TSH 1.7

[pjwg]

My doctor would only authorize testing for TSH, nothing more.  She said only if it came back in an abnormal range would she authorize further testing, and she will not refer me to an endo.  My TSH came in at 1.7, normal.  So many of my symptoms lead me to believe Hashimoto's is a possibility.  Am I correct in understanding that just the TSH cannot rule that out?  The nearest lab for Health Check USA is an hour's drive.  Should I just accept that I am a hypochondriac and not investigate further, accepting that I will have to slog through my days feeling and looking like crap?  What would you say to me when hearing that number for TSH?

Thank you for your input.

[gimel]

Have a look at this old link and see if this is the letter you are looking for.  If not, I'll keep looking.

http://www.medhelp.org/posts/Thyroid-Disorders/Lab-Results-on-Armour---T4-Conversion/show/2048950#post_9694718

[Elizb]

Hi, I loved what you had to say about the patients symptoms being considered first. I have been on thyroid medicine for 28 years due to a brain tumor that had to be radiated. In the last few years, my doctor has lowered my thyroid medicine little by little and I have gained weight each time he lowers it. When the dose was at 237, I weighed 145 pounds. I am now taking 175 of Synthroid along with Liothronine and I weigh 195 pounds. I have worked out every day for the last 25 days, walking 2-5 miles every day while watching what I eat. I've only lost a 1/2 pound. I am beyond frustrated. My T3 is 4.5 and my T4 is 1.7. He refuses to change my dosage. I wanted to see the letter that you mentioned in your post but was unable to pull it up. Would you mind emailing it to me? I'd like to show it to my doctor. Thanks

[pjwg]

Gimel, unfortunately you were right.  Strike two with the NP today on testing beyond TSH.  I guess I am not down for the count, but I am feeling battered and bruised and not up to more fighting for now.  I am sure I will get some spunk back eventually, and I will probably just drive up the freeway to get the online lab testing done.  Wish they didn't require you pay for the basic expensive panel first, though -- i am hoping I read that part wrong.

[gimel]

Just don't go to the NP expecting that all will be well.  Be prepared with all the information you can gather to support your position about proper testing and treatment.  That way you will possibly preclude her making statements/ taking a stand from which they are very reluctant to ever back off and admit that they may have been wrong.  Follow the advice from the UK member, that I gave you above.

"What I have learned from my experience is that you have to go to the Dr's office and TELL THEM WHAT YOU WANT and to go backed up with knowledge.  You have to tell them that you have done your reading and looked into your condition and care about the long-term treatment of your health and thyroid.  If you fight for what you want, you will eventually find someone that is happy to go along with your wishes.  But we all have to take charge of our own health, right?"

Please keep us posted and if you want any reference material, just let us know.  

[pjwg]

I am in the US, Oregon.  After I sent a fax yesterday asking again to be referred to an endo and laying out exactly why, the nurse called today saying that NOW the doctor wants me to come in to do a full work-up so she will know if a referral is justified, this after she made me wait in the lobby for most of my 30-minute appointment and then blew me off, saying she didn't have time to discuss multiple symptoms and discounted the one she made me pick as the most important, the myxedema.  I declined.  I have an appointment with a nurse practitioner in a couple weeks who I hope will be more interested in helping me feel better than about the money she can get by having me there.  Thank you all for the kick in the butt I needed to finally be more assertive on my own behalf.  Funny how women will fiercely fight when it comes to their children but not for themselves, huh?  :-)

[flyingfool]

Your symptoms are consistent with being pretty severely Hypo.

you need to get the free T4 and Free T3 tested.  You may also want to test Vitamin D, and B-12 as well as iron.

Tingling hands and feet can also be a sign I believe of low B-12.

It is pretty common for people who are Hypo to also be low on Vit D and B-12.

Dr's are quick to prescribe anti-depressants ad anti-anxiety medication but seemingly loathe to believe or prescribe Thyroid meds.  The connection between depression/anxiety is clearly linked to Thyroid problems.  Btu for some reason Dr's don't believe it.  Especially if TSH is not completely out or whack.  And since yours is about in the middle of most ranges the Dr' completely rules out that you could have Thyroid problem.  This is a very common thing. But it doesn't make it right.

Several people on this site need to have their TSH at or near zero to feel well.  Others need their B-12 at the very top of the range to also feel well.

Each person is different.  The bottom line is that you may have to be extremely persistent to get the treatment you need and finding a Dr who will treat you properly.  

Are you located in the UK?  I didn't notice this in the link or I missed it.

[pjwg]

Thank you, thank you, thank you!!!  I very much appreciate something I can print out, because my memory is shot lately along with apparently the rest of what used to be a pretty decent brain. :-)

[gimel]

Just want to give you some valuable info about becoming your own best advocate for your health.  In the UK they have an even harder time than we do in getting properly diagnosed and treated for hypothyroidism.  One of our members from the UK, who was finally successful, told me that her success was because of this approach to her doctor.

"What I have learned from my experience is that you have to go to the Dr's office and TELL THEM WHAT YOU WANT and to go backed up with knowledge.  You have to tell them that you have done your reading and looked into your condition and care about the long-term treatment of your health and thyroid.  If you fight for what you want, you will eventually find someone that is happy to go along with your wishes.  But we all have to take charge of our own health, right?"

