Treatment order: Adrenals, Thyroid, BHRT?

[Snuffleupagus]

I am 39 soon to be 40 and from the time I was 15 have had irregular periods. Early on they were non-stop but then through my late teens and 20s they were very sporadic at best. My now doctor diagnosed me with PCOS about 14 years ago. I went on BC for a while and that regulated my cycle but the more research I did the more I knew it was a band-aid. About two years ago I found through saliva testing that my progesterone and DHEA was very low. I started progesterone cream which has regulated my cycle again. When I took my next saliva test progesterone was normal (using the progesterone cream), DHEA still low, and estradiol went from being just slightly elevated at 4.3 in the first test to 1.4 with a range of 1.3-3.3. I tried DHEA cream at 15mg a day but the following saliva test still came back low from being 1.7 in the first test to 2.9 with a range of 2-23.


I have since had a blood test last year which showed: TSH of 1.99 with a range of .4-4.5
FT4 of 1.1 with a range of .8-1.8
FT3 of 261 with a range of 230-420
Thyroid Peroxidase Antibodies of <10 with a range of <35

Ferritin level of 27 with a range of 10-154

I am not sure if the progesterone cream could interfere with the above thyroid results. I have since added iron to my daily supplement as I was taking none before. I am hoping that will bring my Ferritin level up.

I have ordered another round of Thyroid tests and cortisol tests, and DHEA. My questions are:

Should I stop the progesterone cream before I take these next tests to get an accurate reading with no interfering from any progesterone?

What should my treatment order plan be like assuming everything comes back low? Adrenals first, then Thyroid and finally BHRT?

Thanks in advance for any help! I think I have found a new doctor but I want to be as knowledgeable as possible going in.

[nonstickpam107]

I don't see any cortisol tests there? You'll want a 4x in one day salivary kit, NOT a one time in the am cortisol blood draw.

Um..I've heard and seen labs from a little over 1,000 patients (female) taking DHEA, and most of them were well up to 50mg. and more and still didn't see much of anything happen (although it tended to work in women UNDER 38yrs. old or so).

Your low ferritin (do you have the iron test to go with that? Just plain 'iron') would compromise your T4 to T3 conversion, as would progesterone (that IS rx'd and compounded micronized progesterone..um..right? The OTC stuff isn't anywhere NEAR as good). Your TSH would be 'too high' for me, you do not have Hashimoto's (at this time) but your FT4 is decent, your FT3 isn't very good, BUT low iron/ferritin AND taking progesterone (especially Wild Yam cream not Rx'd) would and could lower conversion.

If it were ME, I'd want off the DHEA and progesterone, and have the TSH, FT4, FT3 redone after about 10 days off of those, and I'd want the 4x in one day salivary cortisol, as well as estradiol, progesterone, free testosterone, testosterone, DHEA-S (I'm also assuming your DHEA isn't some OTC stuff...and that it has also been a compound made specifically for YOU?? Let me know). Oh, I see it was transdermal, have never seen that work at all for female with low thyroid.

Just being thrown towards menopause will lower conversion, and being low in iron, etc. will complicate it too. Do you have a doctor who is well versed with BHRT and thyroid (hopefully Rx's Armour Thyroid? and doesn't go by 'just TSH')? If not, you might want to google anti aging docs in your area (some are plastic surgeons, so you'll read their ads...) or call compounding pharms, etc, otherwise, I have lists of thyroid docs (some do great BHRT too).

Pam

[Snuffleupagus]

Thanks so much for responding.

I don't see any cortisol tests there? You'll want a 4x in one day salivary kit, NOT a one time in the am cortisol blood draw.

The one-time cortisol saliva and blood testing I previously had came back normal but I suspect a 4x a day test will come back low. I have this 4x a day saliva test at home now-just need to test.

Your low ferritin (do you have the iron test to go with that? Just plain 'iron') would compromise your T4 to T3 conversion, as would progesterone (that IS rx'd and compounded micronized progesterone..um..right? The OTC stuff isn't anywhere NEAR as good). Your TSH would be 'too high' for me, you do not have Hashimoto's (at this time) but your FT4 is decent, your FT3 isn't very good, BUT low iron/ferritin AND taking progesterone (especially Wild Yam cream not Rx'd) would and could lower conversion.

No, I don't have the iron. The progesterone is OTC - it was working at the time for my cycles but now after reading through these threads I know better.

If it were ME, I'd want off the DHEA and progesterone, and have the TSH, FT4, FT3 redone after about 10 days off of those, and I'd want the 4x in one day salivary cortisol, as well as estradiol, progesterone, free testosterone, testosterone, DHEA-S (I'm also assuming your DHEA isn't some OTC stuff...and that it has also been a compound made specifically for YOU?? Let me know). Oh, I see it was transdermal, have never seen that work at all for female with low thyroid.

Gotcha-will do. Should the estradiol, progesterone, free testosterone, testosterone, and DHEA-S be blood or a saliva test? The DHEA transdermal was purchased through the doc that ordered my original blood tests. So, not RX but only available through dr.s office.

