# Need tips on screening new endo Tuesday.



## StacyAr (Nov 10, 2012)

I go tuesday to a new endo and there arent many choices left where I reside. let's say you find a new endocrinologist. how do you walk in there and say, "the last few were inept. are you? I dont want to waste my time with you if (for example) I have graves , and youre going to dose based on Tsh. How do I know you're competent and not the same as 95% of the other mistrained endocrinologists I've already fired?" Really. What do you do to ensure you aren't travelling miles and going endo hopping? How do you screen on the first visit? for anyone who missed it, the current endo i.travel to see who originally told me she doesn't worry about tsh is, wait for it... yep..now dosing on tsh. smh. so I'm endo shopping again but i don't know how to tell upon meeting the next one if he's competent. and time is precious,especially for your health. I've been told by my family i can't walk into my next endocrinologist with a stack of info from internet forums on the offensive making sure he isnt going to waste my time with amateur care such as TSH dosing, even if i know (thanks to you guys) what the heck I'm talking about. So how does one meet a new dr and not say "i wanna know what misconceptions youre under so i know whether to invest myself and trust you with my care" . I literally want to know what to say to see if i found a.dr worth my time and money. Cause I've been fooled before.


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## StormFinch (Nov 16, 2012)

No offense Stacy but this is where you needed to have done your homework ahead of time; called the pharmacies to see which doctors dosed with natural thyroid replacement, (most that do tend to rely on more than just TSH) checked with any local or regional thyroid support groups for physician referrals, sent letters to all of the Endos nearby with your queries and saw who answered back, etc.

At this point, you can take a page or two of important info from recognized sources such as doctors, studies, or advocates, and fax them to this new endo ahead of time along with a hand written note saying that you would like to discuss the information at your appointment, then include the time and date of said appointment. Don't take or send reams of info because you'll end up with either a distracted or offended doctor. When you get there, ask if he or she has had time to review the info you faxed. If it's a no, then politely ask if they base their treatment plans on TSH. Yes, you could end up with another like the last one, but without a positive referral from someone who has already seen said doctor, there's not much else you can do. If they say they do base on TSH only then politely thank them for their time and leave. If they say they don't base on TSH then also ask if they regularly monitor TSI antibody and liver tests. That will give you at least a little insight as to whether they cover all the bases or not. Truthfully, finding a doctor is a lot like dating. You can't make each one fill out a 20 page questionnaire before you date them, you just have to kiss a lot of frogs.

And I understand the frustration, but for heaven's sake don't go in talking like we do to each other!  lol


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## StacyAr (Nov 10, 2012)

Too late now to fax... so any advice on what to say Tuesday? Going to ask about tsh, but the current endo i see at the first visit said dont worry about tsh, and now seems to dose based on it.


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## StormFinch (Nov 16, 2012)

Like I said, gotta kiss a lot of frogs. Turns out I've been dancing with a frog that just happens to be very good at surgery.

Anyway, like I said if they tell you they don't chase the TSH, ask about where they like your numbers to be before they put you on the maintenance dose of anti-thyroid and if they monitor TSI. A good doctor will get you into the normal range, put you on a maintenance dose, and then check your TSI for a drop in antibodies before they take you off of it.


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## StacyAr (Nov 10, 2012)

Thank you!! Appreciate your time. Nervous about Tuesday.. will report back.


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## Sandbar (Nov 6, 2012)

StormFinch said:


> No offense Stacy but this is where you needed to have done your homework ahead of time; called the pharmacies to see which doctors dosed with natural thyroid replacement, (most that do tend to rely on more than just TSH) checked with any local or regional thyroid support groups for physician referrals, sent letters to all of the Endos nearby with your queries and saw who answered back, etc.


Stormfinch, how do you find these local thyroid support groups? I also called pharmacies and asked for those prescribing Armour and got a list of people that didn't contain _even one _endocrinologist and I live in a big city. When I've called a few endos offices in advance the staff refuses to give me any detailed information and insists they must have all my records and I must make an appointment to find out even one thing about how the endos practice. Still I honestly feel nervous about seeing someone who isn't an endocrinologist and doesn't have hospital privileges for something as serious as Graves. Yet....if almost all endos by definition are closed minded, what to do?

