# Labs, Treatment..should I get another Dr?



## artms (Jul 23, 2011)

I have been treated for hypo for ten years and only last year did a Dr test for Hashi.
THYROGLOBULIN AB	165.0	0.0-14.4	IU/mL	H
TEST INFORMATION: Thyroglobulin Antibody
A value of 14.4 IU/mL or less indicates a negative result
for thyroglobulin antibodies.
ANTI-TPO Ab	0.7	0.0-3.9	IU/mL

Over the last couple years I feel better with higher T4 Synthroid dose but it drops my TSH so my Dr drops my dose and I feel horrible. I talked her into testing for T3 which was never done before. At a higher T4 dose my T4 and T3 are low normal and TSH is too low so she wants to lower my dose....I know I will feel bad at that dose.

I am trying to determine if my Dr is treating me taking into consideration I have Hashi or has my condition progressed beyond her expertise. Should I either get a second opinion or see an endocrinologist? I don't think I personally should have to be figuring this out FOR my Dr.
I appreciate any suggestions you may have because I can't bear the fatigue and brain fog. I want to get this resolved.
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BTW, I also have high cholesterol and low Vitamine D. My GP seems to look at all these as separate conditions but I believe when it comes to Hashi's low Vit D, high cholesterol and low T3 T4 are related. That makes me think she doesn't understand how to treat it.

This is the lab and note from my Dr. 
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Your thyroid blood test results show that your stimulating hormone results is a little low indicating that your thyroid hormone level is a little on the high side, however that T-3 and T 4 levels are in the normal range, so I recommend that you continue on the 88 microgram dose for now. Your blood test result shows that you have a vitamin D deficiency. 2,000 international units daily is recommended. Please purchase the over the counter D3-choleciferol supplement. This is better than the more commonly available D2-ergociferol. A follow up nonfasting blood test has been ordered to recheck your Vit D level in 3 months. A low vit D level can contribute to osteoporosis and may also be a contributing factor to lowered immunity. 
Component Results
Component Your Value 
VITAMIN D, 25 HYDROXY	21.6 
Vitamin D Status ng/mL
*************************************
Deficiency < 10
Insufficiency 10-29
Sufficiency 30-100
Toxicity > 100

Recent studies have suggested the above classification.
This assay quantitatively measures 25-OH Vitamin D which
includes the metabolites 25-hydroxy Vitamin D2 and
25-hydroxy Vitamin D3.

THYROXINE, FREE (FREE T4) 0.95 (0.56 - 1.64)
T3 (TRIIODOTHYRONINE), FREE 2.6 (2.3 - 4.2)	pg/mL
THYROID STIMULATING HORMONE	0.24 (0.35 - 3.30)	mcIU/mL	L

My GP seems to be treating me based only on my TSH and it seems Hashimoto's makes interpretation of labs more complex. 
When I'm taking 88mcg my T3 will probably drop and that's why I feel horrible. 
Would supplementing with Vit D solve my problem with low end T3 and T4? 
I think I need to get to the high end to feel better but that requires too much T4 and that makes me have too low a TSH .
Would T3 supplement solve it?

I know this is long but I appreciate any advise you may have. Thanks in advance.


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## Andros (Aug 26, 2009)

artms said:


> I have been treated for hypo for ten years and only last year did a Dr test for Hashi.
> THYROGLOBULIN AB	165.0	0.0-14.4	IU/mL	H
> TEST INFORMATION: Thyroglobulin Antibody
> A value of 14.4 IU/mL or less indicates a negative result
> ...


Welcome! What can I say except you really need a better doctor. You are way undermedicated and any doc that treats based on TSH alone is not a good doc.

BESIDES; what's w/this?

THYROXINE, FREE (FREE T4) 0.95 (0.56 - 1.64)
T3 (TRIIODOTHYRONINE), FREE 2.6 (2.3 - 4.2) pg/mL
THYROID STIMULATING HORMONE 0.24 (0.35 - 3.30) mcIU/mL L

The answer is staring her in the face. Your FREES are way low. Ideally, we like to see the Frees above the mid-range of the range given by your lab and the FREE T3 serves most of us best when it is @ 75% or the range of the range given by your lab.

Little know factoid. Vitamin D down regulates with autoimmune.

Vitamin D
http://www.eurekalert.org/pub_releases/2009-04/arf-vdm040809.php

Taking exogenous Vitamin D can cause your antibodies to go nuttso!

