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Help me prepare for doctor visit please!
My family doctor typically only tests TSH, although he did test for T3 and T4 (not free) when I was originally diagnosed hypo 3 years ago. I have an appointment tomorrow and I'm going to request Free T3 and Free T4, along with a retest of TSH. My last TSH test was August 7 (6.43) so I assume he's going to be reluctant to retest so soon. His normal interval is 8 weeks, but I will be persistent. I was bumpted from 100 to 125 synthroid on August 8.
My symptoms have been the same mental issues I had 3 years ago: depression, jealousy, obsessive/illogical thoughts, sex drive off the charts, etc. 3 years ago synthroid got me 100% back to normal, so I assume it will again and perhaps the FT3 and FT4 are totally unnecessary. However, after hearing from you fine folks, I don't see any harm in knowing these levels, especially FT3 and how it relates to mood and mental problems. Thanks all! Any advice greatly appreciated!
My symptoms have been the same mental issues I had 3 years ago: depression, jealousy, obsessive/illogical thoughts, sex drive off the charts, etc. 3 years ago synthroid got me 100% back to normal, so I assume it will again and perhaps the FT3 and FT4 are totally unnecessary. However, after hearing from you fine folks, I don't see any harm in knowing these levels, especially FT3 and how it relates to mood and mental problems. Thanks all! Any advice greatly appreciated!
Thanks again flyingfool! I've been sleeping about 4-6 hours so I'm in the habit of taking my pill at 5am and coffd\ee at 6. I don't have a thing to eat until 8am, and no milk until lunch. So I think my absorbtion rate is pretty good. The problem I had the last few years since diagnosis is that when I'm feeling good, all bets are off. There are days when I make breakfast for the family and take my pill at 11am on a full stomach. I need to get serious about medicating, especially when I'm 100% normal.
I'm not going to explore vitamins unless I'm still mental at 6 weeks. I'm at 4 weeks and 1 day. My hope is my SLOW trend continues and I'm myself at 6 weeks. But I'm starting to suspect I'm another dosage increase or 2 away from "normal". I'm hanging in there and actually got more work done today than I have in 3 weeks, so that's a good sign. My hands aren't shaking much either. My main symptoms are still there but I've convinced myself that they aren't as bad as 7 days ago. The symptoms are depression and jealous/controlling thoughts about my wife. She's been gone for 3 days and doesn't have a clue, so I've been able to fight it off. If I was really bad, I would try to wreck her day from 500 miles away. I've been able to play the perfect husband. She will NEVER know how hard it is to keep her life close to normal during this, and there's not reason she should. Thanks again! I'll be back soon!
I'm not going to explore vitamins unless I'm still mental at 6 weeks. I'm at 4 weeks and 1 day. My hope is my SLOW trend continues and I'm myself at 6 weeks. But I'm starting to suspect I'm another dosage increase or 2 away from "normal". I'm hanging in there and actually got more work done today than I have in 3 weeks, so that's a good sign. My hands aren't shaking much either. My main symptoms are still there but I've convinced myself that they aren't as bad as 7 days ago. The symptoms are depression and jealous/controlling thoughts about my wife. She's been gone for 3 days and doesn't have a clue, so I've been able to fight it off. If I was really bad, I would try to wreck her day from 500 miles away. I've been able to play the perfect husband. She will NEVER know how hard it is to keep her life close to normal during this, and there's not reason she should. Thanks again! I'll be back soon!
With thyroid medication you REALLY want to separate your time between the thyroid medication, food and especially other vitamins and other supplements.
You want at least about 2 hours between food and up to 4 hours for other supplements. Specifically Calcium (milk). Calcium is known to significantly reduce absorption of Thyroid medication.
Also you may want to consider being tested for a host of other vitamins and minerals. Many of which seem common to be low or deficient in with Hypo patients. Tests to consider are:
Vitamin D3
Vitamin B-12
Iron
Ferritin
All of these can if low contribute to fatigue. I think B6 is also a good one for mood.
