# Labs off.....again



## PirateRN (Aug 26, 2014)

I had a previous post discussing my labs, and here is an update. Long story short, I was on Tirosint, 150 mcg, and had a TSH of 0.55. I was having issues with Tiro, so I went back on NatureThroid 1.5 grains, much to the chagrin of my endo who prefers synthetic. After about a week, I started feeling hypo again, so she agreed to repeat labs at 4 weeks. Did NOT take my AM dose of medication before my lab draw. My TSH this time is 1.88 (0.5-4.57). She wants to check them again in 2 weeks, which will be a little over 6 weeks on NT.

She has already suggested that I "do not tolerate" NT and wants me back on Synthroid. My argument is that I am not on ENOUGH NT and that's why my labs are off. Overall, my symptoms are better...less swelling, less hair loss, but I don't think that is going to help me. She did say she "might" up my dose one day a week :-(

I am open to ANY suggestions...I want to keep my NT but don't know how to convince her that I need a higher dose. Please help!!


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## Lovlkn (Dec 20, 2009)

My first suggestion is to request proper tests. TSH is diagnostic not the test to track the success or failure of thyroid replacement medications.

You should ask for Free T-4 and Free T-3 tests which will accurately tell you what thyroid hormone is in your system.

TSH lag's up to 6 weeks and agaon - is diagnostic and should never , ever be used to dose replacement medications


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## PirateRN (Aug 26, 2014)

Totally agree, however, endo is bent on only using TSH as I'm on dessicated thyroid. I'm at a brick wall with her. She doesn't like NDT and wants me back on synthetic. I donor think the dose is right. You can't go from 150 Tirosint to 1.5grains NT and expect labs to remain the same. Or can you? My calculations say I'm way under dosed.


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## joplin1975 (Jul 21, 2011)

Then honestly? You need to find a new provider. If yours won't test frees and you are interested in dessicated meds, then you must test both free t3 and free t4. There's no way to regulate properly without those tests and you'll just spend your time spinning your wheels.


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## PirateRN (Aug 26, 2014)

I'm working on it...sadly, with Tricare it isn't the easiest thing to do. I did convince her this afternoon to at least order a free T4, but again, she doesn't want to order free T3. I'm going to "circumvent" her and have my primary care order them for me. She seems to be a lot more open to suggestions.

It makes me nervous to hear her say that she has to look the medication up and review the dosage calculations because "I really don't know anything about this medication", but she prescribed it to me. She keeps quoting best practice guidelines from the American Endocrinology Society, but, I've yet to see anything on paper stating that her plan is recommended. I actually called the manufacturers of both Tirosint and NatureThroid, and both agree that I need an additional 0.5 grain minimum, but, that isn't going to happen anytime soon with this physician.

I am attending a thyroid seminar next week in hopes to find something remote that may help in the meantime. I have to get referred to someone else, and that's another long wait for a visit. I'm so tired that I can't stay away at work, and after walking a 100 yards or so, my legs are aching like I've been running a marathon. Something has to give and fast..


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## Lovlkn (Dec 20, 2009)

Ditto what Joplin said - find a new doctor.

You can order labs online - you don't need to beg doctors to run any tests. It will cost you maybe $100 for FT-3 and FT-3 and TSH which comes as a 3 pack test. I can't remember the name of that website but someone will hopefully chime in.

Order the tests you want run and start keeping a log.

I kept a log with med doses and FT-4 and FT-3 levels and would bring them to every endo appointment and many GP appointments. I've been stable long enough and have a good flow on prescription refills so I don't use it anymore.

A lab log will help you more than you can imagine when speaking with doctors.

You need to give up on being properly treated by an Endo.

If you want "natural thyroid" then go to the local pharmacies and ask if they have any doctors prescribing it. Go to one of them.


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## ifthespiritmovesme (Jan 8, 2014)

> You need to give up on being properly treated by an Endo.


I couldn't agree more....


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## Lovlkn (Dec 20, 2009)

For $49 you can order the FT-4.

http://www.anylabtestnow.com/

At my location they have a Premier Thyroid Panel that had the FT-4 and FT-3 along with TSH for $99

When I was dialing in doses I used to order labs often and bring the results in with me.

http://www.healthonelabs.com/pub/tests/test/pid/205 this lab gives all 3 tests for $49


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## PirateRN (Aug 26, 2014)

Thanks so much. Today, I'm literally in tears I feel so bad. I can't stay awake anymore, I'm falling asleep at work, have no motivation or energy, and hurt so bad I so t even want to dry off after a shower. I had repeat labs done and of course, endo doesn't want to do anything because my TSH looks good. Remember, I'm on 1.5 grain NT and currently my TSH is 1.51 (0.465-4.68) and my free T4 is 0.6 (0.64-1.79). I expressed how I felt and she said my labs were great I asked about treating symptoms instead of numbers and also related all of the research that is done regarding lab testing on NDT vs synthetic she would not budge, so I fired her. I won't go back. I will rely in my internal medicine doctor to keep me going. I have a list of physicians that prescribe natural so waiting on an appointment there. I'm just so frustrated.


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## smandysen (Aug 13, 2013)

If your regular doc will work with you, then request another referral from them. I'm with Tricare as well and it isn't always easy, but you don't need an appointment to put a call request in to them to let them know that your endo isn't working and you need a new referral. Hopefully one of the physicians on your new list will accept Tricare. Good luck!


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