Also it is concievable that your cholesterol is also high because of being undermedicated.

Not only that, she is keeping you in a bad place. The only good place is when you are euthyroid (feel perfectly well.)

Hashi's patients should have the TSH suppressed. It's even in the Synthroid prescribing info.

Pituitary TSH Suppression- In the treatment or prevention of various types of euthyroid goiters (see WARNINGS and PRECAUTIONS), including thyroid nodules (see WARNINGS and PRECAUTIONS), subacute or chronic lymphocytic thyroiditis (Hashimoto's thyroiditis), multinodular goiter (see WARNINGS and PRECAUTIONS) and, as an adjunct to surgery and radioiodine therapy in the management of thyrotropin-dependent well-differentiated thyroid cancer.
http://www.rxlist.com/synthroid-drug.htm

So, you see? I don't think your doc is well informed on how to treat this; I really don't!

Also, with such a high Thyroglobulin Ab result, you should have at the very least a sonogram; at the very best, RAIU.

cancer TPO and thyroglobulin
http://onlinelibrary.wiley.com/doi/10.1111/j.1699-0463.1994.tb04888.x/abstract

Understanding Thyroglobulin Ab.
http://www.labtestsonline.org/understanding/analytes/thyroglobulin/test.html

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

Let us know what you think and action you plan on taking here. And what Test did the doctor do for Hashi?


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## artms (Jul 23, 2011)

Test results were for ANTI-THYROID ANTIBODIES. That's all it said. I was taking 100 mcg. When I needed a refill she did a test. My TSH was .33 The low normal cut off was .36. She said no I was hyper so she would prescribe 88 mcg. I felt ok for a while then my metabolism tanked. My TSH went to .72 and was going up. She was happy but not me. I suspected I wasn't converting T4. Even now she thinks low normal T4 and T3 is fine. I don't know much but I think I have a bit better grasp of my condition.
Thank you for the confirmation. 
I like her but I assumed until I really started educating myself about the condition that it was pretty straight forward in terms of treatment but over time I felt from her messages that she never looked at all my results and the historical trajectory of the results as well. You have given me a lot of food for thought. I feel like I 'm at her mercy and even looked to buying cytomel online on my own...but I know so little about it all really. 
I need to get a referral to a specialist within my medical group affiliated with UC Davis......I think a GP wouldn't do.
How might you suggest I proceed? An internist? An endo?


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## Andros (Aug 26, 2009)

artms said:


> Test results were for ANTI-THYROID ANTIBODIES. That's all it said. I was taking 100 mcg. When I needed a refill she did a test. My TSH was .33 The low normal cut off was .36. She said no I was hyper so she would prescribe 88 mcg. I felt ok for a while then my metabolism tanked. My TSH went to .72 and was going up. She was happy but not me. I suspected I wasn't converting T4. Even now she thinks low normal T4 and T3 is fine. I don't know much but I think I have a bit better grasp of my condition.
> Thank you for the confirmation.
> I like her but I assumed until I really started educating myself about the condition that it was pretty straight forward in terms of treatment but over time I felt from her messages that she never looked at all my results and the historical trajectory of the results as well. You have given me a lot of food for thought. I feel like I 'm at her mercy and even looked to buying cytomel online on my own...but I know so little about it all really.
> I need to get a referral to a specialist within my medical group affiliated with UC Davis......I think a GP wouldn't do.
> How might you suggest I proceed? An internist? An endo?


The criteria is does the doctor understand how to titrate thryoxine replacement by looking at the Frees as well as the TSH and making a good clinical evaluation of his/her patient. It is not always about the numbers. What is good for me, may not be good for you. But a good doc would have experience noticing things about the patient sitting before him/her. Like hair falling out, dry skin or not, edema, buddha belly, tremors or not; questioning the patient (how do you feel, what are your symptoms?)

That said, any good doc could do this. And that doc should always keep uppermost in mind that cancer should always be considered and either ruled in or ruled out.

I actually see a rheumatologist. She is the bomb!

Assuming is never good but I "guess" the Anti-Thryoid Antibodies to be maybe TPO(antimicrosomal, Thyroidperoxidase?) Maybe??

Kind of quiet this weekend but I am sure you will get a lot of input come Monday. Varying opinions are always a good thing.