(Stacy I hope this isn't a thread hi-jack....I'm thinking you'll be interested in these issues too)


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## StormFinch (Nov 16, 2012)

Google is your best bet for groups Sandbar, either your city/town name or your state and thyroid support group. Even a ThyCa group, thyroid cancer survivors, may have members in your area that have been through the doctor search themselves and found a good one. There are both in person as well as online groups available in many places. There are also really large web based groups, Mary Shomon's for example, where you can ask for referrals. In addition, do a google of each doctor you're thinking about. There are numerous doctor rating sites out there, as well as Google itself. Eventually you find enough reviews that you can get at least some idea of what the doctor is like. Angie's List has doctor reviews as well if you don't mind paying the fee. Asking everyone you know and meet can sometimes pan out too. Ask your cashier, your food server, the minister of music at your church. Dollars to doughnuts says they know someone with thyroid problems and some can supply you with a name. Eventually, a few names will pop up again and again.

As for the list you came up with, I do agree that you may want a doctor with hospital privileges, but you don't necessarily need an endo. I had a GP that was familiar with thyroid problems and he was just as good if not better at treating my Graves than any of the endos I've seen. He certainly beat some of the stories I've heard about certain endos from other Graves patients. GPs, DOs and Internists can successfully treat thyroid issues. We have one DO here where I live that just happens to specialize in endocrinology and he's next on my list if the doctor I currently have lined up doesn't work out.

Blind calling a doctor's office simply doesn't work. Their staff are the gate keepers and aren't allowed to give out information. Instead, create a neat, professional letter introducing yourself and ask a few specific questions. Then print out a number of copies and mail them to the doctors you want to query. You can even include an SASE for their convenience. A doctor that really gives a whit will answer you, maybe not right away, but they will. The GP I mentioned above? He has a website with a contact form and answered my query himself 72 hours after I sent it, so it does happen.

Let me ask your question in a different way, if almost all endos are closed minded then would you rather NEED a doctor with hospital privileges because he's screwing up your health care, or would you like to have one that believes in his hippocratic oath; first, do no harm?


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## webster2 (May 19, 2011)

Stacy, correct me if I am wrong , but you atill have your thyroid? If that is the case, phoning pharmacies now, is not going to do you a lot of good. I hate to say it but sometimes the frog kissing stage is the longest and most frustrating part of the journey.

It is your goal to continue nursing and try for remission? Are you feeling any better on the ATD's? I think when you do have your thyroid, TSH is important.

I am sure others will chime in with some useful info. Hang in there, it does get better.


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## StacyAr (Nov 10, 2012)

Sandbar said:


> Stormfinch, how do you find these local thyroid support groups? I also called pharmacies and asked for those prescribing Armour and got a list of people that didn't contain _even one _endocrinologist and I live in a big city. When I've called a few endos offices in advance the staff refuses to give me any detailed information and insists they must have all my records and I must make an appointment to find out even one thing about how the endos practice. Still I honestly feel nervous about seeing someone who isn't an endocrinologist and doesn't have hospital privileges for something as serious as Graves. Yet....if almost all endos by definition are closed minded, what to do?
> 
> (Stacy I hope this isn't a thread hi-jack....I'm thinking you'll be interested in these issues too)


not a hijack at all, lol. I called the staff and they refused to speak to me as well. In a perfect world, sure, that would work. It doesnt in most. Mostly all endos are closed minded, thats a nice way to put it. I am very nervous about my upcoming appt. as there are really no options left after this one, and calling ahead didnt work for me, either. Good to know I am not alone.

personally, I am with you. I would not see a non endocrinologist for Graves. Too risky. Maybe Stormfinch got lucky, but if endos can so very rarely handle Graves, I suspect its a very rare occurance that a general GP can deal with it. Not going to go that route. Also yes, no support groups here either. I am on almost every website there is, however, but have found little info on specific endos. So I am with you on all you said.


