Thyroid testing confusion

[flyingfool]

I'm a male age 44 and I suspect I have Hypothyroidism (I'm visiting with my Dr today to discuss this).  I got the Broda Barnes book actually for my wife who is hypo and on meds but I've been saying for years the dosage was not enough with her still having symptoms.

However while reading the book was amazed to find out that I have like 10 symptoms of being hypothyroid.  One of them being low basal body temp.  (97.0 for three days and today it was 96.5).  I've had most of these symptoms for virtually my whole life as I can remember.

Anyhow I've been doing quite a bit of research and the whole blood testing thing seems so unbelievable/insane to me.

From what I understand it is the T3 that does the work.  Yet when we get a blood test they only seem to want to look for TSH.  Let's see, we look to a Pituitary gland secretion to determin if we have a Thyroid gland problem.  That on its very face seems crazy.  Why in the world would you look for another substance other than the known substance that actually does the work? It makes no real logical sense.  In the police world.  This would be like looking for the murder suspect by looking at the manufacturer of the gun rather than the finger print on the gun. Insane!

To make matters worse, When they find you to be  hypo, "they" tend to give you 100% T4.  Again when natural thyroid is made up of more than just T4, and the fact that it is T3 that does the work.  This seems insane to me.  Why not treat you with T3 as that is what does the heavy lifting?  And it avoids the complication for those folks who have issues converting T4 to T3?

Why would they not first test for free T3 as that seems to be the fundamental key.  And why would they not initially treat with either natural Thyroid (full spectrum T1 through T4) or at the very least focus  on T3 supplement as that is what does all the work?

[Barb135]

I just posted on another thread, on which you mentioned that your doctor refused to do FT3 and FT4.  I strongly suggest that you check out a lab who will either provide these tests without a script or a website, such as I posted above, who will provide a lab order and send you to a local lab.  

Just because your TSH is "normal" doesn't mean your thyroid levels are.  TSH does not present symptoms; it's the presence (or absence) of FT3 and FT4 that make you feel bad.  You also need antibody testing.  It is entirely possible to have antibodies wreaking havoc, with "normal" thyroid levels.

I strongly suggest you begin looking for another doctor.

[flyingfool]

OK now what?

I got my lab tests back.

TSH was 1.61  Which is about exactly at the bottom 1/3 of the range.

But my basal body temp is 97.0 or below. My hands & feet are always cold.  And I have many other symptoms consistent with Hypothyroid.  I could NOT talk my Dr. into doing the FT3 & FT4 tests.

So now what???

[flyingfool]

Still awaiting my test labs results back.  maybe today.  With the holiday weekend maybe there was a delay.  i was hoping to have them back by Friday.

[Barb135]

If your TSH comes back showing that your are hypo, please demand an FT3 and FT4 test prior to beginning med; dosing thyroid med, based only on a TSH level is a recipe for disaster.

Also make sure you get copies of all your labs so you will have a starting point and as you begin (hopefully) feeling better, you can note your symptoms on your lab sheets so you will be able to keep track of the levels you want to stay at.

I don't see where you have had any antibody tests.  If you are positive for antibodies, you might very well have Hashimoto's Thyroiditis, which is an autoimmune disease in which antibodies attack and eventually destroy the thyroid.  It's very common to have hypo symptoms with thyroid labs in the normal range when one has Hashi's.

A thyroid ultra sound would also be a good thing in order to check for nodules.

[flyingfool]

I did read the link that you gave me.  Kind of addresses most of my points in my posts above.  "cut to the Chase!".  and the MD who wrote that is a man after my own heart and I'd go to him in a second if He wasn't 1,000 miles away.

I will at least wait to see what my TSH levels come back at.  And if I need meds I will give my current Dr. a shot. But I will also then be much more demanding on subsequent FT3 & FT4 testing to tweak the dosage rather than relying on TSH.  If that don't work. I will post a new thread asking if they know a good Thyroid Dr. in my area.  Which by the way is Madison, WI vicinity.

[gimel]

First, did you have a chance to read that link I gave you?  

Second, in my opinion the best way to treat a thyroid patient is to test and adjust levels of the biologically active thyroid hormones, free T3 and free T4, with meds as required to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not TSH levels.  

If your doctor is unwilling to treat you in this manner, then you may as well start looking for a good thyroid doctor that will do so.  You should also be aware that just going to an Endo doesn't guarantee a good thyroid doctor.  Many specialize in diabetes, not thyroid.  Many others have the "Immaculate TSH Belief".  Many others are satisfied when your FT3 and FT4 levels are anywhere within their ranges, often leaving you with lingering hypo symptoms.  

The best way to find that good thyroid doctor is from a recommendation from a thyroid patient who is happy with their doctor.   If you start a new thread asking for a thyroid doctor recommendation for your area, you might get lucky.

[flyingfool]

Thanks.

I noticed in re-reading my post. I got the TSH levels backwards.  I think it would be possible that I am on the upper end of the normal range and would want to get down to the middle to lower TSH levels.  But the Dr. may not want to give thyroid meds if I'm in the range.

I'll keep you posted when I get the TSH lab results.

[gimel]

Good post from Barb. I also happened to think that you (and your doctor ?????)  might enjoy reading this good article written by a doctor.

