# Nice....(not)



## pandatx (Mar 27, 2013)

waited 6 weeks for my follow up visit with the Doctor (who I made the appt with) only to find out they switched me to the Nurse Practitioner without my knowledgs. For my first follow up. First blood work since starting meds. Ya think I might have questions for the actual doctor? Who I made the appt with? I'm so ****ed off.


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## Andros (Aug 26, 2009)

pandatx said:


> waited 6 weeks for my follow up visit with the Doctor (who I made the appt with) only to find out they switched me to the Nurse Practitioner without my knowledgs. For my first follow up. First blood work since starting meds. Ya think I might have questions for the actual doctor? Who I made the appt with? I'm so ****ed off.


That is horrible but meanwhile you pay as if you did see the doctor. If the majority of the patients were non-compliant about this stuff, they couldn't get away with it.

I have to speak out; if we suffer in silence, nothing will change!


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## joplin1975 (Jul 21, 2011)

Not trying to be all pollyanna about it...you should see the doctor...but sometimes seeing a mid-level can be a blessing in disguise. They often have more time to discuss your case, go over symptoms, and take a more personalized approach to care.

If I hadn't see a mid-level, I would have never known I had cancer.


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## webster2 (May 19, 2011)

I think they should have told you about the switch but I agree with Joplin, sometimes a PA or a NP can be a blessing. What is the plan from here?


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## pandatx (Mar 27, 2013)

Oh, I complained. They think I'm a huge pain in the ass


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## jenny v (May 6, 2012)

I actually love the PA's I see, they take more time than my usual docs, answering questions and listening to my symptoms. I've found they are just as knowledgeable as the docs, in most cases.


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## webster2 (May 19, 2011)

pandatx said:


> Oh, I complained. They think I'm a huge pain in the ass


Don't ever let what they think of you get in the way from getting treated well. Remember you are paying for their service. Be polite but assertive, and know your stuff. Let them know you are an active partner in your care.


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## abymom99 (Apr 15, 2013)

I agree that sometimes they can actually be better. I've had basal cell and melanoma (in situ) in the past and was always seen by a wonderful PA at a derm clinic near me. But after the melanoma incident, I started going to the melanoma specialist in town and quite honestly, I think my PA is better and so I'm planning to start going back to her. She spends so much time going over every square inch of me and removing anything *I* think might be of concern. That's actually how we found the tiny 2 mm melanoma on my foot. I just knew it wasn't there 6 months before and even though it was tiny and did not meet the criteria, she took it and lo and behold, melanoma.

Sorry, didn't mean to go on about all of that! LOL. But yes, you have all the right to be angry since you made the appointment with the doctor, NOT the PA.


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## pandatx (Mar 27, 2013)

Okay, so I went and the PA was good. I did see the doctor at the end (b/c I asked) but made my next appt with the PA. I just didn't like that being sprung on me. The good news was that my T3 and T4 numbers have come back into the normal range. My TSH is still pretty low but its come up a lot. I don't like that they want to increase the methimazole but they felt pretty strongly about it and I'm sick of being non-compliant. Also, I'm still pretty symptomatic. Still no working out  Although I have been walking and doing yoga when I'm having a good energy day.

So, improvements being made. That's a good thing! I did insist on a TSI test (they didn't want to do it since my RAIU was 74.4%) and it came back positive for the antibodies. I guess I have to stop thinking that maybe they're mistaken.


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## Andros (Aug 26, 2009)

joplin1975 said:


> Not trying to be all pollyanna about it...you should see the doctor...but sometimes seeing a mid-level can be a blessing in disguise. They often have more time to discuss your case, go over symptoms, and take a more personalized approach to care.
> 
> If I hadn't see a mid-level, I would have never known I had cancer.


Extremely true!! Sometimes they are much more informed and devoted and especially caring. Very caring.


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## Thyrodeo (Jan 9, 2011)

joplin1975 said:


> If I hadn't see a mid-level, I would have never known I had cancer.


Could you tell us exactly what happened there?


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## joplin1975 (Jul 21, 2011)

It's not that exciting. 

I had a routine GYN exam scheduled. Sometimes I see the doctor, sometimes the PA. The PA always does a full physical, including palpitating thyroids. The doctor is usually rushed and goes straight to the pelvic exam. Anyway, she poked around my neck, said I had an enlarged thyroid, and that started everything. Otherwise, I would have never considered checking my thyroid.


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## pandatx (Mar 27, 2013)

I'm feeling very nervous about increasing the methimazole. I understand that the TSH is the last thing to go up. Here are my results. I think I should just stay on the dose I've been on for 7 weeks. They want to increase me from 10 to 15 mg.

TSH 0.01 (range: 0.40-4.5) was .008 on 4/5
T4, Free 1.1 (range 0.8 to 1.8) was 1.89
T3, Free 3.2 (range 2.3 to 4.2) was 5.6
T3 Total 113 (range 76-181) not done before
TSI 212 (range <130) not done before

Some symptoms have improved, like I'm not hoarse anymore, sleeping a little better, a little more energy, heartrate not as high (but they put me on beta blockers too). But still highly mood swingy, anxious, heart pounds off and on, weak in my muscles, tired more than I should be.


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## JPGreco (Mar 2, 2012)

TSH is one of the last things to change from my understanding as well. I'm not really sure why they want to up your meds either. I'd want you on the same dose for another 4-6 weeks to retest and see if its holding you stable or even too much medication. I don't get the thought process of doctors sometimes. 
I see no reason to increase meds when you're in the normal range, so I agree with your apprehension. I mean, I completely stopped one of my medications simply cause I could tell it was no longer necessary. I actually feel better off it now than when I was on it. Did it without consultation too (not the brightest, but meh).

Maybe someone else with chime in with better experience being on the AT med since I was only on them for a few weeks and nowhere near normal on them.


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## HotGrandma (Sep 21, 2012)

pandatx said:


> I'm feeling very nervous about increasing the methimazole. I understand that the TSH is the last thing to go up. Here are my results. I think I should just stay on the dose I've been on for 7 weeks. They want to increase me from 10 to 15 mg.
> 
> TSH 0.01 (range: 0.40-4.5) was .008 on 4/5
> T4, Free 1.1 (range 0.8 to 1.8) was 1.89
> ...


Your labs are in a good place right now. If it were me I would call the PA back and let them know your relunctant to increase the dosage. If these were my labs I would probably be decreasing the dose. You are right it takes 6-8 weeks for TSH to catch up. I'm afraid if you increase you will end up hypo which can be avoided. Been there done that and the pain was worse. The antibodies should calm down with your levels exactly where they are. If you dip hypo they could increase. The antibodies are porbably the culpret in your case. The antibodies attack the thyroid. The medication treats the thyroid. There is no medication for the antibodies. Therefore when the thyroid is stable the antibodies SHOULD back off, but this takes a long time.


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## pandatx (Mar 27, 2013)

I really don't know what to do. The doctor (not the PA) was very, very firm about me increasing the methimazole. He wasn't open to hearing anything I had to say about being uncomfortable about it. The PA was okay with me increasing it half that much but he over-ruled her. I'm thinking of just not increasing and not telling anyone, but then at some point, I'd need to come clean. I mean, they should know what I'm taking. And I'm not a doctor so I don't really know how to treat myself. I've been doing the increase (its been one week) but I have to literally force myself to take it every time. I don't know that I can keep doing it when it feels wrong to me.


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