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## StacyAr (Nov 10, 2012)

webster2 said:


> Stacy, correct me if I am wrong , but you atill have your thyroid? If that is the case, phoning pharmacies now, is not going to do you a lot of good. I hate to say it but sometimes the frog kissing stage is the longest and most frustrating part of the journey.
> 
> It is your goal to continue nursing and try for remission? Are you feeling any better on the ATD's? I think when you do have your thyroid, TSH is important.
> 
> I am sure others will chime in with some useful info. Hang in there, it does get better.


Yes on all counts,  . But its awfully hard to attempt remission on ATDs when the endo I see isnt that adept at dosing or allowing me to continue on the meds every time I have an itch  .... I do feel much better on the ATDs, but I suspect its time for a decrease and the endo wants to either increase or switch the meds, neither seem appropriate. Shes also STILL on maternity leave and I am pretty darned tired of dealing with her annoying nurse. So I am going to a new endo Tuesday that many people recommend his practice (but I dont know anyone who has seen him specifically,). Many people I know h ave seen the senior partners in this practice but the seniors dont take new patients. I am hoping he will suffice at the least, and will be thrilled if he can surprise me by having a clue about Graves.


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## StacyAr (Nov 10, 2012)

http://www.aafp.org/afp/2005/0815/p623.html this may be the best article Ive ever seen. Its from a medical journal so I hope I am allowed to post this. (if not, I apologize)Anyway, I am going to print and bring this.


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## webster2 (May 19, 2011)

I hope luck will be with you at your appointment. I am very fortunate (lots of frogs) to have a Naturopath that will care for me but she insists that there is an endo on board. It took me 3 to find him. I am finally only seeing the endo yearly, or as needed.

Some nurses feel it is their duty to guard the keys to the kingdom and may have a nasty attitude, but don't let it get to you maybe they're just doing as they have been instructed. I phoned before my 1st endo appointment with questions and it was not well received. I am still in the same practice as the first 2 endos but my file has a big red mark on it noting that I am unruly or some such lovely term. When it all comes down to it, I am worth it and I want to feel well, so I (politely) advocate for myself.

Now that I am on this side of things, I realize what a battle it was a times. The absolute worst scene is now quite amusing to me, when I look back. TG!

Prepare yourself with knowledge, and questions. I wish you the best!


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## StacyAr (Nov 10, 2012)

Thanks for the support. Xoxo


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## Sandbar (Nov 6, 2012)

webster2 said:


> I am still in the same practice as the first 2 endos but my file has a big red mark on it noting that I am unruly or some such lovely term.


This is what I'm worried will happen with me and that I'll get a rep and no new endo will take me on as a patient. It's good to hear you are doing well and on the other side of the battles though! Do you or anyone remember the Seinfeld where some doctor wrote something about Elaine in her chart and no one would tell her what it was but treated her as if it said "this patient is crazy"?

Stormfinch, excellent point....I would rather not have a doctor that would cause me to _need _them in the hospital 

Stacy, good luck on Tuesday!

Edit..... I found it, here's a clip on the Seinfeld episode!


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## StormFinch (Nov 16, 2012)

webster2 said:


> Stacy, correct me if I am wrong , but you atill have your thyroid? If that is the case, phoning pharmacies now, is not going to do you a lot of good. I hate to say it but sometimes the frog kissing stage is the longest and most frustrating part of the journey.
> 
> It is your goal to continue nursing and try for remission? Are you feeling any better on the ATD's? I think when you do have your thyroid, TSH is important.
> 
> I am sure others will chime in with some useful info. Hang in there, it does get better.


The only reason I suggested calling pharmacies even though she still has a thyroid and is dealing with Graves is that doctors who prescribe natural replacements are more likely to look at Frees rather than TSH, even when treating a Graves patient.


