# My endo said Free T3 is "unnecessary"!!



## slivola (Jun 27, 2012)

Hi Everyone,

I posted recently on how my labs are now in range after starting methimazole 30mg/daily. My endocrinologist had emailed saying "your labs are improving. Please continue on 30mg and retest in 6 weeks." After posting here and doing extensive research on the FDA maintenance guidelines and Elaine Moore's website, I have learned that the FDA's maintenance range is 5-15mg and Elaine Moore has shown research that updates that range to 2.5-10mg. I have decided to take 10mg and retest in 4 weeks from changing to 10mg (I already had 5 days still on 30mg after the blood work was taken.) _ My lab history is provided at the bottom._

So I had emailed my endo (prior to doing any of this research), and I expressed concern that 30mg would make me hypo. (He had once mentioned that most of his graves patients wind up hypo.) He wrote back saying it's just a guessing game and to take 20mg "if it will make you feel better." I also mentioned that I've been really tired the past week and he said my fatigue is unrelated to thyroid "since your labs are in range."

After posting on this board and looking at Elaine's site, I emailed my doctor again and noted about the FDA's range and said I would feel more comfortable taking 10 or 15 mg. I also asked if Kaiser can test for Free T3. Here is the response I received:

_"I appreciate your involvement in attempting to care for yourself.
*A free T3 is unnecessary.* If you wish to take 15 mg instead of 20mg, please cut your 10 mg tablets in half and let me know you have decided to take 15 mg (I still recommend 20 mg for now). I promise we can lower it quickly if you continue to improve. If you would like a second opinion about your care, I can help arrange this."_

So, I have Kaiser so I am doubtful any other endocrinologists there will be any more progressive, but I guess I should get a second opinion. Any suggestions would be appreciated!!!

Thank you!


----------



## slivola (Jun 27, 2012)

Whoops, I forgot to paste in my lab history. Here it is:

T4 FREE (range 0.8-1.5 ng/dL) 
6/7/2012: 3.08
7/30/2012: 1.3

T3 (range: 58-159 ng/dL) 
6/7/2012: 341 
7/30/12 : 118

TSH (range: 0.35 - 4.00 uIU/mL) 
6/7/2012: <0.01
7/30/12 : <0.01

TSI 6/11/12: 345 (range <125)
TPOAB 6/7/12: 79.3(range <5.6ml)


----------



## adenure (May 7, 2012)

I have Kaiser too! When I asked my endo for the free T3, he told me that Kaiser does not offer free T3 testing. So, even with a 2nd opinion at Kaiser, you won't be able to get the free T3 through them. I paid the $85 to get it done myself at Lab Corp. I like my endo a lot though; he sounds a lot like yours. You don't have Dr. Yu in San Diego, do you?

http://www.healthcheckusa.com/Thyroid-Panel-II-T4-Free-T3-Free-with-TSH/46938/

Alexis


----------



## Lovlkn (Dec 20, 2009)

healthcheckusa.com is a wonderful option for the labs your doctor will not run on you.

For those of you in the process of deciding your dosing it is a good idea to have a lab request on hand - in case you need to lab because of symptoms.


----------



## slivola (Jun 27, 2012)

Thanks adenure and Lovlkn. Adenure, I have Dr. in San Diego. Is Dr. like to over medicate, too? What dose did he start you on? I'm just disappointed how my endo didn't even want to lower my 30mg dose when my labs were in range.

I figured Kaiser didn't offer FreeT3, but I didn't appreciate how he said "A free T3 is not necessary." It's my endo suggested I get a second opinion, probably because I keep offering a different suggestion every time he recommends a dosage, and I often email asking for additional blood word like glucose, ferritin, etc. I think he wants to get rid of me, and probably didn't appreciate me quoting the FDA's guidelines for maintenance doses. How often do you get your Free T3 checked to supplement Kaiser's testing? Would you mind sharing your experience, dosage, etc?

Lovlkn- thanks for the healthcheckusa.com website. Right now I'm feeling really tired but it's hard to know if it's thyroid related because my tests 6 days ago were good. It takes a while for the thyroid to cycle through and have changes reflected in the lab tests.

Thank you!


----------



## adenure (May 7, 2012)

Hmmm... I don't know Dr. . Dr. is the opposite; he starts out low and increases slowly. When I was on methimazole, he started me on 5 mg. a day (which got me euthyroid in 7 weeks). He ordered the liver panel (thankfully!) to check my enzymes. I had to stop the methimazole bc of the enzymes problem (8 times the normal amount; I had a normal baseline prior to methimazole).

With my Synthroid dose, he started me at 100 mcg and just increased me dose to 112 mcg. based on my labs.

Dr. is really great. Anytime I email him, he emails me back that day or calls me by the end of the day. He answers my questions, hears me out, gives me his recommendations, but will work with me with all of this. For example, he tried to persuade me to get RAI three times. I know it was out of care for me. He said if it were his wife or daughter, he would want them to have RAI; he said surgery was more invasive, too many variables with the surgeon, nurse, anesthesia etc. But, in the end, I chose surgery and he said that although he didn't recommend it, he supported me in my decision. That meant a lot even though I know he wanted me to do RAI. I've always had lots of questions and wanted to know the "whys" behind his preferences, but he's always talked with me about everything.

He didn't order T3 (total) originally for my post surgery, but when I asked a 2nd time, he ordered it for me. I have not used my Free T3 lab yet, as I want to get further out from my surgery before using it. I'm feeling pretty good for the most part right now, so I'll probably hold off on using the lab slip for awhile. It expires January of 2013, so I have awhile to use it. You might want to see if Dr. is accepting new patients. I also have emailed Dr. (he's in the same office as Dr. ). He's been very helpful as well.

Alexis


----------



## slivola (Jun 27, 2012)

Thank you so much for the information about Dr. ! While my doctor's communication is very prompt and he will listen when I ask about changing a dose, etc, I don't feel we are well matched. Dr. Yu sounds like he has the exact opposite approach regarding the dosing! They are all in the same office in Mission Bay. Glad to hear Dr. is good, too. Apparently Dr. is only in the office a few times a week and then works in "administration" according to what he told me. I think this is reflected in his old school dosing methods. I read that 30mg used to be the standard starting point but now research shows that starting at 20mg has the same results as 30mg and with less side effects.

Thank goodness you didn't have my doctor who would have started you at 30mg and then your liver enzymes probably would have off the charts. I had the opposite happen with my liver. When I started, it was mildly elevated due to the graves disease, but it dropped to almost normal within two weeks meds and now it is totally in range after a full cycle on medication. I'm glad Dr. was so supportive of your surgery even though it wasn't his recommendation. Dr has seemed to be supportive of my many dose suggestions but when he suggested I seek a second opinion, that confirmed it's time to find a new doctor. I think he's sick of me!!

Who did your surgery? Was it a doctor who specialized in TT? How are you feeling now? Is your incision noticeable? I figured I should gather this information so I am prepared with every possible scenario!

Thank you again for all o the information!


----------



## slivola (Jun 27, 2012)

adenure- thank you for the information about your doctor. I already received a referral and there is an opening for me as a new patient. We will need to use actual doctor's name in private messages only due to liability reasons. Thank you so much for your help! I will let you know how it goes once I get an appointment.


----------

