# Help with test results



## GMarie (Mar 2, 2011)

Hi, Got results back today:

TSH 3.81
T4 total 6.0 range 4.5-12.0
T4 free,direct dialysis 1.5 range 0.8-2.7
T3 free 2.7 range 2.3-4.2
T3 total 84 range 76-181
thyroid peroxidase antibodies 56H range <35
thyroglobulin 10.1 range 2.0-35.0
TSI 101 range <140 % baseline

No medication recommended. Thought maybe high antibodies from inflammation?? Endo referral per my request.

Further tests I could suggest to Endo?
Thoughts on results? I know the frees are low!
Thanks!


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## Andros (Aug 26, 2009)

GMarie said:


> Hi, Got results back today:
> 
> TSH 3.81
> T4 total 6.0 range 4.5-12.0
> ...


Okay; FREES are low; TSH sort of high but you do have TSI. I think the binding, blocking and stimulating antibodies are hard at work here.

Because your TPO is high and you do have thyroglobulin and TSI; I recommend RAIU to rule out cancer of the thyroid. I feel this is imperative.

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

Thyroglobulin Ab and cancer
http://qjmed.oxfordjournals.org/content/59/2/429.full.pdf

Another Thyroglobulin and cancer
http://www.mdlinx.com/endocrinology...963/?news_id=811&newsdt=092010&subspec_id=419

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

When do you see the endo? Another clue is that your "totals" are also low in the range.










You should not have any TSI.


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## GMarie (Mar 2, 2011)

Thank you for your input Andros. 

Would you say that I am hypothyroid or hyperthyroid, both or neither? Do you think I should be on medication now? In Dec. 2010, my TSH was 5.26.

I will suggest the RAIU to the endo, don't have the app. date yet. 
Do you recommend this test before any kind of medication? 
Needless to say, it's confusing!
Thanks again!


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## Andros (Aug 26, 2009)

GMarie said:


> Thank you for your input Andros.
> 
> Would you say that I am hypothyroid or hyperthyroid, both or neither? Do you think I should be on medication now? In Dec. 2010, my TSH was 5.26.
> 
> ...


Oh, I think you are hyper. TSI says so. I hope you read that?

Yes; for best results, RAIU should take place before any meds and it would be good to avoid any iodine containing products in the meantime. Like seafood and supplements containing iodine.

You are flip-flopping around. I believe the end result will be full-blown hyperthyroid.

And as I have observed over the years; high TPO, Hyper and evidence of Thyroglobulin (the triad) really mandates that cancer be ruled out.

This "is" very confusing! To the max! If I were a young woman again, I would go into immunological research. Yowza!!


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## GMarie (Mar 2, 2011)

I got my app. with an endo on March 21st. I only hope he can see the whole picture.

Andros, I was reading up on a lot of the tests I got taken and did read that you can still be hypo with a detectable TSI.

Also read that a positive TPO test is indicative of Hashimoto. 
What's your take on this?
Since my FT4 and FT3 are very low, I would think that would lean towards hypo.

Full blown hyperthyroid sounds awful! :scared0011:
Thanks for your advice. 
GMarie


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## Andros (Aug 26, 2009)

GMarie said:


> I got my app. with an endo on March 21st. I only hope he can see the whole picture.
> 
> Andros, I was reading up on a lot of the tests I got taken and did read that you can still be hypo with a detectable TSI.
> 
> ...


That is true; you can be in hypo phase depending on how active the binding and blocking antibodies are. I agree.

TPO is "suggestive" of Hashimoto's and a myriad of other autoimmune diseases as well including cancer. The link I provided tells you all this and actually specifies the other autoimmune diseases that TPO is "suggestive" of.

You would think that by the low FT4 and FT3; yes. But there is much more to this than meets the eye. Once again; stimulating, binding and blocking antibodies and autoantibodies do cause misleading results.

You are welcome; I sincerely hope that the folks on this board are helpful to you!










Please let us know what your endo has to say. When is your appt.?


