# Can someone help make sure I'm on the right track?



## mollymeow (Jan 28, 2014)

Hi all!

In April 2010, I was diagnosed with hypothyroidism. This diagnosis was made by my PCP solely off of my TSH being 15.8. She told me that once the proper level of medication was found, I would feel like a new person. As a result, I've been on 125mcg of levoythyroxine since around the end of 2010. My TSH has been ~3 every time my blood was drawn. The problem is that I never felt any better. I'm still constantly exhausted, cold, mental fog, etc. In August I asked my PCP for a referral to an endocrinologist. Mind you, this is a different PCP from the original as my insurance has changed. My insurance company denied the referral since my labs were "normal." I just had new labs ordered last week.

TSH 8.67 (0.40-4.50)

Free T3 Gould 2.67 (2.3-4.2)

MCH 31.7 (27-31)

MCHC 31.4 (32-36)

MCV 101 (81-99)

T4 Free 1.03 (0.8-1.8)

Thyroglobulin Abs <20 (0-20)

TPO 237 (no range given)

My doctor said my labs were "normal" except for my TSH and suggested I increase my levothyroxine to 137mcg. Upon doing research, I found that having a TPO of greater than 34 is not normal...is that right? I've requested another referral to an endocrinologist, so I guess I'll see what my insurance says. I have no goiter, but am sort of feeling like Hashimoto's may be a possibility. Do you guys feel that these lab results warrant me appealing any denial by the insurance company? I'm dying to feel normal again, but really can't do the $$$ to go out of pocket.

Thank you SO much for any help, I really appreciate it.


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## joplin1975 (Jul 21, 2011)

Well, I think your labs look pretty awful...and I assume that's how you feel, too! So, yes, I do think you should appeal the insurance company's decision.

I'd also ask for a thyroid ultrasound.

I hope you feel better soon.


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## Swimmer (Sep 12, 2013)

Hi, you need the range on your TPO -- and what are the M-tests?


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## mollymeow (Jan 28, 2014)

Thanks guys! I do feel crappy. Joplin - thanks for the well-wishes! I forgot to mention that my weight has been spiralilng out of control. I lost a lot but gained most of it back. I'm back over 300 lbs, which I never thought I would be again.  I'll see what happens with this referral and appeal the decision if necessary. Without going to a specialist there will be no ultrasound or any further blood tests other than TSH going forward. My doctor is completely ignorant about thyroid issues beyond the basics. I can change doctors if I need to, but only once a month, and only after the first of the month. It's the way my insurance works.

Swimmer - there is no range for the TPO. According to the doctor's office, that is the result that they received. The lab does not provide a range. About the M-tests, are you asking about the ones that I listed? If so, I believe that they all refer to hemoglobin somehow, but I've seen them mentioned in conjunction with thyroid before, so I thought I'd put them in.


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## Andros (Aug 26, 2009)

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/health-medicine/understanding-thyroid-why-you-should-check-your-free-t3
(Copy and paste into your browser)

TPO Ab
Mild to moderately elevated levels of thyroid antibodies may be found in a variety of thyroid and autoimmune disorders, such as thyroid cancer, Type 1 diabetes, rheumatoid arthritis, pernicious anemia, and autoimmune collagen vascular diseases. Significantly increased concentrations most frequently indicate thyroid autoimmune diseases such as Hashimoto thyroiditis and Graves disease.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test
(Copy and paste into your browser)

Substances not found in normal serum (scroll down to autoantibodies)
http://www.thyroidmanager.org/chapter/evaluation-of-thyroid-function-in-health-and-disease/
(Copy and paste into your browser)

Welcome! You are right to worry about the TPO. I would suggest to you that you insist on an ultrasound. And your FREE T3 is in the basement.

Most of us feel best w/TSH @ 1.0 or less and the FREE T3 at about 75% or the range provided by your lab.

Also request Thyroglobulin and Thyroglobulin Ab.

Enclosing info for you!

That increase of thyroxine should help you feel a bit better but do request the above tests and scan.

When you have time, can you list all your symptoms?


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## mollymeow (Jan 28, 2014)

Wow Andros, thanks for all of the wonderful information! Quick question - is the Thyroglobulin Ab test you mention different than the Thyroglubulin ABS test listed in my results? Just trying to make sure I understand everything. 

My symptoms:

Weight gain/can't seem to lose weight

Constant exhaustion

Depression (on Sertraline for this)

Debilitating periods (heavy, never-ending) (on Depo for this)

Mental fog/can't focus

Dizziness

Constantly cold to the bones/joints hurt

Hair falling out (luckily I have lots)

These are all the symptoms that brought me to the doctor back in 2010 looking for relief. They haven't changed for the better; in fact, I'd say they're worse now. When you say that the increase in thyroxine should help, I'm skeptical because it never has before.

I called the doctor's office today and tried to insist on an ultrasound and more labs. I was welcomed to find another doctor. I'm going to wait to see if my insurance approves the endo before I do that; otherwise, I'll have to start the referral process all over again. The endo's office said that they hadn't received the referral request, so my doctor's office said that they'd send it over "again" today. I'm about to lose my dang mind. LOL

Thank you all again for the wonderful help!


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## mollymeow (Jan 28, 2014)

Just to give a little update -

I got a call from my PCP's office telling me that the endo was "questioning the referral." I asked what that meant and was told that there's no more info, that my PCP wanted her to call me and tell me. I had her submit a referral to another endo.

I then called the first endo's office to ask what "questioning a referral" meant. I was told that there was no question, that the endo just wanted to talk to my PCP likely to get procedural history/records. Gah! It worked out ok though; the second endo's office called and scheduled an appointment for me on Monday afternoon. Phew!


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## mollymeow (Jan 28, 2014)

Another update - saw the endo today, she says that I have Hashimoto's. She prescribed 30 mg Armour to take along with my 137 mcg Levothyroxine. She said to repeat labs in 4 weeks and then do a follow-up visit with her. She also said that my thyroid felt normal. Here's hoping that I start feeling better soon!


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