective treatment is to listen to the patient's symptoms and test and adjust free T3 and free T4 levels with medication as required to alleviate those symptoms. Many times this will require that the free T3 and free T4 levels are moved into the upper third of their range, which will result in TSH suppressed to the very low end of its range. This is especially applicable if the source of your wife's hypothyroidism turns out to be Hashimoto's disease.
By all means have a good discussion with the doctor about all this to understand how he will go about treating your wife's hypothyroidism. If he has a problem with treating symptoms through testing and adjusting the "Frees", and intends to go predominantly by TSH, then you may have to look for a good thyroid doctor.
I just wanted to make a couple of suggestions that might help get you off in the right direction. Hopefully the doctor will want to do a full panel of thyroid tests, including free T3, free T4, TSH, and antibodies to determine potential cause for her elevated TSH. Many times doctors will include total T4, or sometimes free T4, but not free T3. If he includes free T3, that is usually a good sign that the doctor is knowledgeable about thyroid problems. Surprisingly, not even all Endos are. Many specialize in diabetes or other areas. If the doctor does not initially include free T3, I suggest that you request that it be included.
Free T3 and free T4 are very important because they are the active thyroid hormones that create biological activity in the body. Free T3 is the most important because it is four times as potent as free T4 and it correlates best with hypo symptoms. Many doctors depend primarily on TSH as the diagnostic for thyroid problems. TSH is a pituitary hormone that is affected by many variables. TSH does not correlate very well at all to patient symptoms. Doctors who regulate a patient's meds by just getting TSH down into the reference range, frequently leave a patient with lingering hypo symptoms.
In my opinion the most effective treatment is to listen to the patient's symptoms and test and adjust free T3 and free T4 levels with medication as required to alleviate those symptoms. Many times this will require that the free T3 and free T4 levels are moved into the upper third of their range, which will result in TSH suppressed to the very low end of its range. This is especially applicable if the source of your wife's hypothyroidism turns out to be Hashimoto's disease.
By all means have a good discussion with the doctor about all this to understand how he will go about treating your wife's hypothyroidism. If he has a problem with treating symptoms through testing and adjusting the "Frees", and intends to go predominantly by TSH, then you may have to look for a good thyroid doctor.