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Questions about what my new thyroid doctor told me

Hello. I am a 46-year-old male, and I have autoimmune hypothyroidism.

I've posted to this forum a lot during the last 10 years. For the last 8 years, I've had an endo who believes that keeping the TSH within the reference range is the best way to treat hypothyroidism.

Some people on this forum have advised me to find a new doctor, telling me that my current doctor and her obsession with TSH will keep me ill.


Well, I went ahead and found a new doctor. This doctor is not an endo per se, but she does treat hypothyroidism and she accepts my insurance.

I had my initial meeting with her, and she mentioned some things that I had never heard of before. So, I thought that I would come to this forum and get some additional opinions on what she said.



First of all, unlike the previous doctor, the new doctor actually has an interest in vitamins and minerals (Vitamin E, Selenium, etc.) and their effect on hypothyroidism. However, the new doctor does not like the traditional blood tests that are used to measure these vitamins and minerals. She dislikes blood tests like Selenium (serum) and
Vitamin E (serum). She believes that these blood tests simply measure the amounts of these vitamins and minerals that are in the blood.

The new doctor likes a blood test called the Micronutrient Test Panel, which is processed by SpectraCell Laboratories. This Test Panel is described at the following link:

https://www.spectracell.com/micronutrient-test-panel

According to the new doctor, this Test Panel measures the amounts of vitamins and minerals that are in the actual cells, not in the blood. Also, the Test Panel will cost almost $400 and will not be covered by my insurance. (The doctor accepts my insurance for office visits, but this particular Test Panel will not be covered by my insurance.)

So, have any of you gotten this Test Panel? Do you believe that this Test Panel is a good, valuable blood test?




The new doctor also mentioned some over-the-counter (OTC) thyroid-related supplements that she thought might be helpful to me. These supplements are GTA, GTA-Forte, and Thytrophin PMG.

I asked the doctor whether these supplements could be used *instead* of prescription Synthroid. I thought that it would be nice if I could find some OTC treatment for hypothyroidism that would eliminate my dependence on prescription medicines and doctors. She said that these supplements could be used *with* Synthroid, and that it was *possible* that they could be used *instead* of Synthroid.


I did some research, and I found out that GTA and GTA-Forte contain some porcine glandular material.


I found the following thread on this forum:

https://medhelp.org/posts/Thyroid-Disorders/GTA-Forte-II/show/1738766

This thread is from 2015.


In this thread, a poster named goolarra states that, by law, an OTC product like GTA or GTA-Forte can not contain a measurable amount of T4 or T3. To get around that law, the makers of GTA and GTA-Forte do not reveal the amounts of T4 and T3 (if any) that are present in these products. Basically, how much thyroid hormone is present is anybody's guess.

In 2012, I tried Liothyronine (the generic version of Cytomel). The Liothyronine caused me to have heart issues, and I discontinued the Liothyronine after only a few days. This year, I've had the heart issue called bradycardia from time to time. So, I'm thinking that taking GTA or GTA-Forte (something with unknown amounts of thyroid hormone) would probably be a bad idea. What do all of you think?


I did some research on Thytrophin PMG, and I am still unclear as to what this supplement is. Is this supplement similar to the GTA supplements? Does Thytrophin also have mysterious amounts of T4 and T3?




The new doctor also spoke to me about my circadian rhythms (specifically, my sleep-wake cycle). I told her that I eat dinner and go to bed very late (4 AM or later), and that I wake up at about 12 PM or 1 PM. She told me that my sleep-wake cycle is off and that this bad cycle may be contributing to my hypothyroidism, Vitamin D deficiency, bad bone density (osteopenia), etc.




Also, this new doctor is not obsessed with TSH.


In February 2020, I had the following test results:

FT4 = 1.55 (normal range = 0.82 - 1.77)

FT3 = 3.0 (normal range = 2.0 - 4.4)

TSH = 0.075 (normal range = 0.450 - 4.500)

Because my TSH was too low, my former doctor lowered my Synthroid dose from (137 mcg, 2 times per week) (125 mcg, 5 times per week) to (137 mcg, 1 time per week) (125 mcg, 6 times per week).


In May 2020, my TSH went down even further, and my FT4 and FT3 went up.

FT4 = 1.60 (normal range = 0.82 - 1.77)

FT3 = 3.2 (normal range = 2.0 - 4.4)

TSH = 0.057 (normal range = 0.450 - 4.500)

The former doctor wanted to lower my dose even further (to 125 mcg, 7 times per week). I refused to obey her instructions, and she was not very pleased.