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

[Barb135]

In order to find out if you convert well enough, you have to have the Free T4 and Free T3 tests.  If your FT4 is way high in the range and your FT4 is low in the range, that would indicate that you don't convert and might benefit from a T3 med, whether it be a natural T3/T4 combo or cytomel added to your T4.  

There are websites from which you can order these blood tests on the internet.  You might check out healthcheckusa.com.  I recently ordered a TSH, FT3 and FT4 for $85.  They e-mail you a lab order and you go to a local lab to get the blood drawn.  I had my results in about 2 days.  

If you get the blood tests done and take them to your doctor, you might get some place.

My pcp always wants to dose by my TSH, which typically runs "less than" 0.01, but I won't let him because my endo doses by FT3/FT4; I've explained this to my pcp and though he doesn't like it, he's forced to accept it.

[flyingfool]

Gimel,

How does one determine if your body "adequately" converts T4 into T3?

it seems to me the only way to determine that would be to try 100% T4 and if it doesn't work as you would hope, that you must have a conversion problem.  Again this seems absolutely silly to me.  if you just treat the person immediately with T3 and monitor that, then you do not have to worry about conversion problems.  Or way overdose T4 so that you can get sufficient conversion. But why should you "overdose" T4.

Stop beating around the bush and Cut to the Chase!

I have a female co-worker who's TSH is at the bottom end of the "normal" range and she has all kinds of symptoms.  Her Dr. won't really do anything.  She is on I think she said 200 mgr of synthetic T4.  I wonder if she is still under dosage that she needs or if she is one of those folks who is having a conversion problem.

[flyingfool]

Well went to the Dr. yesterday afternoon.   I was able to get a blood test.  But was not able to talk him into ordering the FT3 & FT4 tests.  He only is asking for the TSH and I think some other things.

I'm in a weird position.  I don't want to wish for the result of the test to show that I have something wrong.  But on the other hand.  I do wish it comes back showing hypothyroid as it would sure explain a lot of symptoms I have had most of my life.

I will be in a bit of a conundrum if the TSH test comes back in the "normal" range.  I suspect that I'm not dramatically hypo.  So I have a fear that my TSH will come in at the bottom of the "normal" range.  At which point I suspect my family practitioner will just say I'm fine and that is that.  With HMO's etc they usually want a Dr. referral to get in to see an endocrinologist.  I may be forced to either demand a referral, demand that i get meds to bring me up to the middle to higher point in the range, or simple make the appointment with the endo and see if I can get in without a specific referral.

What really made me a bit upset was when I told the Dr. that I was reading on this and I determined I may have hypothyroid. He said something to the effect of "you may have a case of med student disease"  That is, when you start learning about diseases in med school you immediately recognize that you have those symptoms and thus you convince yourself you have virtually every disease you initially learn about.

Really kind of ticked me off!  Also he really poo-poohed my mentioning of my low body temp being 97 and 96.5 for days on end.  Simply stating that the 98.6 is just an average that they came up with.  He did take my word for my cold hands & feet and susceptibility to the cold however so I guess in the end he did recognize this common symptom.

I sort of expected this kind of resistance.  But it still kind of made me upset that I, a person who did his due diligence and comes in with a list of 10 symptoms including family history that it would be discounted as simply a case of "med student disease".  I think it is somewhat jealousy. With the internet etc. people are now able to go out and I bet reasonably accurately self diagnose themselves and the Dr's are no longer the smartest person in the room and the Only person able to make diagnosis.  Although I can see where a few hypochondriacs could really cause them pains and the internet probably made this much worse.

This attitude makes no sense to me.  heck if I was a Dr. I'd want to make my life easy where all the patients that I saw came in with at least a short list or what the problem is so that I can just confirm and verify the diagnosis.  Saves work and research on the Dr. part so why should they be so defensive?

[stella5349]

I don't see anything posted that is PTH worthy here.

[egbrew]

T4 includes all of the above as well as PTH. That's your missing link :)

[gimel]

Many doctors have the misunderstanding about TSH that leads to what we call the "Immaculate TSH Belief".  I think that TSH was the standard for testing for many years, in the absence of accurate testing for the biologically active thyroid hormones, which are FT3 and FT4 (not total T3 and total T4).  I think the insurance companies like TSH because they only have to pay for one test instead of several tests.  

In addition there is the belief that TSH is a reliable predictor of thyroid hormone levels.  I have searched and searched for data to support this, but have been totally unsuccessful in that search.  And here I'm only talking about trying to find correlation between TSH and the active thyroid hormones, FT3 and FT4.  This doesn't even consider that the most important variable we are trying to affect is symptoms, not other thyroid tests.  To date the only statistically valid study I've seen that correlates thyroid testing to actual hypo patient symptoms concluded that hypo symptoms correlated best with FT3 and not at all with TSH.  So that is why I always say that the best way to treat a thyroid patient is to test and adjust FT3 and FT4 levels with whatever type of med is necessary to relieve symptoms, without being constrained by resultant TSH levels.  

As far as meds go, I think that if your body adequately converts T4 to T3, then a T4 med
is far easier to use.  In that case I don't know of any additional benefit from a desiccated med with both T4 and T3.  Personally I think that patients who report a benefit, probably had FT3 levels that were too low.  If FT4 is adequate, but FT3 is needed to relieve symptoms, then a T3 or a combo T4/T3 med can be very beneficial.