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## GMarie (Mar 2, 2011)

Andros  My app. with the endo is March 21st.

I want to thank you for all your help and the sites you provide to read. I have read them!

I'm confused about what to ask the endo when I see him. Are there some questions that I need to ask, I want to have them written down when I go?

Is the RAIU the only test I need to have now, in your opinion?

I hope I don't blow it and settle for an explanation that makes no sense to me. It's my life and if something can help me feel better, I want to know what it is! 
Have a good day! GMarie


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## Andros (Aug 26, 2009)

GMarie said:


> Andros  My app. with the endo is March 21st.
> 
> I want to thank you for all your help and the sites you provide to read. I have read them!
> 
> ...


Of course it would be wise to see what the endo has to say first; but then if you are fluffed off, you might want to insist on antibodies' tests and express your need to rule out thyroid cancer by way of RAIU.

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 it is not necessary to repeat the TSI. We know you have it.

And for heaven's sakes; don't mention the Internet. Boy do doctors hate that!! Lord have mercy!!

We are here for you in the meantime and after your endo appt., I know I for one will be most anxious to hear the outcome. If for any reason, you are not satified w/the outcome, we will help you best we can.

I like to maintain a positive attitude and hope that this endo knows his/her stuff and will have your wellness as a mutual goal.


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## GMarie (Mar 2, 2011)

And for heaven's sakes; don't mention the Internet. Boy do doctors hate that!! Lord have mercy!!

LOL - I believe that!

I'll keep you posted and let you know about the doctor appointment. 
Thanks again, Andros!


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## Andros (Aug 26, 2009)

GMarie said:


> And for heaven's sakes; don't mention the Internet. Boy do doctors hate that!! Lord have mercy!!
> 
> LOL - I believe that!
> 
> ...


ROLF!! Keeping you in my thoughts and prayers!

You might find this informative.

http://www.hopkinsmedicine.org/endocrine/graves/TopicAnswer.asp?QuestionID=22

The role of thyroid stimulating immunoglobulins is still evolving, but such stimulators may support the growth of metastatic thyroid carcinoma and promote the development of hyperthyroidism.

Continue here.......... http://lib.bioinfo.pl/pmid:2261908


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## GMarie (Mar 2, 2011)

I had my appointment with the endocrinologist today.
I must say that I liked him and he asked questions about how I felt, looked at my history, felt my thyroid gland, checked my test results and gave me a diagnosis.

He said I had Hashimotos, and definitely wasn't hyper. He thinks I went through that stage in 2001 when I had no detectable TSH, A-Fib, and symptoms of hyperthyroidism. My TSH went up within months of that and symptoms were controlled with a beta blocker.

I asked him about ruling out cancer and he said I could get an ultrasound today, which I did, and if there are nodules, he would do an FNA. So I felt good about that and will get the results of that in a day or two.

He put me on 15mg of Armour, and will see me again in 6 weeks, after another blood draw. He will only retest the TSH, Free T3 and Free T4.

When I asked about the TSI antibodies testing positive, he said they were in range and he wasn't concerned about that. 
He said the high TPO antibodies were indicative of Hashimoto's.

I'd like to ask your opinion of what the doctor has said and recommended? My numbers with ranges are above in this thread. Thanks!


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## Andros (Aug 26, 2009)

GMarie said:


> I had my appointment with the endocrinologist today.
> I must say that I liked him and he asked questions about how I felt, looked at my history, felt my thyroid gland, checked my test results and gave me a diagnosis.
> 
> He said I had Hashimotos, and definitely wasn't hyper. He thinks I went through that stage in 2001 when I had no detectable TSH, A-Fib, and symptoms of hyperthyroidism. My TSH went up within months of that and symptoms were controlled with a beta blocker.
> ...


I like very much that he ordered the ultra-sound and will be anxious to hear what the results are of that.

TSI. The only reason there is a range is to establish a "baseline" and detect movement either up or down.