In September 2020, I had the following test results:

FT4 = 1.40 (normal range = 0.82 - 1.77)

FT3 = 3.3 (normal range = 2.0 - 4.4)

TSH = 0.077 (normal range = 0.450 - 4.500)

Once again, the former doctor wanted to lower my dose to (125 mcg, 7 times per week). Once again, I refused.


However, the new doctor went ahead and gave me a prescription for my current dose (137 mcg, 1 time per week) (125 mcg, 6 times per week).




So, please give me your comments on what my new doctor said and did.

Thank you.






5 Responses
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Avatar universal
Welcome back.  Good to hear from you.  

First I question what the testing company claims.: "What truly makes our test unique is that it measures the functional  level and capability of micronutrients present within white blood cells, where metabolism takes place and where micronutrients do their job—thus taking a person’s biochemical individuality into account. Unlike static serum measurements, which only assess the concentration of nutrients present outside of the cell (extracellular) and only provide a glimpse of your health, SpectraCell’s Micronutrient test is a long term assessment (4-6 months) that addresses the functional impact (performance) of micronutrients—what really matters. "    
Another company doing micronutrient testing says, " It is important to understand that, even though you may be consuming an adequate or healthy diet or supplements, your cellular intake levels of those nutrients may not be sufficient and may still provide risks for deficiencies and the disorders associated with them."  How do they know waht is sufficient within cells and how do they propose to increase cellular uptake?     Color me skeptical, especially for $400 out of pocket.  

Second, I would not take any of those supplements.  If you need higher FT4 and/or FT3, then just increase those meds.    your sleep/wake schedule is not the normal one; however I think the doctor is overstating the effect on your "hypothyroidism, Vitamin D deficiency, bad bone density (osteopenia), etc  

The current doctor only gave you a script for the same dosage.  Why not go back to the prior dose of 137 2 days a week and 125 5 days.  Even that may not be adequate, depending on how you were feeling at that dose.  

I guess that in view of all you have told us, I am very leery about that new doctor.   If you will tell us your location maybe we can come up with a better option for you.  
Helpful - 0
Avatar universal
Hi, gimel. Thank you for your response.


"How do they know waht is sufficient within cells and how do they propose to increase cellular uptake?"

Well, how do labs like LabCorp and Quest come up with their reference ranges? I'm guessing that these micronutrient-testing companies come up with their reference ranges in the same way.

And I don't think that these micronutrient-testing companies have to have a plan for how to increase cellular uptake. After all, LabCorp and Quest simply run tests. LabCorp and Quest do not tell you how to get healthy.


"The current doctor only gave you a script for the same dosage."

She gave me the script for the same dosage because that is what I asked for. She did ask me how I was feeling. So, she did seem to be more concerned about my symptoms than about TSH. Honestly, I wasn't sure how I was feeling. I was feeling OK, but I knew that I could feel better.

However, I knew that my previous doctor wanted to lower my dosage, and I believed that the lower dosage would make me feel worse. So, for now, I asked for the same dosage. But this new doctor seemed very flexible on what dosage she was willing to prescribe.


"If you will tell us your location maybe we can come up with a better option for you."

I live in the Chicago, IL, metropolitan area.

I saw this doctor's name on a list of good thyroid doctors (that is, doctors who care about more than just TSH). I communicated with 5 doctors, and she is the only one who takes my insurance. The other doctors do not take my insurance, and they are expensive.

Helpful - 0
Avatar universal
I tend to be skeptical of any doctor who try to sell very expensive products and tests that are not covered by insurance.  That is not to say that they are not credible. But Just be very wary.

I have heard you ask a lot of questions about tests and you gave us the lab values. But there was no correlation to how you were feeling.  As your levels seemed to slowly increase, were you feeling better, worse, or about the same.

you say you now feel OK. Well what exactly does that mean in terms of actual symptoms you have?

Have you tested other vitamins etc levels such as Ferritin, Iron, B12, and vitamin D3?  Yes they ARE blood levels. But if you are feeling well and your blood serum levels are reasonable. Then you can make an assumption that your cellular levels are probably OK.

If your blood levels are out of whack AND you feel terrible.  Pretty easy to figure the out of whack blood serum levels are the culprit or at least contributing to the symptoms.

MY OPINION is that ONLY if you feel terrible and everything else in serum blood levels look fine, should you start attempting to undergo additional and expensive testing to look for a cause.
Helpful - 0
1 Comments
Hi, flyingfool. Thank you for your response.


