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-   -   Appointment with Endo (http://www.lowcarbfriends.com/bbs/thyroid/785619-appointment-endo.html)

KeirasMom 10-15-2012 01:06 PM

Appointment with Endo
I finally got my referral to an Endocrinologist, and my original appointment was scheduled for the end of November. I asked them to put me on the list to call in case there was a cancellation. I just got called and my new appointment is going to be on Wednesday, October 17! Just two days! :jumpjoy:

I have read some good reviews on this Endo, but none of them mentioned specific treatments or even what the patient was being treated for--they could all have been seen for diabetes for all I know. I'm hoping she's knowledgeable and open-minded.

So anyway, does anyone have any advice for my first appointment? I'm going to take all my copies of previous labs with me, and point out that my last T3 was below range even though my TSH is within range.

Leo41 10-15-2012 02:44 PM

Hi Dawn-
It was great that you could get in because of the cancellation. When I started with my current endo, I had to wait 3 mos. for an appointment, but I didn't mind because I'd just been checked by my former endo, and there was no urgency.

Yes, bring your labs with you. Unless you discover that it's her practice (as it should be), make sure she arranges for you to have labs done before each check up; otherwise the actual office visit is a waste of time.

Make sure you report any specific symptoms you're experiencing because a good thyroid doctor prescribes based on both labs and symptoms. When I was first hypo, my labs always looked better than I felt.

If you have any questions you want to ask, I'd suggest writing them down and taking them with you. During the confusion of an office visit (especially with a new doctor), it's too easy to forget to ask your questions.

I hope this doctor is the one for you!

KeirasMom 10-15-2012 03:15 PM

Thank you Leo! I have a list I've been working on for the past few weeks, mainly with symptoms that come and go, so I won't forget them during my appointment. I asked when I first made my appointment if I should get labs prior and they said they have a lab in-house, so they'd do them at my first appointment. I'm hoping that's just for the first appointment, and not their usual M.O. I hate to waste time having an appointment "just" for labs.

Oh, I really hope she is "the one!" :aprayer:

watcher513 10-15-2012 05:49 PM

Hopefully she goes by labs (Free T's, Not Total T's) AND symptoms.

Leo41 10-16-2012 04:25 AM

My endo also has an in-house lab, and when I first went to him, they did the labs as part of my appointment. It seemed silly to me because he's phone me with the results (and they mailed me a copy), but there was no opportunity to actually discuss the lab results with him. [And my former endo always scheduled labs so that we had results before the office visit.]

So I suggested that I come in a week before each appointment for the labs, and my doctor thought that was a great idea. I've been going in for labs the week before each scheduled appointment since then.

He's an excellent doctor, and I wondered why he wanted to do labs and office visit together. One reason might be cost for the patient. Each visit would involve a co-pay perhaps. I happen to have great insurance, so I have no out-of-pocket costs, so it's fine for me--even though my endo's office is a 40-min drive.

My point is that you should feel free to suggest doing labs as a separate visit--if that works for you.

princessmommy 10-16-2012 05:13 PM

Everyone has Great suggestions! I always have to wait on my labs too. Went Friday and just got my results today and that was after Me calling and leaving a message for his nurse! Good luck with your appt!

KeirasMom 10-16-2012 05:39 PM

I'm excited for tomorrow's appointment. I did think of one question that I haven't addressed yet on this board. I found out (after my diagnosis) that my mother and grandmother (both deceased) also had thyroid disease. I don't know the specifics, only that my mother was diagnosed as a teenager and my grandmother sometime before my mom. My mother was always very secretive about her health, so that's why I didn't know. It sure would have been nice to know so I could have been screening myself for it! Ugh.

Now I recently found out that my niece (brother's daughter) was diagnosed with TD when she was 11! No, my family's not close. :o Anyway, she's 14 now and has been medicated for 3 years.

