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-   -   New results, doctor freaked out over low TSH on NDT (http://www.lowcarbfriends.com/bbs/thyroid/743886-new-results-doctor-freaked-out-over-low-tsh-ndt.html)

brbangl3 11-01-2011 05:11 PM

New results, doctor freaked out over low TSH on NDT
 
HELP! I'm on the verge of tears after talking to my doctor's nurse over the phone. She said that my doctor wants to cut my 2-grains-per-day Naturethroid dosage in half despite normal FT3 and FT4 levels, simply because my TSH is so low! This is upsetting beyond measure to me because I recently have started feeling pretty good since getting up to 2 grains. If anything, I was anticipating a low-normal FT4 and a recommendation to add some Synthroid to the NDT—certainly not taking away any medicine, for crying out loud!

Here are the results (no meds before the draw):
TSH: 0.056 (range: 0.450-4.5)
FT4: 1.03 (mid-range: 1.29)
FT3: 3.2 (mid-range: 3.2)

My FT4 is not even mid-range; my FT3 is right at mid-range with no meds before the draw. But, because my TSH is so suppressed, the doctor wants to cut my dosage in half and recheck my levels in 4-6 weeks.

The thing is: from what I have read, a suppressed TSH is common for people being properly treated with NDT, am I right? So, what can I do to prove my point and be allowed to stay on my current dose? I'm so afraid of crashing on a lower dose of thyroid medication. And, the last thing I want to do at this point is go back to where I have been for the past few years—living a half-life on insufficient thyroid treatment.

Advice is much needed and much appreciated!

Leo41 11-02-2011 02:03 AM

My only suggestion is to talk to your doctor and try to convince him to let you maintain your current dosage--or find another doctor.

I have an excellent endo, but he tends to get nervous if my TSH gets too low, so there may be a medical reason for the concern.

Yes, anyone on meds has a lower TSH. Mine usually runs about 0.5 or slightly lower, but yours is much lower than that. I know my endo would be concerned if I were that low--but, again, I don't know why.

However, the T4 and T3 levels are what's significant for how you function and feel, so that's what I'd want to discuss with the doctor. Your levels are barely adequate, so how does he expect you to manage with a lower dose?

In the past, I've had discussions like this with my endo with positive results. One of the reasons I always have my blood draw the week before my regular appointment is so that we can discuss the results, and I don't have to rely on instructions from his office.

poe2you 11-02-2011 04:36 AM

Geez.. how frustrating for you.. why do dr's freak out over TSH..
i agree with Leo and also have my blood draw a week before appt. to discuss results.. i go armed with info but approach it with respect..
I usually start by saying.. "I'm trying to educate myself and I have learned..."
can we try this? I will call or cut back should I feel hyper...

I'm sorry your going through this.. i really makes me angry..
this is why we as patients go through so many dr's... i'm so envy for those who have found dr's that get it!!

brandywine12 11-03-2011 04:59 AM

Quote:

Originally Posted by brbangl3 (Post 15141546)
HELP! I'm on the verge of tears after talking to my doctor's nurse over the phone. She said that my doctor wants to cut my 2-grains-per-day Naturethroid dosage in half despite normal FT3 and FT4 levels, simply because my TSH is so low! This is upsetting beyond measure to me because I recently have started feeling pretty good since getting up to 2 grains. If anything, I was anticipating a low-normal FT4 and a recommendation to add some Synthroid to the NDT—certainly not taking away any medicine, for crying out loud!

Here are the results (no meds before the draw):
TSH: 0.056 (range: 0.450-4.5)
FT4: 1.03 (mid-range: 1.29)
FT3: 3.2 (mid-range: 3.2)

My FT4 is not even mid-range; my FT3 is right at mid-range with no meds before the draw. But, because my TSH is so suppressed, the doctor wants to cut my dosage in half and recheck my levels in 4-6 weeks.

The thing is: from what I have read, a suppressed TSH is common for people being properly treated with NDT, am I right? So, what can I do to prove my point and be allowed to stay on my current dose? I'm so afraid of crashing on a lower dose of thyroid medication. And, the last thing I want to do at this point is go back to where I have been for the past few years—living a half-life on insufficient thyroid treatment.