Do you have a doctor who is well versed with BHRT and thyroid (hopefully Rx's Armour Thyroid? and doesn't go by 'just TSH')? If not, you might want to google anti aging docs in your area (some are plastic surgeons, so you'll read their ads...) or call compounding pharms, etc, otherwise, I have lists of thyroid docs (some do great BHRT too)

The doctor that ordered my last blood tests is an anti aging doc. He seems pretty generally knowledgeable and uses Armour and BHRT but I am not really that comfortable with him. I have found a doc about 3.5 hours from me that is good with BHRT but I don't know yet about thyroid. Thanks to your other thread (the closed one) I also found a doc about 5.5 hours away who I know is good at both.

[nonstickpam107]

The salivary testing just doesn't work well for ME...it's individual...but everytime I'd go salivary I was over-replaced....too much estradiol was given and too much progesterone based on salivary testing. The progesterone overload was no problem...I just scaled down, but the over replacement of estradiol left me horribly bloated...and took a few WEEKS of working with compounder to re vamp, lol.

Anti aging doc? That low FT3 should have sent his radar going! Would have MY doc. My doc stopped doing the DHEA thing with most over 39 yr. old women..it just wasn't having the desired effect. He says: "If you NEED replacement with estradiol, progesterone, etc. than do it...don't pussyfoot around with DHEA thinking it will do the trick".

I would rather travel to a doctor I KNOW has good success with titration of thyroid and BHRT rather than see a doctor who I'm not 'comfortable' with. And I've been to anti aging docs who told me that they don't actually 'treat with hormones' until the woman is POST meno...when I said "I AM post meno (41 yrs. old cuz they wouldn't treat my thyroid quickly enough) they told me to come back when I was 50. ??? Like everyone all of a sudden goes post meno over night on their 50th birthday?? (gotta laugh yanno?~!).

If you can afford to see that doc further away and you're up to it, I guess that would be what I would do. Best of luck to you!

Pam

[Snuffleupagus]

Thanks so much for your help. I really appreciate it. I will let you know when I go see this new doc and get some test results back. I am so happy to have found these threads!

[nonstickpam107]

You're welcome....and I'm always delighted to have helped someone with any of the thyroid threads/posts/articles I've written.

Pam

[Snuffleupagus]

Pam, do you know of any good thyroid/BHRT doctors in FL? I am in the Tampa area but would be willing to travel anywhere in the state or even as far as into Georgia. I thought I had a doctor picked out but I started reading his website more and am not sure. It is expensive to begin with as most do not take insurance so I really want to find "the one" as quickly as I can. I thought I should start with any you could recommend.

Again, thanks for your help!

[nonstickpam107]

Dr. Ken Wolinar, Boca Raton, Florida. Honestly...that's the ONLY one who does it 'all'. I don't agree with his 'nutrition' info (sorry, Doc Ken..I'm an Atkid from way back) and you might have to be quite proactive...you might have to say "I want the definitive tests, and I want treatment re: BHRT/adrenals IF I need it, and thyroid".

Pam

[Snuffleupagus]

Thanks for the recommendation. I checked on Dr. Woliner and he is more expensive than I thought it would be. Have you heard anything about Dr. Allan Fedosky in Niceville, FL? He takes Medicare (for my Mom) but is more affordable out of pocket for me and his labs are with a lab my insurance covers. He can also get me in like immediately. What about Dr. Maiquez in Miami? Thanks Pam!

[nonstickpam107]

Yes, have heard of Fedosky...he's recommended for Armour (albeit...um..how to say...likes to give very low dose and haven't heard if he does FT's..maybe you can let us all know...??) and BHRT. The other..no.

Pam

[Snuffleupagus]

Thanks, Pam. The person/receptionist who I spoke with on the phone said that Dr. Fedosky does all of the hormones, adrenals, and thyroid. We'll see how it goes.

[nonstickpam107]

I'd try Fedosky if I lived in your area.

Pam

[Snuffleupagus]

Ok-good. That makes me feel better about trying him.

[scarlethazes]

Hi I am new to this site and I just came across it when I was doing research on thyroids. I happen to see snuffleupagus' question about Dr Fedosky in Niceville, How odd it was to see this.

Anyway, I just started going to him in September because my husband saw a flier for him in the office of his doctor. He said that he worked with BHRT and I have been looking for someone in this area to go to for this. Made an appointment, he spent 90 minutes with me explaining the Thyroid and how it works to help regulate just about everything.

It was a total learning experience and he took a full history and set me up for a complete blood work up to go along with my history. The one thing that I like about him so far is his attitude about treatment, treat the whole body! And he listens and give you a choice to continue with him or see another doctor.

I choice to see him since I have suspected for years that I was hypo but could never get "any" doctor to listen to me. Even after I did all the research and had the proof for them to read sitting right in front of them. I gave up after trying to fight it, so when I came across Dr Fedosky I was an open book. He is caring, he listens, and he is ready to treat the body as a whole if you are ready.

