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Tyroid Cascade Test
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Tyroid Cascade Test

How many of you have had to argue with a doctor over what is tested?  My PCP swears up and down that with a thyroid cascade test that everything (all T4 and T3) was tested and since everything was normal only the TSH was reported... This makes NO sense to me. WHY would you do a test and not report the findings regardless if it's normal or not.  I even got so ticked this afternoon, I called the lab and the person at the help desk said what I was thinking, that if the TSH was in the "normal" range the testing stopped.

Can a PCP be that unknowledgeable about the tests she's ordering for her patients or am I just losing my mind along with needing a nap all the time?
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She can be that unknowledgeable, and she is!

This test hinges totally on TSH.  If TSH is "normal", usually defined by a much too broad range, something close to 0.5-5.0, rather than the more reasonable 0.3-3.0, testing stops.  

If you want all three tested, the doctor must individually order FT3, FT4 and TSH.  Sometimes, FT4 and TSH are "bundled" on the lab orders, but FT3 is almost always separate.

You're not losing your mind; your doctor's driving you crazy!  LOL  I'd be tempted to ask your doctor to please request the results of the FT3 and FT4 if they were "run, but not reported".  Maybe that would open her eyes...
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Avatar_f_tn
She can be that unknowledgeable, and she is!

This test hinges totally on TSH.  If TSH is "normal", usually defined by a much too broad range, something close to 0.5-5.0, rather than the more reasonable 0.3-3.0, testing stops.  

If you want all three tested, the doctor must individually order FT3, FT4 and TSH.  Sometimes, FT4 and TSH are "bundled" on the lab orders, but FT3 is almost always separate.

You're not losing your mind; your doctor's driving you crazy!  LOL  I'd be tempted to ask your doctor to please request the results of the FT3 and FT4 if they were "run, but not reported".  Maybe that would open her eyes...
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Or, if you want to be nice, print this off and show it to her:

http://www.necla.org/education/disease_mgmt_dtl_4_7975_21912.html
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649848_tn?1357751184
Not sure I like that site...   While it does explain the cascade, it also says that TSH is adequate to monitor hypothyroidism and for ruling out primary hypothyroidism..   grrrr   Too many doctors already think TSH is enough........lol
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To tell you the truth, I really only looked at the graphic of the cascade.  No, you're right, we don't need to be spreading that around.
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649848_tn?1357751184
Maybe ms_sally could just print off the graphic, without the explanation!!  Or as you suggested "ask your doctor to please request the results of the FT3 and FT4 if they were "run, but not reported"."........I like that one, as that could put the doctor on the spot.  Gee, we learn to be sneaky, after a while, don't we?  LOL
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5133140_tn?1364528769
I call bullsh!t on that one.  I doubt they ran them.
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Avatar_m_tn
>Too many doctors already think TSH is enough....

Having looked at what various tests cost, I'm no longer sure why doctors don't just go straight for a thyroid antibody panel as it costs about as much as a TSH test alone. And 80% of your patients with hashimotos are going to test positive.

If the antibodies are negative, then test T3 and TSH.
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5143317_tn?1383751420
Actually I did request the results and the nurse called me back... (made 4 calls and have as of yet talked to the dr).  When the nurse called me, she said the same thing the dr said. And I said, I don't think so, I looked at the labcorp website because I wanted to understand what the test was and it specifically says "test TSH first and within normal testing stops".  I knew I'd caught her when she put me on hold for 10 mins to "call the lab" and came back with the same answer that all were tested but offered to pay for the other tests "free of charge" which is bs because I have insurance. I was livid, so that's when I called the lab myself and the lady at the help desk told me the same thing the website says....

I'm finding that you really have to be your own advocate. Thank God for the internet and being able to arm yourself with knowledge.
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1756321_tn?1377771734
One of my ex doctors told me i didn't have Hashimoto's and pointed out the negative antibodies on the screen. They were negative alright...for celiac disease. :)
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