# Preparing for doc visit



## Enigma (Jun 13, 2011)

I have been reading a lot here at this forum and others, as well as a couple of books on hypothyroidism... I've kind of been lurking while I try to educate myself on what is going on with me.

I am having my first doc visit since getting my blood work back and starting levothyroxine (50 mcg). Just a little background:

For the past 5-6 years have been experiencing these symptoms:

-Swelling ankles / pain in ankles
-Weight gain (120 lbs in college, up to 165 lbs at highest)
-Fatigue
-Heart palpitations
-Depression

The last year I've had the above symptoms, but also these, becoming worse the last 6 months:
-Hair loss
-Brain fog (even Dx'ed with ADD)
-Constipation (sometimes for over a week)
-Muscle pain, particularly neck/shoulders
-Extreme fatigue, so much that I was afraid I would fall asleep driving to work
-Incredibly dry skin (and horrible dry mouth the last 2 months)
-High blood pressure & heart rate
-Dizzy (to the point that I thought I would faint just while sitting in a chair)
-Low temp. (even if I was sick, it was always around 97.1-97.6ish, almost never at 98, and I would feel feverish when it was 98.6-99ish)

Doc thought it was stress, but ordered a blood work-up since nothing had been done for 5 years (this is a new doc that I started with in November, so he's still getting to know me. Last doc always told me JUST RELAX and never helped).

TSH = 15.4 (.4-4.0)
Free T4 = .9 (.8 - 1.??)

On Tuesday I will go back for my first visit post-diagnosis and starting levothyroxine. I am not feeling GREAT yet... maybe a bit better, but definitely not great. I don't feel my blood pressure anymore and not dizzy, and definitely not constipated (actually having diarrhea every other day, and going at least twice a day). I've had bad heartburn/reflux since starting the meds. Also, still feel EXHAUSTED... but can see that there is a light at the end of the tunnel...

However, after doing lots of reading, I would really like to try Armour instead of the generic levothyroxine. I think the mix of T3/T4 would benefit me, and since it's early yet, I'd like to switch before I get too far into the levo. I'd really like to try the 2%/98% discussed in the Ken Blanchard book, but I don't want to push my doc too far.

So, after all of that!, my questions are:

1. How should I approach the subject of switching to Armour? I don't want to make him mad, or seem like the patient that reads everything on the web and 2nd guesses her doctor (though, I guess I am that type, but I have had BAD experiences with docs recently so I like to do my own research). My doc has been great with listening to other suggestions I've had, and even researching things I've said, calling me back to confirm I was right, and prescribing from there based on what I had told him. So he seems very open-minded and willing to try new things. But I just don't want to push my luck too far, so want to approach it just right, you know?

2. What other tests should I ask him for? I want to find out more about my antibodies (since auto-immune had been a possibility mentioned 5 years ago), but what else would be good to have checked?

3. Any other suggestions?

Thank you so much for your help- this board has been invaluable thus far!!


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## lainey (Aug 26, 2010)

First of all, your expectation should be that this is not a quick fix. It will take a lot longer than the initial 6-8 weeks to fix your levels and symptoms. People often don't feel better until their levels are euthyroid for some time.

Your labs were clearly hypo. Knowing whether you have antibodies is nice, but it doesn't affect your treatment with replacement. If you want to ask for them as part of your labs, feel free, but don't be surprised if the doc thinks they are not necessary.

You should have a thyroid ultrasound though, if you have not had one yet, as a baseline.

Make sure your ferritin and vitamin D are in good ranges. Low levels of these mimic the symptoms of hypothyroidism.

You should be taking a branded form of T4. A vast majority of people do well on T4, but some people are sensitive to the differing bio-availabilities in the different brands--a generic is still a "brand", made by a manufacturer, and each time you fill it it can be different. Pick one--Synthroid, Levoxyl--there are several.

As for Armour, if you switch now, you are going to go back to square one re: labs and possibly symptoms. You really can't say right now that you won't feel well on T4 alone because you're not "done" yet. You need labs regularly as you titrate your dose upward. T3 meds work best in people who don't convert T4 to T3 well--and they are not in the majority. If you get to the point where your T4 and TSH are in a good spot and your Free T3 is still low, adding a little cytomel usually takes care of things.

You'll find out how responsive your doc is just by the titration process. Many of them will titrate you until your labs are simply "in range", while others address your labs and symptoms.

Be careful about what you read about TSH levels, BTW. TSH is a curve, and people can feel well at all different levels---there is no mandate to get your TSH to a certain number, the correct one is the point where a majority of your symptoms resolve and you feel well. And I mean "majority". People who are euthyroid struggle to lose weight, suffer from occasional fatigue, constipation and dry skin. T4 replacement is not a magic pill that is going to take all of these things away.

Are you getting labs before the follow up so that you have something to discuss with the doc? Let us know how it goes.


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## northernlite (Oct 28, 2010)

Boy I agree 100% with what Lainey said!! There must be a reason she is a Super Gold Veteran!

Patiently stepping through the process is the best way to find out what is going to make you feel well again.


