Looking for a new endocrinologist for my Hashimotos disease looking for questions to ask them?

[mirandajkrause]

I have been hypothyroid for about 12 + years and recently they said I had Hashimotos and yet my levels have never been controlled - right now I go in for blood work every 6 weeks and every 6 weeks my levels have changed to the point of them changing my dosage to my meds and yet I am in the "normal range" but still having really nasty symptoms but when i am lower than normal I feel good. what type of questions could I ask some new doctors to see if they go by levels or the way the person feels. and if theres any other questions i am over looking since i am worried about this more than anything?

[gimel]

When TSH is on the low end of the range, the likelihood is greater that it is hyper; however, TSH is a pituitary hormone that is affected by so many variables that at best it is only an indicator, to be considered along with more important indicators such as symptoms, and also levels of the biologically active thyroid hormones Free T3 and Free T4 (not the same as Total T3 and T4).

Please describe for us the symptoms that you have?  Then, If you look at these sites, which one seems most consistent with your symptoms?

http://endocrine-system.emedtv.com/hyperthyroidism/hyperthyroidism-symptoms-and-signs.html

http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html

Also, have you have been tested for any thyroid related test besides TSH?  If so, please post your test results and their reference ranges shown on the lab report.  

[Sofica]

If my tsh level is 0.358, then what i m suffering from :Hypothyroidism or hyperthyroidism

[gimel]

Your doctor doesn't understand that many patients taking large doses of thyroid meds have their TSH suppressed.  This does not mean that your are hyper, unless you also have hyper symptoms due to excessive levels of Free T3.  My TSH has been around .05 for well over 25 years without ever having hyper symptoms.  In fact, even though my Free T4 was at the high end of the range, while taking 200 mcg of Synthroid, I still had lingering hypo symptoms.  After learning about the effect of Free T3 and getting mine tested and confirmed in the low end of the range, somewhat like yours, I got my meds switched to Armour thyroid.  Now after a transition and some tweaking I feel best ever, with my Free T3 at 3.9.

So you really need to feed your doctor enough info to get him to change his treatment, or find a good thyroid doctor that will treat you clinically, by testing and adjusting Free T3 and free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.    

I'm sending a PM with a link to some great info.  Copies of some of the articles might influence your doctor to reconsider his approach.  

[mirandajkrause]

got more results also added the standards

ANTITHY PEROXID. AB 188   Standard Range LESS THAN 35
ANTITHYROGLOBULIN AB: <20 Standard Range LESS THAN 20
Free T3  3.00  Standard Range 2.30 - 4.20
FREE T4   1.51  Standard Range  0.76 - 1.46
TSH  0.868 Standard Range  0.358 - 3.740

Correct usally when my tsh is really low to the point where they think its too low is when i have no huge symptoms but they always want me to lower my dose so i go back into the getting all the symptoms to the point where it affects my daily life.

[gimel]

Test results and reference ranges vary from lab to lab, so to be able to best evaluate your results, we need you to please post their reference ranges shown on the lab report.  If the ranges are close to those I see so often, then your FT4 is at the high end of its range and FT3 below midpoint of its range.  In that case the best approach would be to substitute some T3 for a part of your T4 meds.  

You said that when you were lower than normal you felt good.  I assume by that you were talking about your TSH level, correct?

[mirandajkrause]

Free T3    3.00
FREE T4   1.51
TSH  0.868

so i asked for more of a work up and these are my results i got --- still having symptoms.

[gimel]

Sounds like another doctor with the "Immaculate TSH Belief", that thinks TSH is all that is needed to diagnose and treat a patient.  Wrong!!!!!

A good thyroid doctor will treat a patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results, and especially not just TSH.

I always ask two questions of the nurse of any doctor being considered as a thyroid doctor.  First is whether the doctor is willing to treat clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Second I ask if the doctor is willing to prescribe T3 type meds.  If either answer is no, then keep on looking.