# Finally, a Doc is listening...



## shellebean (Oct 12, 2011)

Went to a second Endo yesterday. He's out of network, but was recommended by my GP. It started out shakey with him saying tests I showed him were "normal"...I prepared myself for the blow off. He also said that the nodules were all small and he wasn't concerned.

He did spend a lot of time with me though, saying it is quite controversial whether to start someone on meds while within range because there could be no changes for 15 years, and now they've medicated someone for that long w/o increasing thyroid issues.

BUT, having said that, he said if I felt badly he would start me on 112 mcg of Synthroid. He just said it may or may not make be feel better. He said we'd try to get my TSH between 1-2. I may feel better temporarily-to just not expect miracles. I got it.

He did say that only antibody test had been done (TPO). He took blood to check others? Which would those be? He also was checking for some deficiencies like B12. Follow up in 6-8 weeks, feel like I'm on the right track!


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## webster2 (May 19, 2011)

shellebean said:


> Went to a second Endo yesterday. He's out of network, but was recommended by my GP. It started out shakey with him saying tests I showed him were "normal"...I prepared myself for the blow off. He also said that the nodules were all small and he wasn't concerned.
> 
> He did spend a lot of time with me though, saying it is quite controversial whether to start someone on meds while within range because there could be no changes for 15 years, and now they've medicated someone for that long w/o increasing thyroid issues.
> 
> ...


Wow, it does sound like you found a caring one!


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## Andros (Aug 26, 2009)

shellebean said:


> Went to a second Endo yesterday. He's out of network, but was recommended by my GP. It started out shakey with him saying tests I showed him were "normal"...I prepared myself for the blow off. He also said that the nodules were all small and he wasn't concerned.
> 
> He did spend a lot of time with me though, saying it is quite controversial whether to start someone on meds while within range because there could be no changes for 15 years, and now they've medicated someone for that long w/o increasing thyroid issues.
> 
> ...


You are on the right track if you got some thyroxine replacement.

In the future, see how he feels about running the FREES.

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.

http://www.drlam.com/articles/hypothyroidism.asp?page=2#diagnosis: standard laboratory test

Did you fill the Rx yet? Let us know how you are feeling while taking the Synthroid.

Whew! Getting somewhere is right!


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## shellebean (Oct 12, 2011)

My GP had run FREES:
T4, Free 1.0 (0.8-1.8)
T3, Free 2.7 (2.3-4.2)

He just said normal.

Got the RX filled yesterday and this morning was day 1. I expect it to take a bit for any felt difference, but I'm thinking positively. Will keep you updated. What other antibody tests would he be running?


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## Andros (Aug 26, 2009)

shellebean said:


> My GP had run FREES:
> T4, Free 1.0 (0.8-1.8)
> T3, Free 2.7 (2.3-4.2)
> 
> ...


You did post those elsewhere's, I believe? Yes............you are in dire need. Both FREES are below the mid-range. It is desirable for most of us to have them at the 75% range of the range provided by your lab.

And most of us like our TSH @ 1.0 or less.

If this doc is going by TSH, he is going to panic when he sees your TSH drop. be prepared. Don't know if he will be amenable to learning about the FREES and such. I hope he is for your sake.


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## northernlite (Oct 28, 2010)

Shellebean-

That is a HUGE starting dose of T4 for someone with a TSH of 3.73 and low normal FT4 and FT3. I was one of the ones in favor of you starting medication now but not there!

25 or 50 mcg is the normal starting dose for a borderline hypo individual. I started with a TSH of 8.4 and was started on 50 mcg, I have been titrated through 62.5 and am now on 75 mcg with a TSH just below 2. I think I need another boost to 88 mcg.

I would seriously consider halving that dose for the first 6 weeks and see how you feel. Everyone is different and reacts different but I would be pushed into hyper at 112 mcg. 112 mcg is in the range of full replacement dose for smaller women. I do not know if you are male or female or larger or smaller.


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## shellebean (Oct 12, 2011)

I am a female at about 155lbs. My more comfortable weight is around 135-140 but have put this weight on in the past 18 months.

I have to admit, I was REALLY surprised he started me that high. I was expecting to dabble with 50 or at most 75mcg. They have already set up an appt for 6 weeks, he will compare labs at that point. Hope this is a starting point that we can work up/down with as needed. They are scheduling another ultrasound in 2-3 months, too to check for changes with the nodules.

I do hope to keep my TPO surpressed because of the antibodies, I appreciate the heads up Andros. He very well could not be looking too closely at FREES, too. I will continue to watch with labs and mention.


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## joplin1975 (Jul 21, 2011)

I was in range (before my TT) with the exception of a slightly elevated TSH...I did 50 mcgs and have to agree...that's a huge starting dose. I'm about your weight and on 50, my heart raced, I sweat constantly, I couldn't sleep...I felt like I was on speed. I would rather be hypo anyday. It was simply Awful. So, just be prepared. It's great he's listening, but that's darn near a starting dose for someone without a thyroid.


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## bigfoot (May 13, 2011)

Gonna chime in here and agree: starting at 112 mcg is a *lot* of levothyroxine all at once!

