# My first visit with the Endo and I learn very little



## Meow2580 (Oct 13, 2011)

After waiting a month to see my Endo I finally got in to see her. I wasn't really pleased with the level of communication in the office. I felt like cattle to tell you the truth. I basically explained all my symptoms to the doctor and she typed a lot on her lap top. She told me that I had the antibodies that would later result in hypothyroid, but I was experiencing all of the symptoms. 
She then said she would start me on a low dose of 50mcg of Synthroid and run some test for other things because some of my symptoms maybe something else. She then said it could be something called Showgrin or Showgren or something like that. She didn't say anything else really either, other than if it comes back I would have to see a rheumatologist, but I told her I didn't have any joint pain when she asked me. The doctor left and the nurse came back with an info sheet on Hashimotos. It was very breif.

She told me to take the Synthorid and not eat for 30 minutes afterwards, but the pharamacy print out says one hour and not to take iron or calcium for four hours later.

She sent me for lab work at a lab place. It had things on there to check like B-12 vitiman D and a bunch of other stuff I don't know what it was.

She didn't say when (or if) she would follow up with the lab work. She just made the next appointment with the PA in three months for me.

I have been taking the Synthroid now since last Friday.. I don't feel anything. I am just tired and seem to need a nap every day.

My origional lab work when I went in the office was

TSH 4.1 Normal Range .03-5.1
TPO 495 Normal Range less than 35
FT4 1.07 Normal Range 0.73-1.95

Is this the normal experience people have? Does anybody know what the Showgren is? How long before something positive happens while taking the Synthroid. How do you take your Synthroid? Like what the pharmacy says, or what the doctor says?

What is the difference between Hashimotos and Hypo Thyroid?

This is really kind of frustrating for me. Any help would be appreciated.
Thanks


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## Andros (Aug 26, 2009)

Meow2580 said:


> After waiting a month to see my Endo I finally got in to see her. I wasn't really pleased with the level of communication in the office. I felt like cattle to tell you the truth. I basically explained all my symptoms to the doctor and she typed a lot on her lap top. She told me that I had the antibodies that would later result in hypothyroid, but I was experiencing all of the symptoms.
> She then said she would start me on a low dose of 50mcg of Synthroid and run some test for other things because some of my symptoms maybe something else. She then said it could be something called Showgrin or Showgren or something like that. She didn't say anything else really either, other than if it comes back I would have to see a rheumatologist, but I told her I didn't have any joint pain when she asked me. The doctor left and the nurse came back with an info sheet on Hashimotos. It was very breif.
> 
> She told me to take the Synthorid and not eat for 30 minutes afterwards, but the pharamacy print out says one hour and not to take iron or calcium for four hours later.
> ...


Okay..............this doc is a very busy doc and you may be better off to find one that has more time for you specifically seeing you every 8 weeks for labs and further titration upward of your thyroxine replacement as needed until you feel well. This is the normal protocul. To make you go 3 months is not standard and rather cruel in the sense that the starting dose could have you in a bad place where you don't feel so well. This is normal but it it not normal to keep you there unnecessarily. Capiche'?

Sjogren's is this; I have it also as well as Lupus.
http://www.sjogrens.org/

Also, she thinks you have Hashimoto's because your TPO is high. Well, Hashimoto's does present with high TPO a lot of the time but it is not a clear cut diagnosis. It just so happens that high TPO is common; that's all. TPO is "suggestive" of many things and that could include your Sjogren's.

Here is info on that.

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)

Also, if she thinks you have Hashi's, she should have ordered an ultra-sound to see if the thyroid has a nodular grape-like appearance (another typical finding but not definitive) and to rule out cancer.

Hashimoto's is diagnosed by FNA. If certain Hurthle Cells indigenous to Hashi's are present, then you have Hashi's.

Histologic diagnosis of Hashimoto's
http://emedicine.medscape.com/article/120937-diagnosis

Read Nasdaqphil's Special Report on Hashitoxicosis here........ http://www.thyroidboards.com/hashitoxicos

Hope all the above is helpful; lots of reading for you to do.

Welcome!


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## Meow2580 (Oct 13, 2011)

Thanks for the reply and the links to the info. I think I am going to get a new doctor after she calls me back with the lab work I took on Friday. It just didn't feel right..


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## Meow2580 (Oct 13, 2011)

They just called and said the lab takes 14 business days to get back to the office and then it takes the doctor a couple of days to review them...Really? I went to Lab Corp. They are pretty quick on anything else I have done with them. I think this office is way too big. I also would have not called this soon if they had told me that it takes 14 business days to get, but that is the problem, no one told me anything. Just a bad over all experience.


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## webster2 (May 19, 2011)

Geez, 14 days? I live in the sticks and get results the next day. Sorry about the bad experience, you deserve better.


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## Meow2580 (Oct 13, 2011)

Thanks Webster.