I really don't know how I'm supposed to be feeling at age 46.

I feel sensitivity to the cold. After I have taken a hot shower, I have to wear a lot of layers of clothing or I will feel very cold.

I live in a home with stairs. Sometimes, I feel as if climbing these stairs is a chore. But, I am 46.

I worked as a Census worker (a physical job) in 2010 and in 2020. I had hypothyroidism in both years. However, I definitely felt more energetic at that job in 2010. Is my hypothyroidism worse in 2020? Or am I just 10 years older in 2020?


In September 2020, I had Iron and Vitamin D tests.

Iron (serum) = 101 ug/dL   (normal range = 38 - 169)

Total Iron Binding Capacity (TIBC) = 265 ug/dL   (normal range = 250 - 450)

Unsaturated Iron Binding Capacity (UIBC) = 164 ug/dL   (normal range = 111 - 343)

Iron Saturation = 38%   (normal range = 15 - 55)

Ferritin (serum) = 332   (normal range = 30 - 400)


Vitamin D, 25-Hydroxy = 22   (normal range = 20.0 - 100.0)


I do have a Vitamin D deficiency. However, as I have mentioned on this forum, I have taken Vitamin D supplements several times in the last 10 years, and I suffered adverse effects each time.


My Vitamin E levels have been low.

Here are my Vitamin E results from May 2019:

Vitamin E (Alpha Tocopherol) = 6.7   (normal range = 7.0 - 25.1)

Vitamin E (Gamma Tocopherol) = 0.6   (normal range = 0.5 - 5.5)


Here is my Selenium result from May 2019:

Selenium (serum/plasma) = 135   (normal range = 91 - 198)


The Selenium normal range used to be 79 - 326. So, I'm not sure whether my Selenium is low normal or mid-normal.


Vitamin E and Selenium supplements are the only things that I have not tried during my 10-year battle with hypothyroidism. So, I thought that, if the micronutrient test shows that my cells are low in Vitamin E and/or Selenium, then maybe I would take these supplements.


My Vitamin B12 levels are normal. Here are my B12 results from February 2020:

Vitamin B12 = 862   (normal range = 232 - 1245)



Avatar universal
Sending you a  PM with info.  To access click on your name and then from your personal page click on messages.
Helpful - 0
Avatar universal
gimel asked the following question about the Micronutrient Test Panel from SpectraCell Laboratories:

"How do they know what is sufficient within cells?"


I contacted SpectraCell Laboratories and asked this very question. I asked, "For each vitamin or mineral, how do you come up with the reference range?"


The Chief Science Officer responded with the following:

"The reference range was determined using data points from 50,000 random patients, approximately 98% North American, the remainder being Canadian and/or central American/Caribbean, by pooling few month’s worth of random test result datasets. It’s not a necessarily ‘healthy’ population (barring MRI scans, sequencing and cardio workups on everyone [etc.], we really don’t know the health status of every patient), but at 50,000 patients it’s normally distributed, and very likely a sample set that is representative of the population, their nutrition status, and their relative risk of various clinical conditions. That is to say, a population sample of that size can be said to be average, and most medical tests compare a given patient’s results to some average (hopefully representative) standard."

"An average value was determined for each analyte (excluding the top and bottom 2.5% of values as statistical outliers), and one standard deviation below the mean is how the cutoff value was determined – so an individual below the cutoff for each analyte is in the approximately bottom 18% of performance."


This officer is a PhD (not an MD), and he is certified to be a High-complexity Clinical Laboratory Director (HCLD) by the American Board of Bioanalysis (ABB).


Also, according to the SpectraCell website, the Micronutrient Test Panel "measures the functional level and capability of micronutrients present within white blood cells". And, this test panel "is a long-term assessment (4 - 6 months) that addresses the functional impact (performance) of micronutrients - what really matters".

I asked, what does the "4 - 6 months" mean?


The Chief Science Officer responded with the following:

"It usually takes 4-6 months to see a significant change in nutritional function for most micronutrients. Therefore we recommend 4-6 months between testing and retesting."


I responded with the following:  

"So, if I change the dosage of some vitamin or mineral due to that Micronutrient Test Panel, I will have to stay on that dosage for 4 - 6 months before I can be re-tested to find out whether that new dosage is doing me any good?"

"In the world of hypothyroidism, whenever there is a change in the dosage of anything (thyroid medications, supplements that affect hypothyroidism, etc.), we are expected to be retested 6-8 weeks after the change in dosage."

