# What more should I ask for?



## jaws318 (Oct 24, 2015)

What I'm having trouble figuring out, is what exactly makes a Hashimoto's diagnosis? After getting the following lab results, my doctor (pcp) said I'm "prone to developing Grave's disease or Hashimoto's thyroiditis". I'm having all kinds of hypothyroid symptoms but she said my "thyroid function is normal". So she's starting me on 25mcg of levothyroxine because of the hypo symptoms. But what else would be needed to confirm if I do or do not have Hashimoto's? I'm very confused and she doesn't seem to be all that concerned with my results even though I feel just god awful and plan to become pregnant hopefully in the next 6mo. I'm switching to a new pcp since this is my current one's last week at the clinic, so I'd like to know what questions I should ask my new doctor or what tests I should ask for. Thanks!

TSH: 3.37 (.45-4.7)
Vitamin D: 34 (25-80)
Vitamin B12: 467 (240-930)
Total T3: 125 (97-170)
Free T4: .81 (.78-2.2)
TPOAb: 945.7 (0-100)


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## Lovlkn (Dec 20, 2009)

> TSH: 3.37 (.45-4.7)
> Vitamin D: 34 (25-80)
> Vitamin B12: 467 (240-930)
> Total T3: 125 (97-170)
> ...


Have you had an ultrasound of your thyroid? With TPO antibodies that high you need to insist they run a ultrasound of your gland.

You are "fairly hypo" not mildly hypo.

Free T-4 should be closer to 3/4 of range or 1.86 and you are at .81

Free T-3 should also be at 3/4 of range.

You need to have a FT-3 run as well and can do so yourself at this site for $29

http://www.healthonelabs.com/pub/tests/test/pid/213

Your D is in the basement - what did your doctor suggest for this? Customary treatment is 50K IU weekly for 12 weeks and re-test D. You will need to figure out what it takes to keep your D in high range. I personally have to take 5K IU daily to maintain and I spent a ton of time outside and live in the South but not close enough to the equator I suppose.

Other tests to ask for Ferritin - note when in your cycle you have the lab and try to be consistent with further tests. Low ferritin causes fatigue.

25mcg isn't going to be high enough to make a difference in your labs.

The absolutely most important point in all I say is have an ultrasound of your gland - this is to rule out Cancer - with the high TPO antibodies you are at risk.


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## jaws318 (Oct 24, 2015)

Thank you! No ultrasound, and no mention of needing one. Though now I know to ask for it, as well as Free T3. Should I also have the other antibody test...the thyroglobulin, or something like that? She also did not mention anything about my Vit D level. I'm actually surprised it's so much lower than the optimal range since I live in Houston and spend a lot of time outside! So far, my consensus with this doctor is that, if it's in range, it's fine. She also told me my TSH was still normal when it tested at 4.42 back in 2008. I'm switching doctors and my new doctor starts at the clinic on Monday. I think I'm going to make an appointment with her right away to have a few more labs done and talk more with her about the research I've done since I got these last labs. My current doctor just wanted me to start the levothyroxine and come back for follow up labs in 3mo.


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## Lovlkn (Dec 20, 2009)

8 weeks is customary for a 1st lab recheck, not 3 months.

Also, Vit D needs to be in upper level range. Low D mimics hypo symptoms but you have enough low thyroid labs so you are in a double whammy of feeling low.

Vit D is easy to fix. A prescription for 50K IU weekly for 12 weeks usually does the trick. Then you will need to figure your daily dose to maintain high range. I need 5K IU daily and I am also outside in the sun and live in the South. We need to live at the equator to have a chance.

Insist on the ultrasound of the thyroid due to high TPO antibodies - better safe than sorry.

Eventually you will find a doctor that "gets it". I've not had much luck with endo's


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