I'm really concerned now about my daughter (age 7). She has already endured one surgery for a bladder/ureter defect. She has no symptoms that I am aware of. Does anyone have children with TD? When should they be tested? Especially with a significant family history. I'm going to ask the doctor tomorrow and have done a little research, but haven't found much other than at birth or at puberty. I thought maybe you all might know. TIA!!

princessmommy 10-16-2012 08:33 PM

Both my parents have Hypothyroid and my Dads Mom had it too. She had a Huge goiter when she was around 30 and had it removed. They didn't put her on thyroid meds until she was in her 80's! I have had my daughter tested a few yrs ago. Thankfully she was Ok

Leo41 10-17-2012 05:07 AM

Thyroid problems can occur anytime in life. However, hypothyroid tends to appear at times of hormonal shifts in women--puberty, childbirth, menopause (including perimenopause).

One problem is that it can often be so mild and the symptoms so vague that a person can be hypothyroid for some time before the person is actually diagnosed, so it's often difficult to determine actually when the thyroid began to slow.

KeirasMom 10-17-2012 01:39 PM

Okay, so I saw the Endo this morning, and so far, so good. She seems very well-informed and open-minded.

She is testing (on her own--I didn't have to ask her for it) my regular TSH, Free T3, Free T4, B12, and more. I can't really remember all of it right now. She asked me if I wanted to try Cytomel, even if my labs come back within range, as symptoms are just as important as labs. :jumpjoy: I told her I'd like to try it, so as long as nothing's totally wonky with my labs, I should have a prescription in a week or two. She also mentioned that she'd reduce my Levothyroxine once I start the Cytomel, which I've read is the right way to do it. My last T3 test was total T3, not Free T3, and she said that's notoriously unreliable, so even though I was low, I might not be now, or could be even lower.

Regarding my daughter, she said not to worry about her unless she starts having symptoms, but recommends if asymptomatic through her teens, to start screening in college and then regularly thereafter.

She really made me feel comfortable and took her time with me, answering all my questions, and putting my mind at ease.

princessmommy 10-17-2012 03:55 PM

Yay! So glad she listened to you! Hopefully you'll be on the road to a level thyroid soon

Leo41 10-18-2012 03:18 PM

I'm happy for you that it went well! I hope this is 'the one.'

KeirasMom 10-18-2012 07:51 PM

Thank you Shelly and Leo! I sure hope so too!

betty301 10-25-2012 11:47 AM

Sounds GREAT!!!
It's such a relief to get the help you need, isn't it??:jumpjoy:

KeirasMom 10-27-2012 07:00 AM

I got my lab results back yesterday.

TSH 1.16 Range: 0.340-3.000 uIU/mL
Free T4 1.3 Range: 0.8 - 1.9 ng/dL
Free T3 2.5 Range: 1.5 - 4.1 pg/mL

So everything's in range. Rather than starting me on T3, which she says she still WILL do if I want it, she'd like me to start taking the name brand Synthroid instead of generic Levothyroxine.h

She says they are usually more accurate in the dosage with the name brand, and more consistent. I feel like I read that somewhere as well, so I'm going with it for now. She gave me 6 weeks worth of samples to try it out and see if it makes a difference, and then I can let her know if I still want to try T3.

Anyone have thoughts? I am glad I'm in range, but still not feeling great. I don't want to just keep piling on meds though that may or may not help.

Leo41 10-27-2012 08:21 AM

Dawn- The Synthroid may solve your symptom problems, but, as you know, it will take at least 6 weeks to be sure because T4 is slow in its effects.

My own experience may be useful. I have taken Levoxyl (another generic form of Synthroid) since I was diagnosed, and I feel fine with it. However, about a year ago, my [former] pharmacist talked me into allowing him to substitute Levothyroxine because it was cheaper--for him. They are identified as the 'same' --i.e., both generic forms of Synthroid.

I gradually began developing 'symptoms' until I was feeling not right at all, and at my next check up I told my endo that I thought I'd made a mistake in agreeing to the Levothyroxine. He told me that I should absolutely insist on Levoxyl and that there is no such thing as an 'identical' med. All the thyroid hormones have various 'fillers' in the pills, and the nature of the filler differs by brand. It's possible to either react to a specific filler OR have the body somehow fail to process that pill effectively because of the filler.

