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Which Doctor Is right?
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This patient support community is for discussions relating to thyroid issues, goiter, Graves disease, Hashimoto's Thyroiditis, Human Growth Hormone (HGH), hyperthyroid, hypothyroid, metabolism, parathyroid, pituitary gland, thyroiditis, and thyroid Stimulating Hormone (TSH).

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Which Doctor Is right?

I was diagnosed with Hypo/ thyriod a little over a year and a half ago. My levels where rechecked last week and my Doctor made me stop taking my medication levoxyl 125. I went for a second opinion because i thought this was a little harsh my TSH was 00.5 another doctor told me to go back on 50 and it was not safe for me to just stop all together.  I've been so confused and lost. Searching websites, watching video's, even made an emergency room visit Can someone please help?

WHICH DOCTOR IS RIGHT?  HERE ARE ALL OF MY LEVELS AS OF YESTERDAY 4-24-2013 ALSO INCLUDED ARE WHAT THEY USE FOR THEIR Standard Range...    Standard Range
T3 UPTAKE 46         32 - 48
THYROXINE (T4) 13.5 4.5 - 12.8
T7(FT4 INDEX) 15.53 4.50 - 13.13
T3 TOTAL 147                 87 - 178
TSH 0.02                        0.28 - 4.10

PLEASE SOMEONE HELP ME, SHOULD I TAKE 50 AND RE-TEST MY BLOOD OR SHOULD I JUST STOP? I FEEL SICK TIRED NO ENERGY HEART RATE IS VERY LOW, DIZZY , EATING NONE STOP SO FAR HAVE NOT GAINED ANY WEIGHT.

9 Comments Post a Comment
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Avatar_n_tn
Your doctor is using some outdated tests.  I doubt there are many docs that do the T3 uptake anymore or the T7.  Also, your doc did a total T3 instead of a FT3 and i don't see a FT4 in there--only a T4.

You need your blood work redone by someone who know what they are doing--your doc is operating in a different time period.

You ned to get a Free T4, a FreeT3, and a TSH---can't hurt to have your antibodies checked, either, as long as you are having blood work done on your thyroid.
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649848_tn?1357751184
I agree that your doctor ordered outdated tests, which tell very little about what's going on.

You need the Free T3, Free T4 and TSH tests.

That said, your T4 is higher than the reference range, indicating that your dosage may be too high.  The problem is that some of that T4 will be bound by protein, and unusable by the body, which is why you need the Free T4, as that will tell how much is unbound and "free" to be used.

T4 can't be used directly by the cells; it must be converted to T3.  Like the T4, some of the T3 will be bound by protein and unusable, therefore, you need the Free T3, which again, tells how much is free for use.

I'm guessing that the doctor who took you off the med, was reacting to your low TSH, only.  

While a reduction may have been called for, completely stopping the med, is never a good thing to do, unless you were having bad hyper symptoms.
It's usually best to increase/decrease med in small increments, rather doing something drastic.

The doctor who told you to take the 50 mcg was right; but expect to be increased over time.

Do get the FT3, FT4 and TSH tested.

Oh, by the way...... I'm sure you didn't meant to, but typing in all caps indicates that you are yelling at people.
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Avatar_m_tn
I agree with kevieb about the outdated tests your doctor ordered.  Also, many doctors don't understand that when a hypo patient is taking a significant dose of thyroid med, the TSH frequently becomes suppressed below range.  That does not mean that you have become hyper, unless you do have hyper symptoms, due to excessive levels of Free T3 and Free T4, with Free T3 being the most important because it largely regulates metabolism and many other body functions.    

Based on your lab info, your Total T4 is above range, but your Total T3 is well within range.  It is not unusual when taking T4 meds that the T4 results are driven into the upper part of the range or over, in an effort to get the T3 level high enough to relieve symptoms.  You current symptoms are due to your doctor erroneously deciding to take you off the T4 med.  There was not sufficient reason to do that unless you were having hyper symptoms.

I agree with the second doctor that you should still be on your meds.   Without the med no wonder you are feeling so poorly.   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 each time you go in for tests you should insist on Free T3 and Free T4 (not Total T3 and T4).  Since hypo patients are also frequently too low in the ranges for Vitamin D, B12 and ferritin, you should also request those as well.  I also suggest that you should give a copy of the letter to your second doctor and ask him if he is going to be willing to treat clinically, as described.  If not, then eventually you will need to find a good thyroid doctor that will do so.

When more test results are available, please post results and their ranges and members will be glad to help interpret and advise further.
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Avatar_m_tn
I thoguht T7(FT4 INDEX) stood for Free T  4? am I wrong? FT4 Free thyroid index right? or no??? I felt great before she took me off. I had no panic attacks, I was still tired but I thought it was due to having the winter blues. I started taking 25 of levoxyl again last night. I have bottles of left over. Because I am still confused and not sure which way to go, I will take a very lose does for now just in case this doctor is right. The only way I will know is when I go back in a few weeks to be tested. For now I feel tired and just BLAH. But So far everyone is saying Dr. Brigell of Harvard Van Guard is wrong. She is out of Boston, MA Stay away...
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649848_tn?1357751184
The T7 test is an obsolete way of calculating Free T4; it's not the same as the actual Free T4 test.   The actual Free T4 test is much more accurate and tests the direct Free T4; no calculation involved.

You'll be okay on the 25 mcg levoxyl for a while, but will need to increase again, soon, most likely.  

If Dr Brigell of Harvard Van Guard is the one who took you off your med, I totally agree that you should stay away from her........lol
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Avatar_m_tn
Is the uptake free? I"m confused as to what is what...
                                                   Normal range
T3 UPTAKE 45                       32 - 48
T7(FT4 INDEX) 10.64               4.50 - 13.13
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Avatar_n_tn
It's not the same test--even though it sounds like it is.

I had a doctor order test on me once--and the lab put a note on the report saying the labs he had ordered had been replaced with new ones ten years previously---then the guy proceeded to ignore the fact that my FT4 and my TSH were both flagged as low---which indicates a pituitary problem---if he had looked at my records he would have seen that I waas on HC for central adrenal insufficiency.  He was just concerned with normalizing my TSH---so he continued to lower my thyroid meds at least twice--until my hair was falling out--and the original doctor that ordered the first test, finally saw the results---somehow he managed to miss what the other doctor was doing---and the second doc told me my thyroid was too low---but my TSH was in the "normal" range.

TSH will never be normal for me.
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Avatar_m_tn
Thank you. I am going back and forth with her for now becasue she is local and I have no energy to find another doctor. I went and seen another doc but she doesn't want me back more test until 3 weeks from now. She wanted me to take 50 of levoxyl and come back in three weeks she is testing my antibodies. Something Dr. Brigell refused to do. i asked her a few times to test me for the anti. I'm worn out. I'm sure you know how it is. My energy is gone/ and I have no fight in me.
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649848_tn?1357751184
Both the T3 Uptake and T7 tests are obsolete and of little value. They are indirect values, arrived at via calculations.

"T3 uptake is an indirect measure of the quantity of thyroxine binding proteins (thyroid binding prealbumin, albumin, and TBG) in plasma."

You should ask your doctor to run the new, direct, more accurate Free T3 and Free T4.  The results you have are of very little value.

Some doctors are "trainable", if you can go in armed with good information.  

It's good that she's testing thyroid antibodies.
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