If tested you will find HUGE wide ranges for the so called "normal" range. many people here find that in particular, B-12 and D3 they need to be on the very upper end of the range in order to feel well. So yet again do NOT let simply falling within the normal range to be "good enough".
Selenium is another thyroid important vitamin/mineral. However too much Selenium can be toxic as well so you don't want to go nuts with this. Selenium seems to help with the conversion of T4 into T3. You can buy Selenium at most vitamin stores etc. Also naturally Selenium is real high in Brazil nuts. Simply eating 1 or 2 Brazil nuts a day is often enough and the same or more selenium than many tablets.
You want at least about 2 hours between food and up to 4 hours for other supplements. Specifically Calcium (milk). Calcium is known to significantly reduce absorption of Thyroid medication.
Also you may want to consider being tested for a host of other vitamins and minerals. Many of which seem common to be low or deficient in with Hypo patients. Tests to consider are:
Vitamin D3
Vitamin B-12
Iron
Ferritin
All of these can if low contribute to fatigue. I think B6 is also a good one for mood.
If tested you will find HUGE wide ranges for the so called "normal" range. many people here find that in particular, B-12 and D3 they need to be on the very upper end of the range in order to feel well. So yet again do NOT let simply falling within the normal range to be "good enough".
Selenium is another thyroid important vitamin/mineral. However too much Selenium can be toxic as well so you don't want to go nuts with this. Selenium seems to help with the conversion of T4 into T3. You can buy Selenium at most vitamin stores etc. Also naturally Selenium is real high in Brazil nuts. Simply eating 1 or 2 Brazil nuts a day is often enough and the same or more selenium than many tablets.
Thanks so much flyingfool! I had my appointment today and my family doctor agreed to test for FT3 and FT4 after he realized I had done my homework. He does want me to wait until the 7-8 week mark which I agreed to, but I told him I'll track him down if my mood/depression doesn't continue to improve. I told him I was at a 2 out of 10 on the depression scale on Saturday and I'm a 4-5 today, so the trend is moving in the right direction. My hope is that I'm feeling so good that I forget to go in at 8 weeks. It seems highly unlikely at this point, but I was thinking the same thing 3 years ago with depression and then I completely missed a 2 month blood test because I had slipped back into normal. That day can not come soon enough. For the time beiing, I'm trying to keep some type of focus at work and trying to limit my alcohol at night. I realize I should eliminate all drinks during this transition, but that isn't an option right now. 3-4 drinks really helps me get to the next day.
The only other thing I was going to ask him about was multi vitamins and could I start taking one. I'll search here to see what the consensus is. I assume he wouldn't have had a strong opinion on that. He's a pretty laid back doc, but he's been really good for my family.
The only other thing I was going to ask him about was multi vitamins and could I start taking one. I'll search here to see what the consensus is. I assume he wouldn't have had a strong opinion on that. He's a pretty laid back doc, but he's been really good for my family.
TSH is a screening tool/test at best. And should NEVER be used solely to adjust dosages. Free T4 and Free T3 are really the only real things to measure and use outside of symptoms and clinical response.
Think about it. TSH is NOT even a thyroid hormone. It is only supposed to be reflective of thyroid. But any amount of study and research will reveal clinical medical studies after study, after study which shows how variable and unreliable TSH really is. And how much of a shortcoming it really is. Symptoms are shown to DIRECTLY correspond with FT3 and only marginally with FT4. There is very little correlation of symptoms to TSH.
Your body ONLY ultimately uses Free T3. And the only way to get FT3 in your blood is by converting Free T4 or by the direct taking of medication or the little bit of pure T3 the thyroid actually produces.
Why would you not test for the very hormones that your body uses and instead test for a hormone that is only SUPPOSED to relate to Thyroid? It makes no sense.
That all being said, it appears you've had good response with taking straight T4 medication. That is good and it would be reasonable to think that an increase in your medication would likely result in a reduction of your symptoms.
Many people find that when symptomatic, they need to meet BOTH of the following in order to feel well. Everyone is different but it is a much better target that simply being "somewhere within the normal range".