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## CA-Lynn (Apr 29, 2010)

Actually, I HAVE gone in and told the new endo point blank that I have a set of expectations and must have a collaborative relationship. Also, that I recognize we're going to be partnered up for a lifetime, so I want to make sure we're all on the same page or I need to continue interviewing doctors. I am merciless. *This is MY body we're talking about and I'm its manager/guardian.*

Be concise. Have a short list [5 or less bullet points] of your expectations. Examples:

~ All lab tests are to be "cc to patient" [not ok for me to wait for office appointmen to get test results]

~ All lab tests are to be [quarterly] and must include [ fill in the blanks]; annual tests must include [ fill in the blanks]

~ All treatment plans are a conjoint decision and are not to be based solely on blood test results.

This is about as simple as you can be. Most doctors will appreciate the "to the point" list and knowing what your expectations are.

And if the doctor doesn't agree........well, back to kissing more frogs.


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## lainey (Aug 26, 2010)

Most endos, when treating a Grave's patient do run the frees, as it is typical to diagnose based on the free T3 especially in addition to the antibodies, and medicate also based on where that is. Calling pharmacies to see who prescribes natural hormone is not material here.

People who are well read on the internet pick and choose how they would like TSH used, depending on how it suits them, but the fact remains that it is still the primary diagnostic tool. Perhaps your doctors' latest dose recommendation, based on your recent labs, has your TSH lagging too far behind in spite of your falling frees--at what point does their experience with other patients treating the disease start to come into play? Are you clinically hypo yet?

I have been to a few smart doctors who will direct your internet research, because they have reviewed it themselves, but otherwise a vast majority don't accept it as "authority". So I agree with your family, it is not wise to go armed with internet evidence, unless you are citing studies from the NIH, PubMed or other known sources, as most internet "evidence" can be considered suspect by source.

I guess the question is, what exactly have YOU decided is the best course of treatment for your Grave's, that you would like the doctor to execute, based on their clinical experience, that fits into the parameters that YOU have determined, based on your experience?

Once you have defined that, you can present it to the new doctor and see what they say.

After following most of your posts, the only common thread I see is that you only want to treat the Graves on your terms. This is not like thyroid replacement--there are specific protocols for treating Grave's, and your choices are limited. You can choose from what is available, or allow the disease to progress. Because most doctors prefer to treat patients under their terms, I suspect you will be looking for a while.


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## StacyAr (Nov 10, 2012)

My terms.. so I am too difficult to be a patient? Huh.. thats an interesting perspective, Lainey. I have been told I am entering hypo, yet my endo wants to increase my meds. I have a slight rash that most literature says to ignore, yet my endo wants me off the MMI. I want to be tested every four weeks but she wants me tested every 6-8. I dont really think my expectations are unreasonable, given what I have read and been told on this board and other forums. Why do you?

I never refused treatment and said I was going to go with having the disease progress. I dont know what has given you the opinion I Am such a thick headed idiot, but I really am not. You folks here on this forum have educated me on how to read my results and what to ask for. So it strikes me as odd that you now fault me for trying to advocate for myself based on what I have learned here. I am not here to change your mind on that, you have made it clear how you feel and it's unfortunate because I think you have some good information to offer, if you were able to not look down on me so brutally.


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## StacyAr (Nov 10, 2012)

Sandbar said:


> This is what I'm worried will happen with me and that I'll get a rep and no new endo will take me on as a patient. It's good to hear you are doing well and on the other side of the battles though! Do you or anyone remember the Seinfeld where some doctor wrote something about Elaine in her chart and no one would tell her what it was but treated her as if it said "this patient is crazy"?
> 
> Stormfinch, excellent point....I would rather not have a doctor that would cause me to _need _them in the hospital
> 
> ...


i remember that episode well! its spot on! lol!


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## StacyAr (Nov 10, 2012)

CA-Lynn said:


> Actually, I HAVE gone in and told the new endo point blank that I have a set of expectations and must have a collaborative relationship. Also, that I recognize we're going to be partnered up for a lifetime, so I want to make sure we're all on the same page or I need to continue interviewing doctors. I am merciless. *This is MY body we're talking about and I'm its manager/guardian.*
> 
> Be concise. Have a short list [5 or less bullet points] of your expectations. Examples:
> 
> ...