The Chief Science Officer has not yet responded to my last response.


So, given what this officer said to me, is this Micronutrient Test Panel a good way to manage hypothyroidism?


Helpful - 0
4 Comments
I've had the spectracell test, but it was several years ago.  I had to have the sample pulled at a special lab and  when I took the test, the lab that drew the sample asked for a $100 (I think that's how much) payment, then they turned it in to my insurance.  They said that's the maximum I would have to pay, whether my insurance paid or not.  They didn't but I didn't ever get billed for the remainder.

I came up deficient in quite a few of the micronutrients, including zinc, selenium and some others as well as borderline on still others.  I'd have to get the results out to find them all.   The report is quite detailed with results, ranges, explanations, etc.

I've since had a different vitamin/mineral panel that Medicare pays for (I think) once/yr.  I also came up deficient in some of the same nutrients, as well as chromium and some others.  

You said the person you talked to at Spectracell explained how they come up with their reference ranges, but there's a difference between a reference range and what's actually in your cells.
Their website says:  "What makes the MNT particularly relevant is that it takes into consideration a person’s biochemical individuality when assessing nutritional status. The MNT is performed intracellularly—it is not a static serum measurement—thus taking into account cellular absorption, metabolism and utilization in its nutritional evaluation of cell function, which correlates with tissue health and systemic health. Serum (extracellular) nutrients fluctuate wildly, are only a snapshot and tell you nothing about the functional health of cells. The MNT measures nutrient status, in the context of cellular function, over a period of 4-6 months. No other nutritional test compares."

Rather than copy/paste the whole explanation, I'll post the link in case anyone missed it for further information:  https://www.spectracell.com/cellular-function-101

You can't use vitamins/minerals to replace thyroid hormone medications, but certain ones are necessary for proper absorption/metabolism of the thyroid hormones.  For instance, zinc helps boost the immune system, selenium has been shown to help reduce Hashimoto's Antibodies and aid in conversion of FT4 to FT3, etc...  

It's true that OTC supplements aren't supposed to contain measurable thyroid hormones.  Manufacturers may get around this by classifying their products as "supplements" not as "drugs" or medications.  
According to the "cellular-function-101" link, the SpectraCell test seems to measure the following: the amounts of each vitamin and mineral inside the cell, and whether these amounts are enough to help the cell do the cell's job.

But will this test measure whether the Selenium and Vitamin E amounts inside the cell are enough to perform the cell's thyroid functions (converting FT4 to FT3, reducing antibodies)?

Also, if I change the dosage of something because of this test, and I'm supposed to wait 4 - 6 months for a retest, then does that mean that I'm supposed to stay with the new dosage for 4 - 6 months?

"But will this test measure whether the Selenium and Vitamin E amounts inside the cell are enough to perform the cell's thyroid functions (converting FT4 to FT3, reducing antibodies)?"  I can't imagine so because the test isn't specifically designed to focus on thyroid issues because these vitamins/minerals are needed for other functions in the body, as well.  In addition, everyone's body is different - i.e. how much selenium *you* need to help perform conversion or decrease antibodies will be different from what *I* need.  This is the reason they come up with reference ranges, which indicate how much of a given substance one should have in order to perform all functions that substance is used for.   They have no way of telling how much of a given vitamin/mineral is used for each bodily function that uses it.  

As to how long you need to stay with a new dose (assuming you're talking about vitamins/minerals),  this is something you should discuss with your doctor.   They're simply saying you should wait 4-6 months to retest, not telling you how long you need to stay on a dosage.  For many of the parameters, you might notice a difference in the way you feel right away (or relatively quickly) after you begin supplementing (as with Vitamin B-12, Magnesium, etc.), others might have to build in the body before you'd notice a difference.  Some- you won't even notice a "visible" difference (this was the case when I was found to be low in selenium and zinc).   I think the best idea is to remain consistent with what you're doing, instead of constantly changing.  Again, though, this should be something to discuss with your doctor.  If s/he knows enough to prescribe this test, hopefully, s/he will know enough to make recommendations based on the results.
  
I forgot to mention that some vitamins/minerals are not stored in the body, so if you only take one for a month or two, but retest in 4-6 months, you may still come up deficient since you didn't stick with the dosage.   If you take a supplement for the entire 4-6 months and your levels end up being over range, that would indicate you could decrease the dosage you're taking.  The idea is to make sure you're taking the right supplements and/or dosages.  
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