1) Free T4 to be in the MIDDLE of the range (50%) or more
AND- that means in addition to
2) Free T3 in the UPPER 1/3 of the range (66.7%)
Notice both of these are WELL up into the range. Often Dr's will say a person is "fine" or "normal" when there lab results are just barely in the bottom of the ranges or well below 50% and 67% respectively. They are often dismissed by the Dr's etc and told that there is nothing wrong with them even though the patient knows they are feeling like crap. This is because the Dr's are only taught about TSH and nothing more and even when tested if within range they are satisfied. However the patient is still sick and are left feeling stupid and frustrated.
The answer to this situation is to find a new Dr. And don't be surprised if you have to go through several before you finally find a Dr who will listen and treat you properly.
A Dr who only prescribes based upon TSH unless just plain lucky, will almost certainly keep you feeling sick or on a roller coaster of hell.
You should also be tested for Hasimoto's. To conclusively test for this you need to test for the two antibodies. TPOab and TGab. An elevated number above the range on either one, or both would suggest you have Hashimotos. This is the most common cause of Hypothyroid in the modern industrialized world. It is when the immune system thinks your thyroid is a foreign invader and tries to go about systematically killing the thyroid. What this means is that over time your thyroid produces less and less thyroid hormones. As such, your oral medication dosage will have to be increased over time to make up for this loss of hormone output by your thyroid gland.
T4 med takes about 6 weeks to stabilize in the blood. So that would be about minimum recommended time between testing. 8 weeks isn't horrible if you don't feel real bad.
Think about it. TSH is NOT even a thyroid hormone. It is only supposed to be reflective of thyroid. But any amount of study and research will reveal clinical medical studies after study, after study which shows how variable and unreliable TSH really is. And how much of a shortcoming it really is. Symptoms are shown to DIRECTLY correspond with FT3 and only marginally with FT4. There is very little correlation of symptoms to TSH.
Your body ONLY ultimately uses Free T3. And the only way to get FT3 in your blood is by converting Free T4 or by the direct taking of medication or the little bit of pure T3 the thyroid actually produces.
Why would you not test for the very hormones that your body uses and instead test for a hormone that is only SUPPOSED to relate to Thyroid? It makes no sense.
That all being said, it appears you've had good response with taking straight T4 medication. That is good and it would be reasonable to think that an increase in your medication would likely result in a reduction of your symptoms.
Many people find that when symptomatic, they need to meet BOTH of the following in order to feel well. Everyone is different but it is a much better target that simply being "somewhere within the normal range".
1) Free T4 to be in the MIDDLE of the range (50%) or more
AND- that means in addition to
2) Free T3 in the UPPER 1/3 of the range (66.7%)
Notice both of these are WELL up into the range. Often Dr's will say a person is "fine" or "normal" when there lab results are just barely in the bottom of the ranges or well below 50% and 67% respectively. They are often dismissed by the Dr's etc and told that there is nothing wrong with them even though the patient knows they are feeling like crap. This is because the Dr's are only taught about TSH and nothing more and even when tested if within range they are satisfied. However the patient is still sick and are left feeling stupid and frustrated.
The answer to this situation is to find a new Dr. And don't be surprised if you have to go through several before you finally find a Dr who will listen and treat you properly.
A Dr who only prescribes based upon TSH unless just plain lucky, will almost certainly keep you feeling sick or on a roller coaster of hell.
You should also be tested for Hasimoto's. To conclusively test for this you need to test for the two antibodies. TPOab and TGab. An elevated number above the range on either one, or both would suggest you have Hashimotos. This is the most common cause of Hypothyroid in the modern industrialized world. It is when the immune system thinks your thyroid is a foreign invader and tries to go about systematically killing the thyroid. What this means is that over time your thyroid produces less and less thyroid hormones. As such, your oral medication dosage will have to be increased over time to make up for this loss of hormone output by your thyroid gland.
T4 med takes about 6 weeks to stabilize in the blood. So that would be about minimum recommended time between testing. 8 weeks isn't horrible if you don't feel real bad.
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