Once I went back to Levoxyl, my symptoms disappeared.

As someone who takes Cytomel, I'd advise you to put off taking it until you're absolutely sure you need it. Your level seems to indicate that your body is adequately converting T4 to T3 right now. Keep in mind that the T3 hormone is very powerful, and you shouldn't take it unless your T3 level is so low that it indicates you're not converting adequately.

Most of the people I know who are hypothyroid do fine on T4 only.

KeirasMom 10-27-2012 09:12 AM

That makes sense Leo. When I had my last T3, I didn't realize they did total and not Free, and I was below range. I'm happy to see I'm in range and converting well enough. I have heard a lot about how powerful Cytomel is, and am only willing to take it if it gives me better results and all else has failed, but I'm absolutely willing to try just changing the brand of T4 until I find what works first. If I don't HAVE to add T3, I'd rather not. I thought that was going to be my only option and I'm glad there are other options available.

Leo41 10-27-2012 09:39 AM

The only reason to take Cytomel is for low T3. My endo usually does the Total T3 because I am not taking any other hormones, and I'm post-menopausal. However, when my T3 tanked (below lab range) he did a Free as well as a Total to make sure that I was experiencing conversion problems before he prescribed the Cytomel. My levels were the same on both tests.

As you know, normally the body converts T4 to T3, and only T4 supplementation is necessary. Interestingly, the conversion isn't a function of the thyroid, which I only recently learned because I have a good friend who had Graves Disease, and he opted to have his thyroid removed surgically (rather than 'killed' by radiation, which is the other option). But without any thyroid, he takes only Synthroid (T4), and his body converts to the needed
T3 with no problems. This has been true for the 10 years since his surgery.

inatic 10-28-2012 10:00 AM

The conversion of T3 is mostly in the liver.
He could have tried medication like PTU, which worked quite well and put me into remission. Hi estrogen from pregnancies also likely helps as it also binds thyroid hormones and also alters thyroid conversion in the liver too. Notice when many have issues with thyroid and hormones.. during times of hormonal upheaval.

My total T3 and ft3 levels never match. Usually my T shows higher but the ft3 much lower, especially when im struggling thyroid wise.

watcher513 10-28-2012 05:55 PM

Free T4 1.3 Range: 0.8 - 1.9 ng/dL
Free T3 2.5 Range: 1.5 - 4.1 pg/mL

For those lab ranges:
Mid-range for FT4 is 1.35 so you're close.
Mid-range for FT3 is 2.8 so you're below mid-range (FT3= energy)

I'm not sure what going to brand Synthroid will do since it's T4, not T3. Will it help you convert T4 to T3? We don't know, only your body knows. If you don't convert, you don't convert. It's really good that your new doctor is willing to let you have T3 if you want, so wait and see how you feel. If you Need T3, it's not a matter of 'piling on meds', it a matter of your body needing it. It may be a simple change. If you feel like you want to try it some day, it's up to you and how You feel.

misslatte 11-14-2012 12:03 AM

Hi Dawn - well, how are you feeling? What did you end up doing?

I'm doing a lot of research and am curious about how you're doing :)

KeirasMom 11-14-2012 07:06 AM

I decided to give it a shot just doing the brand name. It's been a few weeks and I'm not really sure if there's improvement. I started exercising last week, and am feeling a little bit better, though it's a chicken/egg situation.

Did I feel better so that's why I decided to exercise?

Or did I start exercising, and then feel a little better?

I really don't know. :dunno:

KeirasMom 03-05-2013 05:06 PM

Quick update: I've stuck with the brand name Synthroid and I feel pretty much human. I'm exercising 3-5 times per week because I feel like it. I had an appointment with my Endo this morning and my labs were all within range.

TSH 2.440 (0.340 - 3.000 uIU/mL)
Free T4 1.4 (0.8 - 1.9 ng/dL)
Free T3 2.8 (1.5 - 4.1 pg/mL)

TSH is a little high, and she told me it was my decision if I wanted to increase Synthroid or even supplement with T3, but she thought everything looked good and since I feel pretty well, we're leaving things alone for now.

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