should i have been tested for thyroid antibodies?

[rach7612]

Long story short, I've had hypothyroid symptoms for years, and told every doctor I've seen of my mom's thyroid disease. Wasn't tested until a routine physical this year which showed high tsh and very high fasting blood sugar. Still trying to get tsh normal after months of dosing changes on synthroid. After starting synthroid my fasting glucose has been in the 90s so dr. says the other high readings must have been a fluke.

I obtained all my lab reports over the past several months and did some research online to discover 90s for fasting glucose is not very good. I'm 25, very fit, low body fat, etc - my fasting blood sugar should be in the 70s or 80s. Also, I was never tested for thyroid antibodies, which everything I'm reading about hypothyroid seems to mention. Also not tested for free T3. My labs have also showed high creatinine levels which was never mentioned to me..

I think I'm finally at the right dose of synthroid. I'm more awake during the day and losing a couple pounds I gained.

Despite that, would it be worth my time and money to seek an endocrinologist or second opinion? I'm starting to feel healthier, but from what I'm reading online, the recommended labs and treatment are not exactly what I've experienced. I like and trust my primary care doctor, but I don't know if I'm being a fool by not seeking additional advice.

My childhood is filled with memories of my mom napping constantly and screaming angry, breaking down into tears over tiny day-to-day problems - purportedly due to her thyroid. I've already experienced that - just from side effects of the synthroid alone! I'm terrified of what this condition is doing to my life and my future ability to raise children in a normal environment. I'm considering seeing a therapist, as I'm not completely sure which mood swings I'm having are from my thyroid, and which are from the helpless, confused feelings I've had over the thyroid treatment. It's overwhelming!

[gimel]

Truly you need to be your own best advocate in dealing with your doctor.  Definitely with your increased thyroid knowledge, you should give it a try with your current doctor.

Regarding Nashville, I am sending a PM with some info on a doctor that might be of interest.

[rach7612]

Thank you all for the encouragement. The letter you linked was very enlightening. I wish he was my doctor! I am definitely going to be persistant at least as long as I continue to have symptoms. I am moving to Nashville btw.

[gimel]

Please have a look at this list of 26 typical hypo symptoms.  If you still have some of those symptoms, why wait for 9 months.  As Barb mentioned, some young doctors are more flexible.  They just were not taught anything but the "Immaculate TSH Belief" and " Reference Range Endocrinology" when going through med school.

If you give him a copy of the letter I gave you above and ask the questions I suggested, then the answers will either be helpful to you, or not.  If you cannot persuade him, then nothing is lost but a bit of your time.  At any rate, if you will tell us where you are moving in 9 months, perhaps a member can provide a recommendation for a good thyroid doctor based on personal experience.  

[Barb135]

Sometimes the younger doctors are more willing to be flexible when it comes to thyroid conditions, than older doctors who are really set in their ways, and are firmly entrenched in the belief that TSH is the end all, be all of thyroid testing/treatment.  

Additionally, many younger doctors aren't as "offended" by patients doing research on the internet, rather than following  blindly.  I had an older doctor who got downright hostile when he found out I'd been researching; he told me he thought most of the information out there was "garbage"--- yep, Mayo clinic and other research sites, put out garbage...... right (said with tons of sarcasm.......lol).  He also said that the sites that did put out accurate information should not make that information available to patients, because it causes us to "second guess our doctors" or try to diagnose our own illnesses.  

Do your research, and maybe your doctor will be willing to listen and learn from your symptoms.

[rach7612]

That's very reassuring. I am moving to a new city in about 9 months. I'm considering waiting until then when I'll be changing doctor's anyway and just try to be more selective. I am not comfortable questioning or second guessing my doctor, which is partly why I'm inclined to keep waiting and bare through the lab tests and dose changes. However, I realize it's my responsibility to assert my needs and take control of my health instead of just feeling like a victim. I am surprised I was not referred to a specialist to begin with - especially when diabetes was also still being suspected. My doctor is a good man.. but he is young (early 30s) and I fear maybe he doesn't have the experience to deal adequately with this.

[gimel]

TSH is totally inadequate as a diagnostic by which to dose a thyroid patient.  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.  Free T3 is the most important because it largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms.

Ignoring for the moment some of the other tests you mentioned, because they may be imp;roved by correcting your thyroid levels, I suggest that the first thing you need to do is to go back and request testing for Free T3 and Free T4, along with the TSH they always test.  If the doctor resists and gives excuses that it is not necessary, just insist on it and don't take no for an answer.  It would have been good to have the thyroid antibodies tests, TPO ab and TG ab, in order to understand the cause for your hypothyroidism.  It is not as important now, since you are already on thyroid meds; however those tests would help to anticipate that you may need increasing amounts of meds, if Hashi's is the cause.  Additional tests that would help you are Vitamin A, D, B12, zinc, selenium, and the full test panel for iron anemia.  

I'd say that what you need most is a good thyroid doctor.  By that I mean one 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.  You can gain 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

So I suggest that you go back for the testing suggested above, and also ask the doctor if he is willing to treat you clinically, as also described above.  Also ask if the doctor is willing to prescribe T3 meds.  If either answer is no, then you will need to find a good thyroid doctor that will do so.