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## Andros (Aug 26, 2009)

Enigma said:


> I have been reading a lot here at this forum and others, as well as a couple of books on hypothyroidism... I've kind of been lurking while I try to educate myself on what is going on with me.
> 
> I am having my first doc visit since getting my blood work back and starting levothyroxine (50 mcg). Just a little background:
> 
> ...


There is no question but what you needed thyroxine replacement and I am glad the doc put you on it forthwith.

Has your doc run any of these antibodies' tests, would you know?

TSI (thyroid stimulating immunoglobulin),TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/

And has your doc done a FREE T3 lab test? Free T3 is your active hormone.

The thing about going on Armour would be that one would only do that if they need to. The criteria would be that you are not converting your T4 to T3. Most of us, if not all of us feel best w/ TSH @ 1.0 or less and the FREE T3 in the 75% range of the FT3 range given by your lab.

I will say though that I am not in favor of generic anything and you may fare better if you switch to a name brand Levothyroxine.

So there you have it. Only getting the FREE T3 labs tests will confirm or disconfirm the need for exogenous T3.

And I am an Armour fan; if not for Armour, I would be totally non-functional. I don't convert. Plus, there are traces of T1 and T2 hormones in the dessicated porcine.

That's another thing. And I will back you up on this even though I gave an opinion which seems contrary. I am a big believer in instincts and if you believe you will do better on Armour, you probably will. Not to mention that a happy patient is a recovering patient.


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## bigfoot (May 13, 2011)

So glad you're getting treatment and it sounds like you have a good doc! As a fellow newbie, here's a few things that come to mind...

I agree about the brand-name Levothyroxine. I've noticed over the last few months our pharmacy has changed the generic company on my thyroid meds. Endocrinologist said the drug companies are allowed a 10% variable in doses. 
I've read that brand-name Levoxyl is pretty well tolerated, and is supposed to be relatively cheaper, too. I just started it the other day (it's printed with "Levoxyl" right on the pill). There is a family member with Hashi's who takes it along with Cytomel and has had good results for years. Some people can tolerate Armour, some can't. (This particular family member couldn't.)

Another thing you might ask or think about is taking your medicine at night, depending on your schedule. There are apparently some small studies out there showing folks who take their thyroid meds at night have a better reduction of TSH levels. Something to do with slowing of the digestive track where the medicine is absorbed, along with having less interaction with other drugs / vitamins / supplements you might be taking in the AM, not to mention food intake.

Selenium as a supplement has been okay'ed to me by both doctor and naturopath doc. I believe 200mcg is a good starting point. Lots of studies out there. I've been taking the "Pure Encapsulations" brand provided by the naturopath, which seems to have a good following and reviews. If I remember correctly, brazil nuts also contain selenium. Even some daily multivitamins will have it if you look close. The selenium is supposed to help suppress TPO antibodies you may have.

Gluten-free is something I've seen mentioned here on the forums, as well as by a doctor. Not everyone has gluten allergies or intolerances, but if you do, it could be revving up any thyroid antibodies. We've been trying to work in gluten-free products here and there, as well as planted a garden and eating healthier.

Some foods are supposed to be worse for thyroid sufferers. I've seen mention of soy products, things like broccoli & cabbage, seaweed, iodine, and of course coffee, soda, and refined sugars and artificial sweeteners. Also, a high-fiber diet can impact the ability of your body to absorb thyroid medicine; just something to be aware of. So that oatmeal that is going to be anti-inflammatory and really good for the rest of your body might give you a little grief with the thyroid.

The adrenal connection is something I've mentioned to all of my docs. All but one have dismissed it without even checking. Hopefully you can have better luck in getting tested for adrenal / cortisol issues, just in case. With your past dizziness it might be something to investigate. I know when my TSH was nearly 7.0 I could hardly stand up and walk straight -- I can't imagine how one of 15.4 felt. And of course, the previously-mentioned B12, Iron / ferretin, and Vitamin D levels wouldn't hurt to get checked.

Let us know how it goes and hang in there! There are speed bumps along the way (which no doctor tells you, btw) but things will improve!
:anim_32:


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## Enigma (Jun 13, 2011)

Thank you guys for your info and feedback (and being honest!!) - I really appreciate it. I will take it slow, and step by step and try to trust the doc. I will mention the brand-name however, since I have had similar inconsistencies with other generic drugs (non-thyroid meds).

I have only been on the levothyroxine for 6 weeks (he started me right at 50 mcg) so it hasn't been too long. However, I am not liking the side effect of diarrhea. This has been horrible. At least once a day, sometimes more. I'm not sure why I am having this side effect, but I have been very sensitive to other meds in the past, maybe I am sensitive to this as well. I am going to mention this to him tomorrow and see what he says. Not sure if a brand-name will take care of this, or if Armour could possibly be better for my system. I will try to discuss this with him and see what his thinking is.