Like that. Im not real good at concise, so that fits the bill, thanks!


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## CA-Lynn (Apr 29, 2010)

Don't be too hard on Lainey. No doubt she was reading in between the lines and decided to address that which wasn't clear. Frankly, I wondered about that [possibly leaving it untreated] myself.


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## chopper (Mar 4, 2007)

StacyAr said:


> I dont know what has given you the opinion I Am such a thick headed idiot, but I really am not. You folks here on this forum have educated me on how to read my results and what to ask for. .


No one suggested you are a thick headed idiot Stacy. Everyone here is trying to offer help.

Frankly, you are asking questions in this thread that there are simply no answers to. The subject of doctor selection is about as unique to each person as their fingerprints or personality.

Myself, I don't take **** from anyone. I input my own labs or I'll pay cash to have my own labs drawn. I would never deal with anyone who diagnoses or titrates based on TSH. TSH is useless in my opinion. I've been fired by 2 endos and have fired about 5.

The bottom line is you need to do what's right for your personality, level of disease, etc. telling a doctor how to be a doctor never works. They get ****ed at that. Rather, ask smart questions so he knows you are informed and when it comes time for testing or meds, have an intelligent conversation. You can guide the entire conversation as long as the doctor thinks he's right in the end.

"I've heard a lot about Armour, Doc, do you think that is something that would benefit me and if you wouldn't mind, I would like to give it a trial run and if it doesn't work out, we can go with Synthroid after. Do you think that strategy makes sense, Doc?" See what I mean?

Getting back to your post.....I know it's frustrating but let's keep the tone a bit more casual please...we're all here to help and everyone's opinion, whether you agree with it or not, will cumulatively help you make better decisions down the road.


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## StormFinch (Nov 16, 2012)

lainey said:


> Most endos, when treating a Grave's patient do run the frees, as it is typical to diagnose based on the free T3 especially in addition to the antibodies, and medicate also based on where that is. Calling pharmacies to see who prescribes natural hormone is not material here.


Well now that's odd lainey, since the American Association of Clinical Endocrinologists and American Thyroid Association, both of which endocrinologist tend to follow, have this to say about hyperthyroid tests:

"Serum TSH measurement has the highest sensitivity and specificity of any single blood test used in the evaluation of suspected hyperthyroidism and should be used as an initial screening test (29). However, when hyperthyroidism is strongly suspected, diagnostic accuracy improves when 
both a serum TSH and free T4 are assessed at the time of the initial evaluation. The relationship between free T4 and TSH (when the pituitary-thyroid axis is intact) is an inverse log-linear relationship; therefore, small changes in free T4 result in large changes in serum TSH concentrations. Serum TSH levels are considerably more sensitive than direct thyroid hormone measurements for assessing thyroid hormone excess (30). In overt hyperthyroidism, usually both serum free T4 and T3 estimates are elevated, 
and serum TSH is undetectable; however, in milder hyperthyroidism, serum T4
and free T4 estimates can be normal, only serum T3 may be elevated, and serum TSH will be <0.01 mU/L (or undectable). These laboratory findings 
have been called "T3-toxicosis" and may represent the earliest stages of disease or that caused by an autonomously functioning thyroid nodule. As is the case with T4, total T3 measurements are impacted by protein binding. Assays for estimating free T3 are less widely validated than those for free T4, and therefore measurement of total T3 is frequently preferred in clinical practice." - https://www.aace.com/files/hyper-guidelines-2011.pdf

Sounds to me like they would rather rely on just TSH and Free T4, and prefer the total T3 test when warranted. And, considering that I've had to ask for Free T3 tests with practically every endo I've seen, I'm going to have to stand by my statement that finding a good doctor, even for a hyper patient, includes looking for those that prescribe natural dessicated thyroid replacement. Not to mention the fact that if they don't look for those docs now, a hyper patient that goes through TT or RAI is just going to have to go doc hunting again once they go hypo.