I just called Lab Corp to see how long it takes them to complete the ANA test. The lady on the phone looked up my name and date of birth and said all test were complete except for the Vitamin D D2 and D3. She said that would be ready on Nov 3rd and my doctors office has a Lab Corp machine in their office. As soon as the lab knows it is printed on that machine in the doctors office. So I may call them back around Nov 8th if they haven't called me back. I think it is insane that they told me 14 business days!! and then a couple of more days for the doctor to review. I live in a large metropolotin area. They are just too big of an office and people get over looked. Andros is right.... New doctor coming my way.


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## webster2 (May 19, 2011)

Yes, a new doctor wouldn't hurt. 14 days.....ridiculous. Hang in there!


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## northernlite (Oct 28, 2010)

Answers to some of your questions. Your bloodwork indicates that you are hypothyroid. Even though you are in range for your TSH, your lab is using the outdated range. The max should be 3.0 and you are above that.

50 Mcg is a good place to start with Synthryoid. I take it about an hour before I take any other meds or eat anything. As long as you take do what you do consistently, you can get to the right level of medication. It takes a couple of weeks before you feel the effects of the Synthyroid and then you should get progressively better from there until you level out. Then you might need an increase in your medication.

You have TPO which indicates an autoimmue response in the thyroid. With your TSH where it is and the TPO, many doctors will diagnose you with Hashimoto's. Hashimoto's is the autoimmune disease that is attacking your thyroid and is causing your hypothyroidism.

Although not a good bedside manner, your doctor seems to be ordering a lot of the right lab work and has started you on medication. That is a good start.


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## Meow2580 (Oct 13, 2011)

Thank you for your feedback Northernlite. I have my fingers crossed for waiting for a couple of weeks to feel something...anything. I appreciate you for taking time to answer my questions.


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## Andros (Aug 26, 2009)

Meow2580 said:


> They just called and said the lab takes 14 business days to get back to the office and then it takes the doctor a couple of days to review them...Really? I went to Lab Corp. They are pretty quick on anything else I have done with them. I think this office is way too big. I also would have not called this soon if they had told me that it takes 14 business days to get, but that is the problem, no one told me anything. Just a bad over all experience.


Oh, yeah.............................tch!! I hate this for you! I hope you can find a doctor who has the time, is more personal and cares to get you well as quickly as reasonably possible.

This is a disease that requires a doctor to work with you often.


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## Meow2580 (Oct 13, 2011)

Well so much for 14 business days. They just called me can you believe it? Here are my lab results regarding the tyroid (sjogrens was negative..thank goodness)

Thyroid Panel With TSH

TSH 3.460 uIU/mL 0.450-4.500

Thyroxine (T4) 9.3 ug/dL 4.5-12.0

T3 Uptake 30 % 24-39

Free Thyroxine Index 2.8 1.2-4.9

These don't look like the other test my GP took. Can anybody tell me what these test results imply? I got a brief call from the nurse telling me to stay with the synthroid and I also needed to take vitamin D. She emailed me the lab results.


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## Andros (Aug 26, 2009)

Meow2580 said:


> Well so much for 14 business days. They just called me can you believe it? Here are my lab results regarding the tyroid (sjogrens was negative..thank goodness)
> 
> Thyroid Panel With TSH
> 
> ...


Wow; they did the cheapest and most outdated tests. That is why they look different to you.

Dang!

understanding thyroid labs
http://www.amarillomed.com/howto/#Thyroid

http://pro2services.com/Lectures/Spring/Thyroid/ThyTests.htm

Free T3 etc. 
http://www.thyroid-info.com/articles/freet3woliner.htm

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

What a sin! Now what makes them say you tested negative for Sjogren's. What tests did they do?

http://www.mayoclinic.com/health/sjogrens-syndrome/DS00147/DSECTION=tests-and-diagnosis

Sending hugs,


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## Meow2580 (Oct 13, 2011)

This is the readings off the lad regarding Sojgren's

Sjogren's Ab, Anti-SS-A/-SS-B

Sjogren's Anti-SS-A <0.2 AI 0.0-0.9

Sjogren's Anti-SS-B <0.2 AI 0.0-0.9

ANA w/Reflex

ANA Direct Negative Negative


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## Andros (Aug 26, 2009)

Meow2580 said:


> This is the readings off the lad regarding Sojgren's
> 
> Sjogren's Ab, Anti-SS-A/-SS-B
> 
> ...


You do have the merest little whiff of SSA and SSB; so..............this is something you and the doc have to watch periodically. They come and they go. They are below range but you should not have any.

Sjogren's or Lupus or both.

Here is info.

http://ard.bmj.com/content/61/12/1090.abstract


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## Meow2580 (Oct 13, 2011)

Thanks Andros!


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## Andros (Aug 26, 2009)

Meow2580 said:


> Thanks Andros!


You are welcome and I am sure the doc mentioned that this needs to be monitored?


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