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## hochelaga (Jul 10, 2011)

Andros said:


> Little know factoid. Vitamin D down regulates with autoimmune.
> 
> Vitamin D
> http://www.eurekalert.org/pub_releases/2009-04/arf-vdm040809.php
> ...


WHAT? Now I'm really confuggled! I thought we were supposed to take vitamin D. My doc suggested I supplement as well. Have there been other studies to substantiate the one cited?


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## bigfoot (May 13, 2011)

That makes two of us. I had no idea about the Vitamin D. Interestingly enough, my doc last year tested me for it and mine was low. Now I think this (Hashi's) points out why it was low.


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## mkalazan (Jul 19, 2011)

Hi Andros,

You stated, "Vitamin D
http://www.eurekalert.org/pub_releas...-vdm040809.php

Taking exogenous Vitamin D can cause your antibodies to go nuttso!"

Yikes! I read the article! I have Hashi's and low vitamin D. I am currently taking 4000 I.U.'s daily. Initially, muscle aches and pains felt better, but now I am feeling terribly fatigued. I suppose this is the reason. What should Hashi sufferers do to supplement when they are diagnosed with low Vitamin D?

Lab test 3/27/10
Vitamin D, 25-Hydroxy 19.0 (32.0-100.0)

Thanks,
M


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## Andros (Aug 26, 2009)

hochelaga said:


> WHAT? Now I'm really confuggled! I thought we were supposed to take vitamin D. My doc suggested I supplement as well. Have there been other studies to substantiate the one cited?


I have not had the time to research that but if you do, I would appreciate your sharing.


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## Andros (Aug 26, 2009)

mkalazan said:


> Hi Andros,
> 
> You stated, "Vitamin D
> http://www.eurekalert.org/pub_releas...-vdm040809.php
> ...


I get D in food and also from the sun. I make sure I am out in the sun every single day that the sun is out and here in Ga., that is a lot!

Many foods have D besides dairy products. For me, I like the saying, "Moderation in all things!" I have no idea where they come up with these ranges anyway. That alone leaves a lot of doubt in my mind.


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## hochelaga (Jul 10, 2011)

From what I understood, "exogenous" in the article meant vitamin D from food as well as supplements. Hard to over-do it though if your sole source is from food. Here in Canada there is no possible way to get enough D from the sun except during the summer months, and UVB lamps seem to be rather expensive. Off to the tanning salon???


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## Andros (Aug 26, 2009)

hochelaga said:


> From what I understood, "exogenous" in the article meant vitamin D from food as well as supplements. Hard to over-do it though if your sole source is from food. Here in Canada there is no possible way to get enough D from the sun except during the summer months, and UVB lamps seem to be rather expensive. Off to the tanning salon???


I also did the tanning bed for over 10 years until our local gym went out of business. But only for 15 or 20 minutes a session and not every week either. Gotta' take care of the skin too!

And yes; food sources are also exogenous. But you can only eat so much. That if you wish to stay slim and trim which I do wish!! LOL!


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## artms (Jul 23, 2011)

After all I have read so far I think that I have Hashimoto's with VDR plymorphism and adrenal fatigue. 
That's just a semi educated guess. 
I take 88mcg synthroid. I read that Armour works well although I also read that it was re formulated and people don't like it. 
I read an addition of Cytomel is helpful. Is there any consensus as to what might be a preferable treatment. If Cytomel is added what dosage is commonly ordered? 
If Armour is now considered to be helpful...how much is generally prescribed for someone with my numbers on 88mcg with a low T3?


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## Andros (Aug 26, 2009)

artms said:


> After all I have read so far I think that I have Hashimoto's with VDR plymorphism and adrenal fatigue.
> That's just a semi educated guess.
> I take 88mcg synthroid. I read that Armour works well although I also read that it was re formulated and people don't like it.
> I read an addition of Cytomel is helpful. Is there any consensus as to what might be a preferable treatment. If Cytomel is added what dosage is commonly ordered?
> If Armour is now considered to be helpful...how much is generally prescribed for someone with my numbers on 88mcg with a low T3?


Armour is better than it was. The FDA made them change the filler and now it absorbs better and faster.

If you were to start that, the recommended starting dose is 30 mg. (1/2 grain) If you have myxedema, the recommended starting dose is 15 mg. (1/4 grain)

Cytomel is also readily available. Recommended starting dose is 5 mcg. per day added to low dose of T4.

Each has to be titrated based on 8 week interval of labs and clinical evaluation.


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