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Should I be seeing an endocrinologist yet??
I was diagnosed with hashimotos in March by my PCP. Anti-TPO was 500+. TSH was 2.3. Went back to dr in July. TSH was 3.2. He didn’t run TPO again. Said wasn’t necessary b/c once u have an autoimmune response it doesn’t stop. He did ultrasound at that time & I had a nodule <1mm all fluid filled. Went back to him about 30 days later (August) with increasing hypo symptoms & he went ahead & DX sub-clinical hypo. And put me on levoxyl 25mg. Thyroid disease runs in my family on my fathers side (grandfather & aunt). So, when should I be referred/asked to be referred to an ENDO ?
You can see an endo if you want to. My endo was excellent. But I had researched online and read reviews first. Selenium may lower TPOAb. Try one or two Brazil nuts a day. I did an my TPOAb dropped 15%.
Several things to note. Hypothyroidism is not just "inadequate thyroid hormone". Instead, it is correctly defined as insufficient T3 effect in tissue throughout the body, due to inadequate supply of, or response to, thyroid hormone." So it is TISSUE T3 EFFECT which determines a person's thyroid status. There are so many things that affect TSH levels that, except at extreme levels, it is totally inadequate in diagnosing a person's thyroid status. Instead, an evaluation for symptoms is the most important consideration, supported by tests for Free T4, Free T3, and initially Reverse T3 and cortisol. Along with those, hypothyroid patients are frequently deficient in Vitamin D, B12 and ferritin all of which affect response to thyroid hormone, so these need to be tested and supplemented as needed to optimize.
As said by Red_Star, you don't necessarily need an Endo, You need a good thyroid doctor that will diagnose and treat clinically by testing and adjusting Free T4 and Free T3 levels as needed to relieve symptoms, without being influenced by resultant TSH test results. Symptom relief should be all important, not just test results. And of course you need to test and assure that the other mentioned variables are optimal.
Since you have started on a low dose of thyroid med (25 mcg, not mg) you also need to be aware that it will not be additive to your prior serum levels. The once daily dosage will cause TSH to drop, which results in less output from your thyroid gland. Since serum levels are the sum of both natural thyroid and thyroid medication, your levels will not rise significantly until TSH is essentially suppressed. After that further increases in your dosage will start to raise Free T4 and Free T3. levels. Many hypo patients taking T4 med also find that reduced conversion of the T4 to T3 causes Free T3 to lag changes in Free T4. In order to get Free T3 high enough to relieve symptoms often requires the addition of some T3 to your med.
Also note that you should delay your morning dosage of thyroid med until after the blood draw for followup tests, in order to avoid false high results.
The biggest problem you face is finding a good thyroid doctor that will diagnose clinically, supported by expanded testing, and then treat as needed to relieve hypothyroid symptoms, rather than just based on TSH. Also important for the doctor to be willing to prescribe T3 meds if needed to adequately raise your Free T3 level. If you think your doctor is not likely to be willing to do both, then please tell us your location and perhaps we can suggest a doctor that has been recommended by other thyroid patients.
If you want to confirm what I have said, please click on my name and then scroll down to my Journal and read at least the one page Overview of a full paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.
As said by Red_Star, you don't necessarily need an Endo, You need a good thyroid doctor that will diagnose and treat clinically by testing and adjusting Free T4 and Free T3 levels as needed to relieve symptoms, without being influenced by resultant TSH test results. Symptom relief should be all important, not just test results. And of course you need to test and assure that the other mentioned variables are optimal.
Since you have started on a low dose of thyroid med (25 mcg, not mg) you also need to be aware that it will not be additive to your prior serum levels. The once daily dosage will cause TSH to drop, which results in less output from your thyroid gland. Since serum levels are the sum of both natural thyroid and thyroid medication, your levels will not rise significantly until TSH is essentially suppressed. After that further increases in your dosage will start to raise Free T4 and Free T3. levels. Many hypo patients taking T4 med also find that reduced conversion of the T4 to T3 causes Free T3 to lag changes in Free T4. In order to get Free T3 high enough to relieve symptoms often requires the addition of some T3 to your med.
Also note that you should delay your morning dosage of thyroid med until after the blood draw for followup tests, in order to avoid false high results.
The biggest problem you face is finding a good thyroid doctor that will diagnose clinically, supported by expanded testing, and then treat as needed to relieve hypothyroid symptoms, rather than just based on TSH. Also important for the doctor to be willing to prescribe T3 meds if needed to adequately raise your Free T3 level. If you think your doctor is not likely to be willing to do both, then please tell us your location and perhaps we can suggest a doctor that has been recommended by other thyroid patients.
If you want to confirm what I have said, please click on my name and then scroll down to my Journal and read at least the one page Overview of a full paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.
1 Comments
TU gimel. So glad you responded. I’ve read one of your journals already & will definitely read that one too. I’ve done a lot of research since hashi dx & ironically was going to ask doc to let me try a NDT or cytomel when I go back Monday for lab results. He’s been good about doing what I suggest or think I need but would much rather have a specialist take care of my thyroid needs. I’m in Louisiana.
If by specialist you mean an Endo, please understand that most of those specialize in diabetes, not thyroid. Also Many of those have the "Immaculate TSH Belief" and only pay attention to that, which is very wrong. If they go beyond TSH they will usually only test for Free T4 and then use "Reference Range Endocrinology", by which they will tell you that a thyroid test that falls anywhere within range is adequate. That is also very wrong.
What part of Louisiana?
Do you know what lab results you will be getting Monday? Will they include Free T4 and Free T3, and the others I mentioned? If not, you can get a good idea about your doctor by asking for the other tests and see if he is willing. You will need those tests done no matter what doctor you end up with.
What part of Louisiana?
Do you know what lab results you will be getting Monday? Will they include Free T4 and Free T3, and the others I mentioned? If not, you can get a good idea about your doctor by asking for the other tests and see if he is willing. You will need those tests done no matter what doctor you end up with.
1 Comments
I’m in north central LA. Yes, I know all about the TSH fixation with most docs. Guess I was lucky in that mine was willing to start me on levoxyl at 3.2 TSH. And yes, he has been doing t4 & t3 along with vitamin & minerals ( checking for Defi’s I guess). No reverse t3 though. I haven’t pushed it b/c I figured that would be done when my levels were enough to constitute a referral to a specialist. Had no idea that should have been done initially like you said. Monday will be results of full ( comprehensive I guess you would say) blood work plus ultrasound of neck That was done sametime as blood draw. Would love to give you some levels of first full blood work up I had in March & get some advice before Monday. Knowing what I know now I have concerns if this lab report isn’t any different. Like cortisol, ferritin, free t3......
I'll be happy to look at any of your thyroid related blood test data. I am looking around for a doctor to suggest for you. More later.
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