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## StacyAr (Nov 10, 2012)

I am not being hard on Lainey, no worries. Some statements come across a certain way online that can sound harsh. I think everyone here is trying to help and very knowledgable, and I have gotten a wonderful education here and I appreciate it.


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## webster2 (May 19, 2011)

Stacy,
I noticed in your signature, 2nd generation Graves. How did your parent treat theirs?

Are there similiarities between the two of you? I only ask that because my daughter is showing almost the same symptoms I did at her age (31) and she is ignoring everything.

I have to request that the Free T3 & Free T4 be tested. Apparently in the practice I go to, they are not tested as a rule. However, they do not discourage them from being tested. I am my endo's only patient taking NDT replacement. I don't know if that matters at all.

I wish you the best.


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## piggley (Sep 15, 2012)

Stacey,
Dont worry about your effect on him because you want to ask questions,
If you were interviewing someone who was putting in a new Kitchen, teaching your Child, designing your Garden, then you would feel justified in finding out their approach to the Job, because you are paying them to do a service for you.. how is this different- except that this is more important because your Health is at stake here..
We patients are entitled surely to select the best person for the job, hopefully someone who you can have good communication with.. if you ask this person if he tests for the things you know you want tested, and they say no, ask why doesnt he/she think its a good idea ect.. their answer could give you an indication into how their tiny mind works, if nothing else..if you arent happy,dont feel comforable, walk. it's his loss..(and less money for that House extension he's building.)
Good luck,


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## lainey (Aug 26, 2010)

As we know, thyroid disease treatment takes patience. The OP is interviewing her third doctor since November I believe, and while finding someone who matches your philosophy is important, you need to leave time for the treatment to take its course.

As I see it, the new endo can suggest the following, after reviewing the records and probably running their own labs:

1. Stay on the current dose as the free T4 has been stable.

2. Decrease the dose, as the it has already been halved since treatment began, because free T4 has been stable.

3. Increase the dose, as the patient, with TSH .02 on last test, is still not euthyroid.

4. Switch to PTU, as the patient has had a rash reaction to methimazole.

5. Have RAI ablation

6. Have surgical ablation.

StacyAr needs to decide which of the above she prefers, discuss with the doctor what they think the best course is, and proceed accordingly. While there is never any harm in seeking other opinions, the current doctors have already suggested options 3 and 4. As generally the conservative approach is to try ATD's first and see how the patient responds, the most pertinent questions would be about which of 5 or 6 the doctor prefers should she get to that point. After that, it might be worthy to ask the doctor what is their preferred method of replacement, but it would not be a surprise if the doctor thinks that this is way ahead of the game.

I would point out the the ACCE guidelines quoted do question the use of free T3 which we in the forums love to use to "treat" thyroid disease. My comments on free T3 were based on my experiences having read the treatments of other Grave's patients over my years in the forums. The guidelines also rely heavily on TSH as a determiner, another measure considered suspect online, so use the guidelines as you will.

Sometimes, being supportive involves pointing out to a person that real choices, while they may be undesirable for emotional reasons, are choices all the same. It is premature at this time to suggest that a doctor will titrate replacement in the same way they titrate ATD's, as the treatment modalities are different.


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## StacyAr (Nov 10, 2012)

Lol piggley about the house addition..too true. Thanks for the kind thoughts.

Webster, my mom had rai. This was 38 yrs ago, when the only atds were said to possibly cause leukemia. Her graves presented stronger than mine in that she had eye and skin involvement and got painfully thin. Talk to your daughter, this is definitely a hereditary disease.

One of the 2 docs i saw so far also did not test my t3, for what it's worth. Just ft4 and tsh.



webster2 said:


> Stacy,
> I noticed in your signature, 2nd generation Graves. How did your parent treat theirs?
> 
> Are there similiarities between the two of you? I only ask that because my daughter is showing almost the same symptoms I did at her age (31) and she is ignoring everything.
> ...