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

Perhaps you are through the hyper stage of Hashimoto's and things will quiet down with the TSI dropping in numbers until gone. We will have to take a wait and see attitude.

It is common to find high titers of TPO in Hashimoto's but keep in mind that is "suggestive."
TPO
http://www.nlm.nih.gov/medlineplus/ency/article/003556.htm

This doc seems proactive on your behalf and certainly is an amenable fellow so I think you have a good one. Allaying your fears about cancer is a very very good sign. Most docs turn a deaf ear.

When will you know if you are going to have FNA?


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## GMarie (Mar 2, 2011)

Thank you for responding Andros, you've been with me from the start!

The office just called on my ultrasound results and said that I didn't have any nodules. I asked them to mail me the results so that I could see exactly what it says.

So, there will be no FNA since there are no nodules. I'm also assuming that means no cancer.

I will stay on the Armour for now and get retested on April 25th - TSH, FT4 and FT3. Then I see him again on May 2nd.

Doctor also said I should know in just a few days if the Armour is having bad side effects for me. He did acknowledge that I have a bit of hyper and hypo going on, what with the positive TSI and High APO antibodies.

He also told me we could take a wait and see approach or start on the low dose med, and I chose the med. 
I guess time will tell!

Andros, do you think I should get the TSI retested in April or is it not necessary? Anything else that stands out in your opinion? Thanks for all your help.


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## McKenna (Jun 23, 2010)

Hi GMarie,

Your situation sounds very similiar to mine. I had high TPO and high TSI, my labs showed hypo, RAIU showed hyper. It was nuts!

My endo started me on 15 mgs Armour last year, but I have to say that it was difficult for me to be regulated, b/c of the hyper/hypo push-pull situation going on. Speaking from experience, you are going to have to keep on top of it.


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## GMarie (Mar 2, 2011)

Hi McKenna, Thank you much for your input!
It's nice to have someone respond who is in a similar situation.

How are you feeling now?
Are your labs normal? I see you have increased the Armour, are you completely hypo now?

Take care and thank you again.


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## McKenna (Jun 23, 2010)

I had my thyroid removed in October of last year, so yes, I am hypo now. I'm still in the process of getting my Armour dose right, so I have good days and bad days, but nothing like last year when I was swinging up and down. My antibodies are still high, despite not having a thyroid anymore, and I'm sure that contributes to how I'm feeling at times.

It does take a while to get used to an Armour dose. You will most likely feel the T3 in it right away. It takes me about a month to 6 weeks to really get used to a change in Armour dose.

My labs right now are:


> TSH .087 .45 - 4.5
> Free T3 3.4 2.0 - 4.4 This was fasting, no Armour dose that morning
> Free T4 .89 .82 - 1.77
> TPO 243


T4 is naturally supressed when taking a T3 supplement, like Armour, so it looks low, but it's ok. My TSH is very supressed right now, which is ok with me, but my endo is not happy. He's having me decrease my Armour on one day per week and hope that it bring it up a bit.


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## GMarie (Mar 2, 2011)

McKenna 

If you don't mind my asking, why did you have your thyroid removed?

I chose the Armour because it's natural, I hope I made the right choice. The doctor said he didn't care which one I used. 
Did you ever try Synthroid?

Thanks again for your responses!


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## Elegant_Phoenix (Feb 26, 2011)

McKenna said:


> Hi GMarie,
> 
> Your situation sounds very similiar to mine. I had high TPO and high TSI, my labs showed hypo, RAIU showed hyper. It was nuts!


This is what is happening to me!

It sounds like we all have similar situations. Had my RAIU today and the radiologist is pushing for a Hashi's diagnosis with a bit of further testing.

GMarie - it will be interesting to see how we both shake out. I'm not ready to start posting in the Hashi's forum yet, but I know that is where I'm headed.

Keep us updated with how your meds are making you feel. I will hopefully start on something within the next few weeks. I know it's not a silver bullet, but I'm ready to give it a go. I hope it goes well for you.