I have only seen him 3 times but I am pleased with the way he listens and treats. He all for the natural Armour pill but doesn't push you, the choice is yours to make. I think that he is a great choice for a doctor and can't reconmend him enough.

One last bit of information about him, he also being treated for a thyroid problems and maybe that is why he is so understanding. I think he is driven to help others so they can be whole again.

When I get the thyroid in control, we will see where I need to go with BHRT. I am just happy to know that there is help for me and so glad my husband just happened to see his flier. It was my lucky day...........and the best news for me is I live less than 2 miles from his Bluewater Bay office in Niceville.

One other thing that nonstickpam107 said about his dosing methods, yes he does go slow. I am up to 1 1/4 pill a day after 3 weeks and I will up it to 1 & 1/2 next week. But for me that is okay, I may be suffering some now but better than over doing it.

[nonstickpam107]

Thank you so much for your post, Scarlethazes. It's good to know that I'm not getting 'eroneous' recommendations nor giving them.

Hmm, well your dosage titration is FAR from 'conservative' IMHO. BUT...I was in the middle of Hashi toxi cosis and my titration was: First replace progesterone along WITH beta blocker (very small amount) coupled with about 1/2 grain, for about six MONTHS..then went up another 1/2 grain in the next four, then 1/2 in the next four (removal of beta blocker at this point). My doc had developed a really nice 'block and replace' technique.

Hmm, I'd like to know who Dr. Fedosky is seeing for HIS care, lol. I hope he doesn't mind me recommending him in that area...but sending patients who've been denied care and are suffering needlessly is my 'advocation'

Pam

Pam

[scarlethazes]

Good Morning……you know I don’t think that Dr. Fedosky would mind at all about the referrals. He really understands that there are so many people out there that are not diagnosed or diagnosed correctly. He seems to be a huge advocate of giving everyone their own personalized scale and not lumping them into one “general” scale.

No I guess you wouldn’t think that his titration is slow (not compared to your dosing) but to me it seems slow, especially when I have been intensely suffering since January of this year. You know you want to walk in get your test done and start feeling better in a week and it doesn’t happen like or at least mine didn’t. He did mention last time that he wants to check my Adrenals as well because of the mixed messages that my system is sending.

I was reading some of the threads in the BHRT and I am excited to get these under control as well. When he started treatment he did say that we could start with the Thyroid or the BHRT, I choose to start with the Thyroid first as this seemed to hit me over the head suddenly after a second surgery in Jan 08.

Let me ask you this one last question before I close this comment up. I had a endoscope & colonoscopy in mid Jan 08 at the end of Jan 08 I had a knee scope done. I know something traumatic happened during that knee scope from the moment I woke up I didn’t feel right.

I had such horrible loss of strength, hot and cold flashes that were so severe (now I am just HOT), bloating, brain fog and weight gain. Now I know from my research in the past that I have been mildly hypo for the past 6 or so years. Could a stressful surgery suddenly cause your thyroid to revolt, kind of like the “straw the broke the camels back”? My body has never been in such distress as it has been in since that Jan surgery.

Even after I had to have another knee scope in late April my body did not reach like it did in Jan. I have been searching for answers to those questions but haven’t found them yet. You know how doctors are they won’t say anything bad about another doctor even if they know the doc did something wrong.

So I have talked to several doctors about my problem and how I didn’t feel good how I have NO energy, no get up and go. I would tell them I know something is wrong and they would all refer me back to my family doctor. I knew he was going to help because my blood test always come back with in the normal range (except white blood cell they are always in the 12.4 or higher range).

Do you know if anyone else has had this happen to their thyroid after a major surgery?

Thanks,
Scarlet

[Snuffleupagus]

Hi scarlethazes! I am sorry I haven't responded to your post but I have been away from the board for a little while. I really appreciate your posting about Dr. Fedosky. I am making an appointment with him soon and thanks to your positive experience am looking forward to meeting with him. Do you live near his office or do you have to travel?

[scarlethazes]

Snuffleupagus, Good Evening!!! Don't worry I totally understand, to answer your question no I don't travel. I am so very lucky that my husband found his posting on the wall and brought it home. His office is just about 2 miles from where we live and even from where I work it only takes me about 20 minutes to get there.

So either way I am very close, but I would say that if you have no other good kudos for any other doctor close by I would at least give him a try. Call the office first and check your insurance and see if he is on your list and be sure to tell them you are traveling. He is not a PPO member for my insurance but they covered about half and you have to pay the full amount at each visit.

The first visit was $205 and he spent about 1 hour and 15 minutes with me, but I know the price will vary on the first visit but no more than $255. Each visit after that has been running me $175. Each visit runs about 1 hour and HE LISTENS AND UNDERSTANDS. Oh and they will file your insurance for you even if he is not on your provider list.

Good Luck and keep in touch especially if you make that appointment, I know you will like him.

Hug,
scarlethazes