worth consulting an endo?

[RCinNY]

Hi, all.  I only vaguely remember posting here with a similar question a very long time ago, and sure enough, I did.

http://www.medhelp.org/posts/Thyroid-Disorders/to-treat-or-not-to-treat/show/288077#post_1770290

Since then, I've gotten SO MUCH more tired in recent years, that it's difficult, and on some days impossible, for me to get out of bed and to work on time.  In the last year, I've been diagnosed and am being treated for sleep apnea and anxiety/depression.  I also take vitamin B12 and D supplements.  I am now a 36 year-old male, decent weight and diet, and way too tired to exercise.

My numbers are largely the same as they were in those long-ago posts.  Latest labs show TSH = 3.5; FT4 = 1.2; FT3=2.9.  Years ago, my anti-Tg antibodies were > 100.  I also have copies of labs all the way back to the 90s and my TSH was always around 3.5, and I've always been low on energy, but never nearly this bad.  With so many causes of fatigue now controlled for or ruled out, my primary dr. just wants to wait and re-test.  She said she doubts a low dosage of thyroid medication (which?) would be helpful and might make the now-controlled anxiety worse.  Maybe I'm grasping at straws, but should I pursue this further - with an endo for the thyroid or yet another health professional who may have other ideas or is more aggressive?  If so, what should I ask for?  And does anyone have recommendations for the central NJ area (willing to travel into NYC or other parts of the state for answers)?

Thanks.

[gimel]

Sent PM with info.

[RCinNY]

Thanks.  Here are my thoughts...

- I've thought about the general consensus of this board on and off since originally posting in '07.  At this point, still tired and desperate for answers, I'd like to see a dr. (any kind, but likely an endo) who has the same philosophy of the posters here and who would once and for all rule out that there's a thyroid problem or actively treat it.

- Being on the low end of normal for this, Vit. B12, D, testosterone maybe has the cumulative effect of bringing me down.  Sleep troubles aren't helping.

- I'm in the south Old Bridge / East Brunswick, NJ area, but I'm willing to travel to most of the state and into Manhattan if I'm pretty sure I'll be taken seriously.

- To clarify, my most recent lab results are:
TSH 3.48 (0.4-4.5); FT4 1.2 (0.8-1.8); FT3 2.9 (2.3-4.2).  With most other fatigue-related problems ruled out or controlled for, it seems that with my persistent symptoms, I'd have been treated already in some countries which use a lower cut-off for TSH.  I don't know medicine, but I understand stats and it's unusual (if not a problem) for a 36 y/o male to have a TSH that high.  It's at the top of a confidence interval that has a skewed distribution toward the low side.  Again, with anti-Tg Ab present 7 yrs ago.

- Agree about psych meds.  Was already on one, had to be weaned off it, and the current one seems to be working well with therapy.  Will be watchful.

[flyingfool]

I would recommend you find a new Dr.

I am NOT a believer in TSH.  But even the American Academy of Clinical Endocrinologists (AACE) recommended that the range of TSH be changed to 0.3 to 3.0 and that anyone over about 2.5 should be considered for treatment for Hypothyroid.  

Your TSH has remained above this new maximum range for by your ammount for YEARS.

Anxiety and Depression symptoms which are consistent with  Hypo. While both could be Hyper as well. The fact that you exhibit several other sylmptoms consistent with hypo (fatigue and higher TSH).  I would suspect that your anxiety/depression might be relieved once you get proper dosage of thyroid medication.

Many people here have been able to lower or completely ean themselves off antidepressants and anxiety medications once they were properly treated for thyroid.  Not to say that this is a "for sure" thing. But just giving you experiences that people have seen.

Also be aware that many of the anti-depressants and anxiety medications will claim them not to be addictive. But again many people have reported this to NOT be true.  So I could caution you in the event that you want to decrease or eliminate the other medications you may NOT want to do it cold turkey byut instead carefully wean yourself off.

But first I think you need to get the proper tests and find a different Dr.  becaue I believe that your depression would more likely improve than worsen with a starter dosage of thyroid.

If nothing else, challenge your Dr to a "clinical trial" of thyroid.  Have him prescribe you a starter dosage of thyroid and then monitor how your symptoms and how you feel changes.  You may very well find out that after a couple months you may start to feel some improvement.  But if very Hypo, even a starter dose may be spitting into the ocean and be so insignificant that you won't "feel" much better.  But you have to start somewhere!

[gimel]

When analyzing thyroid test results it is always best to compare with the lab's reference ranges.  That is because test results and resultant calculated reference ranges vary from lab to lab.  That said, I am confident that your Free T3 is very low in the so -called "normal" range.  Due to the erroneous method used to calculate reference ranges, reference ranges are typically far too broad to be functional for many people.  Without getting into a detailed explanation of that, just let me say that the ranges for healthy people with no thyroid issues, would be more like the upper half of the current ranges used by most labs.  Since Free T3 has been shown to correlate best with hypo symptoms, while Free T4 and TSH did not correlate at all, I expect that your Free T3 level is the reason for many of your symptoms.

So, you do need to change doctors.  Not necessarily an Endo, just a good thyroid doctor.  Endos frequently specialize in diabetes, not thyroid.  Also, many of them have the "Immaculate TSH Belief' and only pay attention to TSH.  That is unfortunate because TSH cannot be shown to correlate well with either of the biologically active thyroid hormones, Free T3 or Free T4, much less correlate well with symptoms, which should really be the concern, not just lab results.

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

I have been collecting names of good thyroid doctors for over 4 years, so I may have a prospect for you.  If you will give me a better idea of your specific location, I'll send info to you by PM.