Sorry, I forgot to add that my most recent test results, done in the a.m., non-fasting, were 1.46 tsh, 1.16 t4
Thank you so much! I'm very good at being my own best health advocate (read: pain in the @ss), so I fully intend to not move my butt from the exam room until I get what I need. I appreciate the backup. ;) I'll let you know how it goes.
Another question, if you don't mind - does it matter what time of day I get the tests? Should I fast? And should I return to my rheumie or start with my PCP and go to an endocrinologist? Er, sorry, that was more than one question...
I also had my D level checked within the last six months and it was normal. Also recently started taking a B12 supplement to see if it would help my energy level - so far no difference.
With most reference ranges there is "normal' and then there is adequate. For Vitamin D, you want to be higher than the lower end of the range.
Regarding testing, if the doctor is one with the "Immaculate TSH Belief" I would have suggested the afternoon. Only because TSH has a Circadian Rhythm and is lowest around 9 a.m. Since your a.m. TSH test was 1.16, it is not likely to matter much. Fasting is required for only selenium, that I recall.
I think I would start with your PCP, unless you can find a good thyroid doctor. That does no imply an Endo. Frequently they are the most rigid when it comes to using TSH as the sole diagnostic, or using the very broad reference ranges for FT3 and FT4 as pass/fail, rather than as guidelines within which to adjust levels as necessary to relieve symptoms. A good thyroid doctor will treat you clinically by testing and adjusting FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not test results. Test results are valuable mainly as indicators during diagnosis, and then afterward to track FT3 and FT4 levels as meds are increased toward symptom relief.
I think you can get some good insight into clinical treatment by reading this link. The link is to a form letter written by a good thyroid doctor for patients that he is consulting with from a distance. The letter is sent to the PCP of the patient to help guide treatment.
If you will tell us where you are located, members might be able to recommend a good thyroid doctor in your area.
Thanks again!! I'm in the Toledo, Ohio area. We *might* be moving to Florence, SC in a few months, though, if my husband is offered a job down there.
gimel has given you excellent advice. I'm curious if that T4 is "free" or "total". If it doesn't say free on the lab report, it would be considered total, which is of little value.
I'd also suggest that you stop the B12 supplements for a while, then request to have your B12 levels tested. Since you already have RA and your symptoms strongly suggest Hashimoto's/hypothyroidism, you could also have pernicious anemia, which, along with Hashimoto's and RA is an autoimmune disease, which prevents vitamin B12 from being absorbed through the stomach. I have both Hashi's and pernicious anemia, and do weekly injections of B12 to help control my levels and prevent the never ending fatigue.
You could also try a sublingual B12, which would be absorbed without having to go through the stomach; but it would be best to be tested first, in order to find out what your levels really are.
When there is no doctor recommendation based on personal experience, I've had some success with finding doctors on the Top Thyroid Doctors listing.there are two listed for the Toledo area. Do you have any info on either of those?
If you do move, I'm not sure about the travel time for you, but I do have a member recommended thyroid Doctor in Greenville, Sc. Just let me know if you want the name.
Thanks again! You've given me tons of invaluable info with which to prepare for dealing with getting diagnosed.
I'm not familiar with the doctors listed for Toledo, but hopefully my PCP will know. Greenville is a bit of a haul from Florence, but I have family in that area (actually all over North Carolina) so it wouldn't be hard to coordinate an appointment with a visit to my cousins, aunts, uncles, sister or mother. :)