This doc seems like a good doc. He actually listens, and even called me a couple of times when I switched to him and he prescribed me a new med. I wanted to try a particular ADD med, but he hadn't used it in the past, so he wasn't sure. He researched it, checked that the info I gave him was right, and then prescribed it. I even wanted to try taking it in a different way, twice a day, and he looked into it, and got back to me right away, and it was a go! He doesn't seem offended if I suggest things, and actually seems to take it as a challenge to learn more and get updated on literature. He even talks to my cognitive psychologist on a regular basis to see how things are going on that side (and the psych calls him as well). And he and his partner (a D.O) even recommend acupuncture, and other such "alternative" things that the average main-stream doc wouldn't recommend. It is great to have a doc (a general practitioner at that!) that takes a more holistic approach and makes sure he is in tune with not just the body side, but the mind as well. I know many docs, and grew up in the medical world, and this is so uncommon for an MD to go out of his way to research what a patient brings to him and follow through with a patient's other non-medical specialists.

So I think he might be the right doc for this thyroid stuff, or at least, more open and ready to learn than the average doc (and he's in his 50's so should be "set in his ways" but thankfully he is not!). Plus, my dad is a pediatrician, so I can call him and run things by him if I have questions or need to know the latest thinking on something.


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## bigfoot (May 13, 2011)

Enigma said:


> have only been on the levothyroxine for 6 weeks (he started me right at 50 mcg) so it hasn't been too long. However, I am not liking the side effect of diarrhea.


I seem to remember this last year when they first diagnosed me hypo and gave me 50 MCG of Levothyroxine to start taking. After a little while it cleared up and went away.

More recently, they bumped me from 50 MCG to 75 MCG and then to 100 MCG. This was really too much, and I again noticed the diarrhea. They put me down to 62.5 MCG and just the other day bumped me up to 75 MCG. Queue the increased stomach function and diarrhea, although not as bad since it was just a 12.5 MCG increase this go-around.

My understanding is this could be from a few things: a) plain old side effects of the medicine; b) your body just getting used to it; c) some sort of reaction to the medicine; or d) increased motility because it's too high of a dose and/or your body is briefly hyperthyroid.


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## Enigma (Jun 13, 2011)

Hello all!

Here is an update from my doc visit today. This was my first visit since finding out that I am hypo and being on levothryoxine (for 6 weeks).

I would have to say that I am mildly optimistic about this doctor. He was genuinely happy that I had read a lot and brought in outline notes (yes, outline notes, highlighted an everything! They help me think and cover everything and not forget stuff).

He tried to explain to me that most docs only treat hypo when TSH is over 12. I didn't really like that answer, of course. But then he continued to explain how I will need blood tests and how often, and if I start feeling symptoms again (once everything is normal) then they'll readjust meds and do more frequent tests. So he did acknowledge the importance of symptoms.

I mentioned that 4 or 5 years ago I was tested for rheumatoid arthritis, lupus, thyroid, you name it, due to ankle swelling and joint pain (I was 22 or 23 years old at the time). Well, he pulled up my labs from then and apparently my TSH was 3.7ish (I can't remember what he said exactly but it was over 3.5) and he said, wow, that was even on the high end of normal and you were already having problems! So, again, he acknowledged the symptoms, and that even those numbers were on the high end (even tho, looking back, had i known what i know now, I would have pushed to be treated). I can also use this as an argument for wanting to get to MY own body's comfort level of TSH since I apparently was sensitive to even an increase to 3.7.

He did not want to test my T3, but did agree to antibodies, along with the other standards. He said he didn't think it was medically necessary at this point (I didn't feel like arguing) and that between now and my next office visit he would research more on T3. He said to ask him next time for a T3 test once he can see how my T4 levels are responding. Ok, I can deal with that. I forgot to ask about an ultrasound, but will mention it next time.

He also put my on brand name Levoxyl.

He didn't fight me (and i didn't fight him), and he actually discussed things with me and listened, rather than being THE DOC. He's definitely not "thyroid cutting-edge" but he's also not stuck in his ways. He was wiling to work with me and consider things. I would feel comfortable putting a bunch of info together for next time and sharing it with him. He is not intimidated by that, or threatened. He actually takes it as an opportunity to learn.

So it was about as good as I could have hoped for, and definitely no reason to be worried yet.

Thank you guys for your help!!


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## northernlite (Oct 28, 2010)

Personal note here, don't think this happens to everyone but my TSH rose from 0.84 to just over 2 when I switched from generic levothyroxine to the brand name Levoxyl at the same dose. My symptoms returned. I am sticking with the Levoxyl because I want to stay on a name brand and not have to worry everytime my pharmacy changes brand of Levo.

I was euthyroid on 62.5 mcg of my generic levothyroxine and am now up to 75 mcg of Levoxyl and doing better again and am due for more blood work now.

For some reason, either the generic had more T4 in it or my body absorbed it better than Levoxyl.


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## webster2 (May 19, 2011)

Enigma said:


> Hello all!
> 
> Here is an update from my doc visit today. This was my first visit since finding out that I am hypo and being on levothryoxine (for 6 weeks).
> 
> ...


Congrats on going prepared! It sounds like you have a good doctor to help you through this. I hope the medication will begin to help you. Best wishes, Sue


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