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## Elegant_Phoenix (Feb 26, 2011)

GMarie said:


> McKenna
> 
> If you don't mind my asking, why did you have your thyroid removed?
> 
> ...


If the choice is offered, I'm not sure what I will pick. My gut says natural, but I read somewhere that if you have Hashi's, your body will attack the natural hormone and it's best to try the synthetic. HOWEVER... I have a good friend who also has Hashi's and she was miserable on two different types of synthetic and has switched to the natural from a compounding pharmacy. She is doing great! I'll bet it has to do with each individual's own body chemistry. Dunno.

Maybe I will ask the question in the Hashi's forum.


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## GMarie (Mar 2, 2011)

Hi Elegant Phoenix,

I've been reading about your ordeal also and I hope you get all the answers you need!

I'm a little iffy about starting the Armour with the TSI antibodies. But since my doctor thought I was definitely Hashi's, I thought I'd give it a try. 
I hate the idea of another "medicine for life" also!

So, I will give it the six or seven weeks before my next lab testing and see how I feel in the meantime.

I will keep you updated on everything and you do the same!
GMarie


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## McKenna (Jun 23, 2010)

Yes I did try synthroid first. I wanted Armour and my endo would not go for it first. I had severe stomach cramps from synthroid so he let me try Armour. I was thrilled.

I had my thryoid removed for several reasons. I had hashitoxicosis, could not stand the hyper/hypo ups and downs, didn't seem to get regulated on meds, plus the fact that I had a large cold nodule with inconclusive FNA. I figured it was a sick gland and only going to get sicker with Hashi's.

In hindsite, I had symptoms for a long time, at least 7 years. Things came to a head last year when I had a terrible hyper episode and didn't know what was happening to me. I lost 10 pounds, was sweating constantly, diarrhea, unbearable anxiety, severe heart papitations, shaking, couldn't sleep, nausea and vomiting, my fingernails grew like crazy. It was terrible. I didn't get in to the doctor for about a month and things settled down a little by then and he did a ton of bloodwork, not knowing what to look for. That's when my thyroid labs came back with an elevated TSH and "normal" T3 and T4. More tests, antibodies found. More tests and high RAIU and TSI. It was a long road but I feel on the way to finally feeling better.

There is no quick fix for thyroid disease so hang in there and don't get discouraged. This forum helped me a lot and Andros and Lovlkn have been the greatest helps to me. I'm certainly not an expert, but if you have any questions that I can help you with, please don't hesitate to ask.


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## GMarie (Mar 2, 2011)

Thanks McKenna!
You sure have been through a lot with this disease. I'm glad you are on your way to feeling better!

I had a horrible hyper episode 10 years ago that sounds a lot like yours. I was really hungry but still lost weight, very anxious, heart palpitations and a very scary ER episode of a-fib. My TSH was undetectable, but I had a normal uptake, plus my FT4 was on the low side of normal.

I'll keep updating and asking questions. This is a great board!


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## McKenna (Jun 23, 2010)

Elegant_Phoenix said:


> This is what is happening to me!
> 
> It sounds like we all have similar situations. Had my RAIU today and the radiologist is pushing for a Hashi's diagnosis with a bit of further testing.
> 
> ...


Flip-flopping around is no fun. Several doctors told me it would eventually burn itself out, but the ride is no fun.

GMarie, did you start the Armour?


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## GMarie (Mar 2, 2011)

This is just my second day on 15mg of Armour. I haven't noticed any major differences yet. 
If I do, I'll be sure to post it, good or bad!


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## Andros (Aug 26, 2009)

GMarie said:


> This is just my second day on 15mg of Armour. I haven't noticed any major differences yet.
> If I do, I'll be sure to post it, good or bad!


72 hours is where "some" of us have noticed a difference. For me it was; wow.................my feet quit hurting! So............it will be subtle. Listen to your inner doctor!

Hopefully you are going in for labs at the 8 week mark and doctor will titrate your Armour by 1/4 to 1/2 grain as needed if needed?


