False false false! TSH really should not be used to diagnosed thyroid problems, and thats why its one of the most undiagnosed medical problems out there. It took me five years of symptoms and doctors telling me I was perfectly fine until I finally found a doctor who said that, without a doubt, I was hypothyroid. I was told I was fine for so long because my TSH was normal (1.6, the normal range was ~0.5-3.0). However, my free T3 was .8 (should be above 1.5) and free T4 .9 (should be above 1.4), which means my actual thyroid hormone levels were pretty low.
Now that I’m on medication, my T3/T4 levels are good, but my TSH is >0.001! Just shows how TSH really isnt a good indicator…</p>
<p>Unfortunately, not all endocrinologists (most of whom focus on diabetes) seems to know this, or that the reference ranges have been narrowed recently, and still seem to want to treat based on TSH. I went to an endocrinologist at my schools health center because my hypo symptoms were acting up, and she tried to take me off the medication and tried to tell me that I never had a thyroid problem to begin with because my TSH was fine…</p>
<p>poetsheart,
Take your basal (first in the AM) temp every day for a month.
A common symptom for sub-clinical hypo is below normal body temp.
Even a rigid PCP cannot argue with that. Then you can get a referral to an endo,
who will examine your thyroid gland and even sonogram it, and check your reflexes. And listen to your story.</p>
<p>I am sure there will be changes in how to DRx thyroid problems- the ranges for all the values are really unreliable. Hope somebody out there is doing the research!</p>
<p>Ironically, being hypo makes you gain fat, which in turn raises your insulin and blood sugar, so it’s a bad cycle.
My endo thinks that having high insulin/high blood sugar due to obesity inflames the thyroid! As does a drop in estrogen or too much testosterone…</p>
<p>Yup we are hard-wired to store… Now we are struggling to survive in a jungle of processed foods and abundant calories and sedentary life-styles and toxins…</p>
<p>First do no harm. Although I think this area warrants a lot more research, the mainstream endocrinologists, including mine (nationally known expert on thyroid disease) feel that too many people are taking risks with unproven, inconsistent combination therapies. It is especially notable that there can be considerable variation in terms of delivery and that some doctors are concerned about the long term effects on cardiac health. Here are the current practice guidelines for anyone who is interested.</p>
<p>Current guidelines also call for treatment of anyone with a TSH over 5 - at that point the aim is for a TSH between .3and 3.0 ( my doctor says studies have shown most feel best between 1 and 2).</p>
<p>OP here. Saw my PCP today. He basically said what roshke posted above about the current guidelines and that my TSH is within the 1-2 range. He said that adjusting my medication won’t make me feel better but he is running another TSH. He threw a T4 on the lab slip at the last minute. I’m tempted to write T3 on it also. I’m not sure why he doesn’t run all three - my previous PCP always did.</p>
<p>I understand the controversy. I think what upsets me is I’ve had life-long confirmed thyroid problems and never have seen a huge improvement with standard T4 replacement. My sister, who’s TSH is normal was recently diagnosed with ‘subclinical’ hypothyroidism and gets Armour and says she’s never felt better in her life. I’ve heard this same story from several other people recently.</p>
<p>Anyway - I didn’t push for an endo referral. I decided to ask around and find out which endocrinologists in my area don’t subscribe the the ‘only base the dx on the TSH’ theory. Since I work at the hospital, I have access to a lot of people in the know. It wouldn’t do me any good to go to an endocrinologist who holds the same position as my PCP. In the meantime, I plan to do more research on this, if anyone has any good links.</p>
<p>Best wishes for resolution. I’ve been hypo for over 3 decades and well controlled but as I entered menopause I was all over the place for the first time sincx dx…yet my TSH, T3 and T4 all remained in range. From fatigue, hair thinning and depression and a quick 7 lbs to racing heart and crazy amount of energy and a quick loss of 7 lbs…simply all over the place. My doc believed me but there wasn’t much that could be done and the symptoms passed over the course of the year. Personally I won’t mess with Armour…I might consider Cytomel if my T3 and T4 were wacked out.</p>