Advice is much needed and much appreciated!

are you taking your meds any time before your appt ? I used to take mine at 4 in the morning and go to the dr and it would be low too . I don't do it any more, I take my meds at nite. I will not take them at all the nite before the visit now. Which gives me a true reading and some that the dr likes :clap:.I know what happens when he sees that almighty TSH go down, not happening, had it happen before n he almost put me in the ground! So , be your own advocate here. Do you still have a gland ? I don't. Live n learn .

brbangl3 11-03-2011 08:33 AM

Quote:

are you taking your meds any time before your appt?
No, I don't take my meds the mornings before blood draws. Since you mentioned it, though, it did occur to me that perhaps my doctor thinks my dose is too high because my results reflect fasting values. Had I taken my meds that morning before the draw, I'm assuming both Frees would have been higher and the TSH even more suppressed, right?

Quote:

However, the T4 and T3 levels are what's significant for how you function and feel, so that's what I'd want to discuss with the doctor. Your levels are barely adequate, so how does he expect you to manage with a lower dose?
This is exactly how I think I will approach the conversation during my next appointment: "Let's discuss our goals for treatment again, because I'm not sure we are on the same page anymore. I've been focusing on getting my T4 and T3 levels to at least halfway within their respective ranges, but am now concerned that my levels will never get there as long as we are focusing so much on my TSH. I feel better with my T4/T3 levels higher in their ranges. How can we meet in the middle to achieve this balance?" I think he should respond pretty well to that. I have a tendency to step foot into his office in defensive mode—up in arms, ready to fight for my precious meds. I think if I just know ahead of time how to approach the conversation calmy and rationally, he and I can work together to better understand each other and work out a solution that we are both okay with.

----

So, reluctantly, I am going to be the "good patient" and drop down to 1 grain of Armour for four weeks, then recheck my levels immediately. My attitude towards the whole thing is really terrible, and I'm already anticipating a total crash before it has even happened. I'm just going to try to shift my outlook on the situation and stay strong for four weeks, until I can get back into my doctor's office.

brandywine12 11-03-2011 01:24 PM

No, I don't take my meds the mornings before blood draws. Since you mentioned it, though, it did occur to me that perhaps my doctor thinks my dose is too high because my results reflect fasting values. Had I taken my meds that morning before the draw, I'm assuming both Frees would have been higher and the TSH even more suppressed, right?

No , what would happen next, they would be low . Your tsh will be a tad higher n your free's a little lower.

inatic 11-04-2011 03:34 AM

no, if you took your meds, your results, at least the ft3 would have been higher...TSH can flucuate up to three pts on one day.....

I dont think dr is managing your medication properly. Id want another dr because i wouldnt consider dropping my meds with that result. My tsh is wayyyyyyyy surpress and Ft3 at top of range with ft4 midrange. this is how *I* feel good.

brbangl3 11-04-2011 08:14 AM

Quote:

My tsh is wayyyyyyyy surpress and Ft3 at top of range with ft4 midrange.
Ileen, by "wayyyyyy" suppressed, do you mean like mine at 0.056? Like Leo said, some doctors are okay with "suppressed" around 0.5 or slightly below, but then freak out when it gets seriously close to 0.

Quote:

I dont think dr is managing your medication properly. Id want another dr because i wouldnt consider dropping my meds with that result.
ARGH! I know, right?! Thing is, I'm in the armpit of south Louisiana, and it's really hard to find an open-minded, liberal thyroid doctor around here who would be comfortable with my results. Endocrinologists: forget it! I've seen four so far. My current doctor is the best I've seen yet, and he's just a family medicine doctor. I really want to stick with him, which is why this situation is especially upsetting!

brbangl3 11-04-2011 08:43 AM

I made an appointment for next Thursday just to meet with my doctor and open up the discussion. Maybe I'll bring along a copy of my results on 1 grain of NDT, which was less than six months ago, just to remind him that there was a reason why I ended up on 2 grains. Seriously, him cutting my 2 grains in half at this point seems like a mean joke.

inatic 11-04-2011 01:25 PM

do bring your copies just incase. I hope you effort results in something good.

