# Seeing Dr tomorrow, help w/test results



## GeekGirlNB (Nov 7, 2010)

Hi, I haven't been here in a long while. I recently got health insurance after years of not having any. I've been treating my thyroid for over 15 years.

Just to recap, I'm 30, female. Originally diagnosed with Hashimotos.
For the past 8 months I have been on 125 mcg of synthroid (generic) and 12.5 mcg of Cytomel (generic). Taking in the a.m. once daily, empty stomach.

Here are my labs:

TSH: .04 lab range: .35-4.0
Free T4: 1.12 lab range .81-1.54
thyroperoxidase antibody 792.4 lab standard range <5.6

I don't have a Free T3. I think Dr. forgot to order it! But, obviously my antibodies test is way out of range, even when I'm being treated.

What does this mean? And what questions should I be asking my Dr.?

Thanks! I hope someone gets this tonight!

Nicole


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## lainey (Aug 26, 2010)

The purpose of the treatment is to replace the thyroid hormone that your body is no longer making.

From your results, your dosages look adequate. Patients who are taking T3 (cytomel) will often show low values for TSH and free T4. Yes, you really do need that free T3 test to evaluate the whole picture.

Antibodies tests are used primarily for diagnosis. They don't impact treatment in the sense that the treatment is the same regardless of whether or not you have them. Also, they are not always affected, ie: reduced, by the treatment.


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## Andros (Aug 26, 2009)

GeekGirlNB said:


> Hi, I haven't been here in a long while. I recently got health insurance after years of not having any. I've been treating my thyroid for over 15 years.
> 
> Just to recap, I'm 30, female. Originally diagnosed with Hashimotos.
> For the past 8 months I have been on 125 mcg of synthroid (generic) and 12.5 mcg of Cytomel (generic). Taking in the a.m. once daily, empty stomach.
> ...


Just to add to what Lainey has said.......

TPO Ab is "suggestive" of many things.

TPO Ab
http://www.nlm.nih.gov/medlineplus/ency/article/003556.htm

TPO Ab should be negative, 0
http://www.medlabs.com.jo/docs/Leaflet-17.pdf
(The normal thyroid has TPO but should not have antibodies to TPO)

An ultra-sound of your thyroid would be a good idea if you have not had one recently.

Good to see you!


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## GeekGirlNB (Nov 7, 2010)

Ugh.

New insurance. New Doctor.

OK, so obviously, my TSH was way low at .04. Needs to come up especially cause I'm feeling too hyper.

New Dr said he wanted to lower my Synthroid from .125 to .112 and remove Cytomel all together. I pointed out that he was going to cause my TSH to swing wildly in the other direction eventually. He said no. I also said that I was feeling better since adding T3.

He said he rarely if never prescribes T3 because it doesn't matter. He runs thyroid conditions by the TSH number. I told him I didn't like doing things that way because TSH was never a good indicator of how I feel.

I agreed that my TSH needed to come up. I also agreed that the Synthroid could be lowered and I wanted to slightly lower my Cytomel to 10mg. He argued that I needed to drop the Cytomel, risk for heart issues, etc etc but agreed to what I asked: .112 mg Synthroid and 10 mg Cytomel.

I tried to smooth things over, since he seemed annoyed that I was dictating my treatment, but, in all fairness, he met me and my chart 5 minutes earlier. I've been Hashimotos for 15 + years and I know my past labs and he doesn't have copies of them yet. So, I told him that I was open to making medication changes as long as I continued to feel good, but since I had just last week added Wellbutrin SR to my body, I did not want to remove Cytomel because I wouldn't know which med was making me feel which way, you know?

So, I'm not happy that I snagged myself a TSH-reading Dr. He didn't even want to order the T3 test! I can see this is going to be a fight. But, I'm proud of myself for not backing down. I'm sorry, but moving the Synthroid down and REMOVING 12.5 mg Cytomel would feel MUCH different.

Then we moved on to my depression and anxiety, female menses issues and cramping pain, and all of it, in his opinion, was because my TSH was so low.

He also said something else, I thought was interesting. He claimed that dropping my Cytomel wouldn't be that big of a deal because it was such a low dose he doubted it was doing anything anyway... does that make sense to ANYONE? As I understand it, 12.5 mg is not very low... and, if it was 'barely doing anything', then why the fight to get rid of it, LOL?

Yikes, I'm kind of disappointed.

I also asked the pharmacist if he knew of any doctors being big on prescribing Cytomel or any T3 med. He said he rarely sees it, in fact, they didn't have enough on hand to fully fill my prescription.

Should I ask to see an Endo? Or is that gonna be a waste of my time?


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## Andros (Aug 26, 2009)

GeekGirlNB said:


> Ugh.
> 
> New insurance. New Doctor.
> 
> ...


This guy is way scary. I hope you have some time to seek out another.

W/o T3; we are dead in the water.

Dr. Lam

Free T3 and Free T4

Thyroid gland produces four thyroid hormones called T1, T2, T3, and T4. The number indicates the number of iodine molecules attached to the molecule. T4 is what synthetic thyroid such as Synthroid has. T4 is a hormone precursor and is converted into T3, the form that performs most of the thyroid function in the body. Thinking that synthetic thyroid proves steady hormone levels, it is widely prescribed by doctors. Easily overlooked is the fact that many people cannot convert the T4 to T3. This is easily confirmed by measure.

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=3

I am quite upset on your behalf. I am sure others will back me up. Not to mention that w/o running the FREE T3 lab test, how would he or anybody know if you are over medicated or not?

Defies the imagination!


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## webster2 (May 19, 2011)

GeekGirlNB said:


> Ugh.
> 
> New insurance. New Doctor.
> 
> ...


Wow, are you able to get another doctor? Or, an endo? This guy was just not what you need. I am very impressed how you stuck up for yourself. Hang in there!


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## GeekGirlNB (Nov 7, 2010)

Thanks. Yeah, it was tough to tell him he was not correct. I had high hopes as my experience with my new insurance and other Dr.s had been good. Also, this wasn't just a GP. He is an internist who claims to be pretty 'in the know' and 'current', so I expected something different.

I think I'll try to see an endo after my next round of labs. This Dr. told me an Endo wouldn't say anything different...


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## webster2 (May 19, 2011)

Are there many endo's in your area? Thyroid disease is rampant you'd think someone would get on the band wagon. I just phoned my pharmacy just to see what doctors in this area were prescribing for replacements. The pharmacists said there is one person taking cytomel and 5 taking Armour. I live in rural area. I was curious after your experience. Good luck, these doesn't seem to be an easy road to travel...but you're not alone!


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## Gwen1 (Sep 3, 2011)

My first thought was, he does not have experience in using T3 and doesn't want to start. Wonder where he got his education. And since you were already on a T3 medication, who is he to change that and mess you up? He needs to start where you are!


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