A doc bumped me from 50 mcg to 75 mcg to 100 mcg over the course of a couple of weeks and it was pretty rough. I was really out of it. I had to drop back down to 62.5 mcg, then taper up through 75 mcg again and onwards to 88 mcg. Even that has been bumpy. Who knows, you may get lucky and it works fine for you at 112 mcg, but you might want to consider seeing if you can start "low and slow".

hugs3


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## northernlite (Oct 28, 2010)

Shellebean -

You are my size. In my opinion, 112 is too high to start. I would half your pills (Synthyroid is splitable) and then confess at your next appointment that you were nervous about starting on so much medication and that you want to work your way up slower.

Levothyroxine has such a long half life that you don't want to overshoot. If you begin hyper symptoms, you have to wait many days for the drug to exit your system and get relief.


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## HeidiBR (Apr 4, 2010)

You really, really, really don't want to overshoot this as the others have said. It took me a year to titrate up to 112 - I am your size and my labs were almost identical to yours.

I know you are excited about your endo, but... I am just going to say this...What the heck is he thinking? I have never heard of an endo starting someone on such a high dose for subclinical hypo. In my opinion, it verges on malpractice.


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## shellebean (Oct 12, 2011)

I appreciate all this feedback so much. I only know what I've researched and learned from this wonderful board. As much as I really wanted to start Synthroid, I was shocked he started so high. I've taken full doses yesterday and today, but think for tomorrow I will split. Should I call and let him know that or just do it and follow up as northerlite says...fess up later? Wouldn't do any harm, right? I think it may be more harmful to stay at the 112mcg and I don't know how he'll react to questioning him.


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## shellebean (Oct 12, 2011)

I do want to clarify, I don't think this Endo is "all that and a bag of chips". But first doc willing to spend time listening. Haven't come across any yet, Endos or ENT that I truly feel confident with.
I'm gonna start splitting and "fess up" at my 6 week lab appt. Love you guys!!!


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## Andros (Aug 26, 2009)

shellebean said:


> I appreciate all this feedback so much. I only know what I've researched and learned from this wonderful board. As much as I really wanted to start Synthroid, I was shocked he started so high. I've taken full doses yesterday and today, but think for tomorrow I will split. Should I call and let him know that or just do it and follow up as northerlite says...fess up later? Wouldn't do any harm, right? I think it may be more harmful to stay at the 112mcg and I don't know how he'll react to questioning him.


I certainly agree; I just did not want to be so fast to bring up a negative. We all have so many problems and I just hate to be the one to shoot every little thing down. I erred though; I really did. My bad!

Glad Northernlite addressed the issue.


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## shellebean (Oct 12, 2011)

I just take it all in. I appreciate EVERYONE's thoughts and input. I really respect your positive attitude, Andros! Love your input on another post about being positive! I truely value your opinion. I just hope I can someday positively help others with my experiences the way many of you do!


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## Andros (Aug 26, 2009)

shellebean said:


> I just take it all in. I appreciate EVERYONE's thoughts and input. I really respect your positive attitude, Andros! Love your input on another post about being positive! I truely value your opinion. I just hope I can someday positively help others with my experiences the way many of you do!


You are already and have been a very positive force on this board. And that is in spite of your medical issues! That is commendable to the enth. degree!


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## Jya1124 (Oct 1, 2011)

Wow 112 is really high!!! I started at 75 and went hyper within a couple of months...I would be really careful starting that high, but I'm not a doctor!


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## shellebean (Oct 12, 2011)

Thanks for the feedback. I've decided to listen to my friends here and have been splitting the tabs to 56. Don't know what Doc will say when i see him at the end of January, but if he wants to still go up then, we'll have more labwork to review first.
THANKS to everyone!


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## Andros (Aug 26, 2009)

shellebean said:


> Thanks for the feedback. I've decided to listen to my friends here and have been splitting the tabs to 56. Don't know what Doc will say when i see him at the end of January, but if he wants to still go up then, we'll have more labwork to review first.
> THANKS to everyone!


How are you feeling? Just tell the doc that you were scared to start on that high of a dose. Pure and simple.

Then you will get your labs and I hope we get to see them with the ranges included.

And if needed, I hope your doc increases your med by another quarter. This truly is the best way to do it. Guarantees a high success rate.

Let us know!


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## shellebean (Oct 12, 2011)

Feeling better. Was off last week and can't believe how much I slept. I averaged 10-11 hours of sleep EVERY night!! It was well-needed, but hope I don't pay for it now, going back to my mear 8 hours/night!! Holidays were stressful with work (retail manager) but now is great time to start fresh and get my body/mind on track, too! I go back for labs on 1/27/12.


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## Andros (Aug 26, 2009)

shellebean said:


> Feeling better. Was off last week and can't believe how much I slept. I averaged 10-11 hours of sleep EVERY night!! It was well-needed, but hope I don't pay for it now, going back to my mear 8 hours/night!! Holidays were stressful with work (retail manager) but now is great time to start fresh and get my body/mind on track, too! I go back for labs on 1/27/12.


Don't worry; you are headed in the right direction. Total healing takes about 18 months but it gets better and better every day.


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