Doggygirl 11-06-2011 04:17 AM

Hi all - poking my head in for a moment! My doctor is VERY good with this stuff and she has never expressed concern about my very low TSH on NDT and in fact, has always said that is exactly what she expects. Her focus is on FT3/FT4. I've been on NDT since June 2008 with this same doctor. My last TSH was .01 (.4 - 4.5) and she said she was not concerned. FWIW, on this same blood draw my FT3 was 3.5(2.3-4.2) and FT4 was 1.3 (.8 - 1.8).

It's great that you have found an MD who is at least willing to work with you. I don't know what I'm going to do when my doc retires.

OT - Ileen, you look fabulous in your avatar as always!!!!!!! You never cease to inspire me!

DG

inatic 11-06-2011 04:22 AM

DG!!!

thank you!:heart:

brbangl3 11-14-2011 09:35 AM

Update: I met with my doctor last week. I told him I was frustrated because I felt that we were taking giant leaps backwards by going back to 1 grain of Armour. I told him I had just started feeling really good mentally on 2 grains of Naturethroid and was confused by his decision to drop my dose so significantly based on the low TSH alone. He looked over my results again, agreed that the drop to 1 grain was a bit drastic, and told me to go back to 1 1/2 grains Armour for two weeks before retesting. He has already suggested that the next step will be adding in some Synthroid, per my request. (I keep bringing up the Synthroid addition with him for two reasons: first, even on 2 grains Naturethroid, my FT4 was not yet mid-range; second, my energy level and overall brain function is noticeably inconsistent throughout the day, and I have been convinced that the extra T4 will help keep my energy level stable after the T3 starts wearing off by mid-to-late afternoon.)

I'm somewhat "okay" with the outcome following my visit, and I'm glad he wants to recheck after only 2 weeks on the lower dose. HOWEVER, I am guilty of being incredibly stubborn and impatient (and, mostly just sick of feeling sick!) and must fully confess that I have sort of jumped the gun on my own... I had some leftover 75mcg Synthroid pills and have, for the past few days, been splitting them in half (37.5mcg dose) and taking it with my morning grain of Armour. This is bad patient behavior, I know. I just can't help it—I want to feel like I'm making progress in my thyroid treatment! Someone please talk me down and tell me that I need to follow my doctor's advice, if only for two weeks before he tells me it's okay to start taking Synthroid...

brandywine12 11-14-2011 01:46 PM

that is good news that he decided to adjust the way you want him to, good for you!
I know how you must feel , been there did that sooo many times! But you do need to do what he suggests as far as your meds tho . You do not want to over shoot your feel good spot! I have done just what you are doing, but became a scared chicken to carry it out, only a few of mine went down the hatch. The meds aren't going to fix you over night or in a week or two , you DO need to have some patience here for that sorry .
Once a dr dropped my dose and kept on dropping , well , I got soo sick , I am now and have been over a year back to my normal self .This woe lc has also helped me in so many different ways . Between my dose and vits and lc , I feel GREAT! I never thought I would get there again . Patience my dear, patience.

brbangl3 11-15-2011 09:05 AM

I know you are right about needing to do what the doctor tells me, brandywine. Thank you. I just feel so tired and apathetic again already. And, my eye weakness is back with a vengeance, just when I had started feeling like I was overcoming it on the higher dose of thyroid meds! (In the evenings, especially—when I'm really tired, I can barely keep my eyes from crossing. It's truly embarrassing!)

I'll discontinue the Synthroid and only take my 1.5 grains of Armour; start counting down to two weeks; and, in the meantime, try to find online sources of information arguing the suppressed TSH in the presence of sufficient FT3 and FT4 for proper treatment. He already said that he doesn't credit the TSH result as much as the FT3 and FT4 levels; but, clearly, he gets nervous when it dips so close to 0. And, yet, he did acknowledge and agree with what Ileen said about the TSH being in a constant state of flux. Which only makes me wonder why he was so willing to change my dose so drastically based on that one TSH reading... ARGH!

Natalie1985 11-29-2011 06:14 AM

I think your doctor should dose you on how you feel as well as test results


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