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## GMarie (Mar 2, 2011)

I get labs again on April 25th. 
I'm still so tired, even with getting a good 8 to 9 hours of sleep a night. Constipated also. 
Maybe 15mg of Armour is too low for me. Patience is a virtue, and my doctor wanted to be cautious, so that's good.

With having MS, and fatigue is a factor with that also, it's confusing to know what's causing what for sure.

One question, is the Armour now it's original formulation? I read that is was re-formulated a couple of years ago and it's users were very upset. 
I want to make sure I'm getting the good stuff!


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## Thyroidmommy (Mar 25, 2011)

You might want to try Naturethroid if you don't feel better with Armour. I have been using Naturethroid for over a year now since armour changed and most of my symptoms are gone. No more hair loss, constipation, my irritibility is way better, fatigue is better, my period returned to normal, even my back pain is alot better. My only bothersome problem is my eyes right now  not sure if this problem will eventually go away also or not but I am sure hoping. I am also on a much higher dose then alot of people I take 5 grain a day..But my free's are top level and for the most part I feel good 

Good luck getting your dose right it takes alot of patience :hugs:


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## Andros (Aug 26, 2009)

GMarie said:


> I get labs again on April 25th.
> I'm still so tired, even with getting a good 8 to 9 hours of sleep a night. Constipated also.
> Maybe 15mg of Armour is too low for me. Patience is a virtue, and my doctor wanted to be cautious, so that's good.
> 
> ...


15 mg. is the appropriate starting dose for most people. Your doc has me impressed by that. Since you do have MS; slow is good, very good.

Armour is better than ever. They just had to ramp up the absorption (filler) factor. I am very pleased with it. Very pleased and quite grateful to have it back on the market again.

Do you make sure you have a lot of fiber and water on a daily basis? I do know hypo slows down intestinal motility and truth be told, not a whole lot helps except for getting to the euthyroid state.


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## GMarie (Mar 2, 2011)

Thyroidmommy said:


> You might want to try Naturethroid if you don't feel better with Armour. I have been using Naturethroid for over a year now since armour changed and most of my symptoms are gone. No more hair loss, constipation, my irritibility is way better, fatigue is better, my period returned to normal, even my back pain is alot better. My only bothersome problem is my eyes right now  not sure if this problem will eventually go away also or not but I am sure hoping. I am also on a much higher dose then alot of people I take 5 grain a day..But my free's are top level and for the most part I feel good
> 
> Good luck getting your dose right it takes alot of patience :hugs:


Hi Thyroidmommy, I'm glad your're doing well on Naturethroid. I wonder what the difference is between that and Armour? 
I'll stay on the Armour at least until my next labs and go from there. 
Hugs to you too!


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## GMarie (Mar 2, 2011)

Andros said:


> 15 mg. is the appropriate starting dose for most people. Your doc has me impressed by that. Since you do have MS; slow is good, very good.
> 
> Armour is better than ever. They just had to ramp up the absorption (filler) factor. I am very pleased with it. Very pleased and quite grateful to have it back on the market again.
> 
> Do you make sure you have a lot of fiber and water on a daily basis? I do know hypo slows down intestinal motility and truth be told, not a whole lot helps except for getting to the euthyroid state.


I try to eat plenty of fiber, drink water and I take magnesium, which helps at times. 
Glad the Armour is still working for you!


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## Andros (Aug 26, 2009)

GMarie said:


> I try to eat plenty of fiber, drink water and I take magnesium, which helps at times.
> Glad the Armour is still working for you!


Magnesium; yes!! You are on top of it! Excellent!


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## GMarie (Mar 2, 2011)

I am updating!

I have been on Armour 15mg for 6 weeks now. 
Today I saw my endo after getting blood work a week ago.

Results:

TSH 1.49 (.40-4.5)
FT4 1.0 (0.8-1.8)
FT3 2.8 (2.3-4.2)

Symptoms - After a couple of weeks on Armour, I felt like a had a bit more energy. I am still not where I'd like to be, but with also having MS, I know I'm never going to feel 100%.

