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Old 02-19-2013, 09:10 PM   #1
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Family Physician vs. Endocrinologist

Hi guys,

I have a problem relating to doctor frustration and hypothyroidism. I recently moved to a new city and was referred to an endocrinologist whom I saw today. I had previously been treated by my family doctor with Armour, and she always looked at T3 and T4 and tried to dose me where I felt good and had those lab values above midrange. I was completely above both ranges at one point 5 months ago and was lowered on my Armour (180-120mg) but I strangely never felt nervous or had palpitations.

I've been feeling decent but still not quite "optimal", and my most recent labs showed TSH at 0.007 and T3 and T4 both just under the middle of the ranges. So I saw the new endo today who was horrified at my labs, said I was in real danger of osteoporosis and heart problems because of my TSH. She said I was receiving way too much Armour and basically said my family doc has no idea what she's doing! I currently take 120 mg of Armour. She doesn't support Armour, so she prescribed 75 mg Synthroid. And said see you in 4 months.

I've read so much about thyroid problems and the benefit of Armour. I really trust my old family physician. I am so confused now! I don't want to hurt my body in any way, but I can't risk 4 months of feeling like crap if this endo is all wrong. Who am I supposed to believe?

I made an appt to go back to my old town in one month and see the doctor who prescribes me Armour. I will have a ton of questions for her. Do you think I should go against the endocrinologist and keep taking my Armour until then?

Thank you for any advice you can offer!
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Old 02-20-2013, 01:53 AM   #2
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You need to keep in mind that it's your body, and doctors work for you. That's why we have to pay them. If you're not happy with the care you receive from a doctor, you should definitely seek other medical opinions.

However, you also need to be well informed about your condition. Many endos prefer using synthetics for solid medical reasons. And I have an excellent endo, but he'd be horrified too at your TSH because too low can leave you prey to the conditions your doctor mentioned.

In my experience, good thyroid doctors consider both labs and the patient's symptoms in prescribing. For example, my TSH is quite low, but I take T3 separately which tends to suppress the TSH. Since I have no hyper symptoms at all, and my T4 and T3 are barely adequate, my endo would not reduce my Rx. My point is that there are multiple issues to consider in treating thyroid, and you want to have a doctor who doesn't overreact to one particular lab value.

When you have a chronic condition like hypothyroidism, I believe that it's really important to build a trusting relationship with your doctor so that you are partners in your care.
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Old 02-20-2013, 04:18 AM   #3
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It was an endocrinologist who prescribed me Armour...and since I have run into countless doctors who fancy that a TSH test being low will rob me of all my bones.

It's actually an over range Free T3 that will leach calcium from the bones...and no doctor should 'rely' on just the one test (TSH) in order to titrate hormones. Bones don't 'feel' hyper, and is why a DEXA is a great tool...I do have osteoporosis because of a parathyroid condition and my FT3 is monitored to be around 2/3 to 3/4 of it's range.

I would (personally) stay with the home town doc and Armour. At least Armour HAS calcitonin in it for bone health and synthetic levothyroxine and synthetic Cytomel doesn't.
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Old 02-21-2013, 11:31 AM   #4
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Thank you both for your responses! I plan on continuing with what I've been doing since I will see my old doctor in a month. I will be sure to ask her many questions and get resources of her knowledge and medical opinions if possible. It would be great if physicians consulted one another more often, so their patients weren't stuck in the middle feeling so confused. Hopefully one day soon, the way doctors are taught to manage hypothyroidism will be uniform (and accurate) across the country.

I feel that FT3 levels are much more important in determining thyroid health, but I want to find out for sure and also get some answers about my suppressed TSH.
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Old 02-22-2013, 04:46 PM   #5
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Well, that's just it. Doctors started using porcine thyroid first (that was the first available hormone for replacing thyroid...and the Armour meat packing company took the pig thyroid and 'dessicated' (made it powder) and then used it. Then a doctor came along with a 'new test' (before this test, a patient was replaced by symptoms)...called 'TSH'. Sigh. (if you go and research how this came about, it was tested on ALL MALE subjects, and no female subjects, and we know estrogen and progesterone have a part in this, as those hormones interact with the thyroid hormones and the adrenals).

Anyway, then a laboratory came up with synthetic T4 (levothyroxine). You can't get a patent on a natural product (pig thyroid) but the companies found out that they COULD get a patent on synthetic T4 and T3 and they could make a lot of money selling that.
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Old 02-24-2013, 01:02 PM   #6
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Thank you so much for the info! Do you happen to know of any good doctors in Houston, TX? I plan to ask my PCP if she knows any as well so I don't have to travel back and forth. I would PM you, but I can't figure out how!
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Old 02-25-2013, 04:32 AM   #7
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You should go look for the Yahoo Texas Thyroid Group and ask them. It's a great group and very helpful.
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Old 02-25-2013, 05:28 AM   #8
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Amen on the Yahoo Texas Thyroid Group...just go to Yahoo and sign up..Jan is a lifesaver.
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Old 02-25-2013, 11:23 AM   #9
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Thank you!! Amazing resource!
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