<p>MomLive - if at all possible, find someone who practices integrative medicine, but who has been trained in conventional medicine.</p>
<p>They don’t become your primary care physician, meaning they don’t see you for routine sick stuff; but they are very tuned into the ‘how-you-feel’ approach rather than relying just all labs. I, too, have thyroid issues (had ½ removed about 15 years ago), but my gynecologist, who has recently trained with Dr. Erika Schwartz
[Balanced</a> Hormones for Life! | DrErika.com](<a href=“http://www.drerika.com/]Balanced”>http://www.drerika.com/)</p>
<p>has started to readjust some of my meds, very, very slowly. I started by adding Iodoral, which supports thyroid health, and we will see how that works. In a couple of months, we will re-evaluate and see if we need to make an adjustment in my Levoxyl. My labs are within ‘normal’ range, but she does not believe in labs alone. I KNOW that I don’t always feel my best, even when I’m within normal ranges. For instance, my iron always tests on the low end of normal… low, but normal. But I’ve added daily slow-release iron supplements to my routine, and definitely notice the difference (mostly with restless legs and night leg cramps). </p>
<p>A good friend of mine who practices integrative medicine in Texas pointed out to me, as an example, that gluten intolerance is on a continuum. It’s not like you either are, or aren’t gluten intolerant and it’s not like you do or don’t develop it overnight. Just because people do not test positive for celiac doesn’t mean they might not be sensitive to gluten (but not test positive for celiac). I think the same is true for many other conditions. Just because you test within normal ranges for a given condition, it doesn’t mean you wouldn’t benefit from some supplemental support.</p>
<p>When you are on a rx which requires different strengths on different days, we treat the monthly fill as 4 weeks, 28 days. It just makes calculations a lot easier.</p>
<p>Desiccated thyroid, i.e. Armour, is still on limited distribution.</p>
<p>I wish I could get all of the docs in one room to look at all my results, look at what meds I’m on, talk to me, and figure out a plan. </p>
<p>Because I’m a lawyer, I compare doctors to lawyers. When we have a complicated deal, we’ll involve corporate lawyers, tax lawyers, real estate lawyers, environmental lawyers and anti-trust lawyers. I can’t imagine me, as a real estate lawyer, recommending that the client also see a corporate lawyer in a different firm, he makes an appointment, two weeks pass, he sees the corp lawyer, who also recommends an enviromental lawyer, etc. It could take half a year to get done what we get done in a couple of days. That is really what we do with our own health care.</p>
<p>^^^ That’s why the clinic-model HMO is a really good way to go. Everyone is right there, under one roof, and getting an additional test is just a walk down the hall. </p>
<p>Ideally, in the medical care system, your PCP can be that quarterback. If s/he’s not, maybe it’s time for a new PCP.</p>
<p>missypie, she’s not in Dallas, but she has clients all over Texas… seriously, all over. Even has a patient in Hong Kong. I guess they come to see her initially for the consultation, and whenever they can get back, but she often does conference calls.</p>
<p>Only down side, is that it’s all cash pay. If you want the practice’s website, I can send it to you.</p>
<p>When you submit the claim to the insurance, you pick how many days the prescription will be good for. For 4 week rx, we put in 28 days, not 30. That should allow you to get the refill at the needed time.</p>
<p>missypie - it doesn’t mean you can’t submit insurance claims after the visit, it’s just the office won’t file it for you and will require payment at time of visit (although I’d guess that they might work something out via a payment plan, et al).</p>
<p>If by “promising” you mean unorthodox or out of mainstream medical thinking then it may be more a case of the insurance companies refusing to cover it rather than the practitoner refusing to take insurance.</p>
<p>I do think that can be the case. My BF sees an alternative medicine physician who likes to run all sorts of non-mainstream tests. For example, she routinely runs blood tests for things like heavy metal toxicity, celiac disease, salvia tests for hormones, etc. She only accepts cash. I think my friend said insurance will pay for some of it but not much.</p>
I’m not sure why he doesn’t run all three - my previous PCP always did.</p>