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## haimia (May 9, 2012)

*I am on my 3rd doctor for thyroid meds since August (actually started journey in March or April - took until June to be medicated - first doctor must not have believed my labs - did them three times before medicated). I had TT in August and the doctor I started with, left the hospital-based practice the week before I had surgery. So, associate took over. After a visit with his NP, then him, he did not want any more bloodwork/follow-up for four months! Said bloodwork was fine (only TSH and FT4 that was low) even though I complained about fatigue, dry skin, weight gain, etc., etc. So asked family doctor to test TSH, FT4 and FT3 after symptoms continued. Just had bloodwork done last week and I am running way hypo, AGAIN! TSH is 6.945 (.4 - 4.2), FT4 is .94 (.89 - 1.76) and FT3 is 2.26 (2.2 - 4.0). This endo is on notice! I am not a happy girl!*


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## StacyAr (Nov 10, 2012)

It's just so pathetic that there's no good standard of care for endocrinologists. Everyone i talk with mostly has had the same inadequate journey. And yet because most doctors are.unwilling to learn from patients, it never seems to improve. So you have to force your opinions on unwilling.ears, then look like Elaine from Seinfeld, the crazy bit-h patient.


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## CA-Lynn (Apr 29, 2010)

Don't totally blame the doctors. Many are governed by the bloody insurance companies...which tests they can bill for, which they can not......


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## Sandbar (Nov 6, 2012)

I think the doctors do have a responsibility to keep up with the latest research - they expect to be paid in current prices, not 1980's money so we deserve current treatment. It's not hard to find articles that explicitly state that in Graves' patients (before or after ablation) that medication dosage (anti-thyroid or replacement) should be determined by Free T's and NOT TSH. However it seems the majority of doctors do exactly that because they are not keeping up. This has real and terrible consequences because even being slightly hypo compromises a person's wellness mentally and physically, the ability to live their lives and meet their obligations - speaking from personal experience here. I think it's okay if we are a little mad about it and get proactive. That's if we've got any energy left to do so


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## piggley (Sep 15, 2012)

Sandbar said:


> I think the doctors do have a responsibility to keep up with the latest research - they expect to be paid in current prices, not 1980's money so we deserve current treatment. It's not hard to find articles that explicitly state that in Graves' patients (before or after ablation) that medication dosage (anti-thyroid or replacement) should be determined by Free T's and NOT TSH. However it seems the majority of doctors do exactly that because they are not keeping up. This has real and terrible consequences because even being slightly hypo compromises a person's wellness mentally and physically, the ability to live their lives and meet their obligations - speaking from personal experience here. I think it's okay if we are a little mad about it and get proactive. That's if we've got any energy left to do so


Well said Sandbar- Bravo to that!now you've got me started, rant alert!
Not just happening with Endocrinologist either - its endemic and scares me to death, the complacency and out-of -touch factor is very obvious with many specialists generally,
Instead of wrapping themselves in self approval, many of these folk would do well to hit the books and bring themselves up to date .. we need for them to do that, we expect and should get the current best practise
Instead often we are getting suboptimal treatment but paying top dollar-worse still-paying with our Health as well.Probably worried their MD friends wont talk to them any more if they become up to date and start listening their patients, groupthink is powerful-Easier to stick fingers in ears and say nanananana when we complain.


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## piggley (Sep 15, 2012)

Having said all that I suspect for some reason the Public as a whole very much overestimates the IQ of Doctors generally, even worse, overestimates their commitment to getting us well- Some care, but too many do not. 
(Thanks, i'll stop now.)


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## StacyAr (Nov 10, 2012)

piggley said:


> Having said all that I suspect for some reason the Public as a whole very much overestimates the IQ of Doctors generally, even worse, overestimates their commitment to getting us well- Some care, but too many do not.
> (Thanks, i'll stop now.)


 Agreed. And yes, very well said sandbar. 
There are numerous advocacy groups for Better thyroid care, and a petition as well. How many other medical specialties can boast about that claim, that their care is so antiquated that there are tens of thousands of sick people begging for change? By the by, have you all seen the petition? Just wondering..

http://www.change.org/petitions/end...s-with-thyroid-dysfunction-demand-better-care


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