Doctor visit - He would not increase my dosage and even suggested going off of it if I wanted to! I would have liked to increase it to 30 mg., but he wouldn't go for that. He said it was bad on your bones and he didn't think I needed it anyway. He said the TSH is the main thing he looks at and mine was fine.

So, my thoughts are that this doctor isn't as great as I first thought he was! My Free T3 still seems on the low side to me. 
What do you guys think of this?

To refresh - I had an ultrasound with the following findings:
Right thyroid - 4.4 x 1.4 x 1.6. Left lobe - 4.5 x 1.3 x 1.8cm
The thyroid isthmus measures up to 4 mm in thickness. The thyroid gland is homogeneous in echogenicity. No focal nodules are identified. Normal vascularity is identified.

Doctor says I have hashimoto's, wants to recheck levels in 3 months now. 
Thanks for your thoughts!


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## Andros (Aug 26, 2009)

GMarie said:


> I am updating!
> 
> I have been on Armour 15mg for 6 weeks now.
> Today I saw my endo after getting blood work a week ago.
> ...


Uh, oh. Not good! You are undermedicated. 3.2 is about mid-range on your Free T3 so you are way below that. Most of us feel best w/FT3 @ about 75% in the range given by your lab. Most of us also feel best with TSH @ 1.0 or less.

The "truth" is that being over medicated or undermedicated can cause bone problems. Being properly medicated does not. Your goal is the euthyroid state where you feel very well.

I hope you can find a doctor that concurs w/ that.

And by the way, when taking Armour, you do expect to find the FT4 just a bit lower than if you were on T4 med only. This is normal when taking any form of T3 and I am not a fan of tampering w/that.

TSH worshipper is not a good thing. And not to mention that just because you are in range w/TSH he is willing to leave you there. No,no! Don't let that happen.

Get proactive and find another doctor.

What a shame.


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## GMarie (Mar 2, 2011)

Thanks Andros!

The problem is, I live in a small town with no access to a lot of doctors. I could go just outside this town, but don't because of vision problems related to my MS. Husband can't take me everywhere because of his work.

My primary physician won't work with me on this either, because she's also a TSH worshipper!

Perhaps I should take 2 of the Armour pills myself a few times a week for a few months. Then when I get tested again, I could see where my numbers are and how I feel. Thoughts on this?

The only other option would be to interview other primary physicians to see what their thoughts are about it. Then hire a new one who's more open minded.


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## Andros (Aug 26, 2009)

GMarie said:


> Thanks Andros!
> 
> The problem is, I live in a small town with no access to a lot of doctors. I could go just outside this town, but don't because of vision problems related to my MS. Husband can't take me everywhere because of his work.
> 
> ...


I am not a fan of self-medicating plus you do have to rely on a doctor for your Rx and that could cause problems if you run out too soon.

But, I would get on the big horn and start "trying" to interview doctors if you can. Hard to get past the person who answers the phone though. You could try a DO, an Ob/Gyn, an Internal Medicine..................

I hear ya' loud and clear about the driving. I have no peripheral vision as a result of untreated Graves' Exophthalmos (and just poor vision in general now as a result of all that) so I have to drive on familiar grounds. No interstates for me.

Keep the faith; a good doc is going to pop up for you. I will say a prayer for that.


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## GMarie (Mar 2, 2011)

Thank you for the prayer and the hugs, Andros!

I'll see what I can do about getting a doctor who will listen to my side of the story. The doctor I saw was not a good listener, that's for sure!

Right back atcha with the :hugs:
GMarie


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## Andros (Aug 26, 2009)

GMarie said:


> Thank you for the prayer and the hugs, Andros!
> 
> I'll see what I can do about getting a doctor who will listen to my side of the story. The doctor I saw was not a good listener, that's for sure!
> 
> ...


Aw; shucks!


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