In order to get your doctor to reconsider, you are going to have to feed her information showing that TSH is inadequate for diagnosing and medicating a patient.  TSH is a pituitary hormone that is affected by so many variables that at best it is 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.  TSH is supposed to accurately reflect levels of thyroid hormones, but in reality I have been totally unable to find any statistically valid info that shows it to correlates adequately with either Free T3 or Free T4, much less with symptoms.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  I think you can get some good insight into clinical treatment from this letter written by a good thyroid doctor for  patients that he sometimes consults with from a distance.  The letter is sent to the PCP of the patient to help guide treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf


Note especially the statement, "The diagnosis of thyroid insufficiency, and the determination of replacement dosing, must be based upon the patient’s symptoms first, and on the free T4 and free T3 levels second. The TSH test helps only to determine the cause."

Also note, "The ultimate criterion for dose adjustment must always be the clinical response. I have prescribed natural dessicated thyroid for your patient (Armour or Nature-Throid). These contain T4 and T3 (40mcg and 9mcg respectively per 60mg). They are more effective than T4 therapy for most patients. Since they provide more T3 than the thyroid gland produces, the well-replaced patient’s free T4 will be around the middle
of its range or lower, and the FT3 will be high-“normal” or slightly high before the AM dose."


In this study it was shown that hypo symptoms correlate best with Free T3, while Free T4 and TSH did not correlate at all.  

http://www.ingentaconnect.com/content/routledg/cjne/2000/00000010/00000002/art00002

These links are only two of many that can be provided to help influence the doctor to reconsider.  I would suggest sending copies to the doctor and explain that there are many reasons that TSH does not accurately tell the story about thyroid status.  Tell her that you need to know much more, in order to determine if hypothyroidism is the cause for your many symptoms that are typical of being hypo.  I would also give her a copy of this list of 26 typical thyroid symptoms, marked up to show the ones you have.  

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

I would then follow up by phone and request that you be tested for Free T3 and Free T4 (not the same as Total T3 and Total T4), along with Vitamin D, B12 and a full test panel for iron anemia.  If you get resistance, insist on it and don't take no for an answer.  

I would suggest that you be respectful but forceful, and if this doesn't work then you may as well find another doctor.

[pjwg]

Thank you, flyingtool!  My symptoms are pretty long, so you may be sorry you asked. :-). A couple months ago, it was not being able to get enough sleep, waking up in the middle of the night with extreme anxiety, restless, depressed.  First Trazadone, which helped me sleep but nothing for the anxiety, so then she moved on to Zoloft.  That did help with the anxiety, and I am sleeping better but still wake up regularly at 2:00, 3:00 most nights.  Now it has moved to the other end of the spectrum, still extremely fatigued and now to the point I can barely get through my work day.  I have always had massively thick hair, and now I can see my scalp, including loose follicles.  My always oily skin is now extremely dry, and I have several areas of funky looking thickened skin patches on my face and neck.  Very dry, irritated eyes in addition to dry mouth.  Gut problems, numbness in feet (but I have diabetes, so it's probably linked to that, a couple numb toes on each foot and feel like I have a rock in my sole), and now problems in my hands that feel like carpal tunnel, one finger now staying numb when the rest of the fingers "wake up".  My biggest freak-out is the swelling in my face, but people keep telling me I am just getting older (53).  All around my eyes, top of my cheeks, and sometimes in my jaw, along with intermittently swollen glands.  I am a mess!  I guess I can deal with the cosmetics aspect, but the worst of it is the fatigue and the cognitive issues.  I just can't seem to track anymore, can't find the right words or follow conversations, can't manage normal "have tos" like bills and paperwork.  Sitting down to accomplish them just seems beyond me, too overwhelming to tackle even though I know there will be consequences.  No sex drive of course, but that could also be menopause or depression.  I just don't even recognize myself anymore in so many ways.  I've been downing iron for months now and still have very low levels, so I suppose that explains a lot of it but certainly not all of it.  And now I feel like such a loser 'cause I have been labeled a hypochondriac.  I've been trying to accept that maybe they are right, but something's is telling me to not give up, because so much of the Hashi's fits, and I am starting to wonder if my 16-year-old might have the same problem.

Thank you for listening!  The doctors dismiss these forums, but since *they* won't listen or care...

[flyingfool]

Go somewhere else.

Could you describe your symptoms.

I too have a TSH of 1.6.  But my Free T4 are at the bottom of the range.

That being said.  I could NOT get any treatment medication.  I do have several symptoms.  i agree they are not terrible but they are still present and I think would go away with a starter dose of medication.  But no joy.

i recently switched HMO's so a new Dr.  Have not approached the new Dr yet to see if I can get a Dr to prescribe a starter dose.

just because your TSH is within range tells you absolutely NOTHING really about where your FT4 and FT3 are or if they are in range or where in the range.

Simply being within range means NOTHING.  The ranges are too broad.

Most people seem to feel well when their FT4 are in the MIDDLE of the range if not slightly higher AND (that means in addition to) their FT3 in the UPPER 1/3 of the range.  So simply being "somewhere" within the "normal range" is just NOT good enough for most.  Getting a Dr to believe this and prescribe medication when you are within the rage is a whole other story.