My MD's Mastery of Understatement

[MBombardier]

My GP just released my latest lab results online. Yes, at after 8:30pm on a Saturday night. He must have been waiting for the Rapture.

Anyway, he said that I have elevated thyroid antibodies, which is a slight understatement. Here are the results:

Component Your Value Standard Range
Thyroid Peroxidase Ab >1300 0 - 60 U/mL
Antithyroglobulin Ab 145.0 0.0 - 60.0 U/mL

At least now I have ammo next time a node goes hot and he wants to mess with my dosage. And now I have another thing to research to see exactly what this means besides that my hypothyroidism is of autoimmune origin. Oh joy.

[tex]

Yep, your thyroid is definitely under attack.

Tex

[annie oakley]

Ya know your report about the thyroid make me decide that when I go back to my Doc I want a test***been years and There are good reasons to test. My sister has thyroid issues my mother did also. Father just dealt with cancer, arthris and cluster headaches. What kind of doctor does thyroid? can My MD do te original blood tests or a special doctor?

[TXBrenda]

Annie
Your PC doc can order the tests. In my case he even ordered the T3 & T4 tests when the TSH lvls came back in "normal range." I was having the excessive sweating, fatigue, & others I didn't know until I went to a doc in Houston. I also had ridges in my nails, swollen & white tongue, swollen face. The meds they put me on have greatly reduced the symptoms. Good luck, especially if you are having symptoms.

[MBombardier]

I mentioned in another thread that I had been referred to an endo (who is a DO) for my thyroid issues, and he seemed to know less about thyroid than my GP. Well, here is Act II:

I went in on Sept. 12 to have labs so that I could renew my Armour prescription. I suspected I was hyper, which of course is a symptom of my lovely Hashi's, shown in the elevated antibody results above, and I was. I have lost about 4 lbs., which I hope will stay off this time when the nodule goes cold again since I am eating paleo/primal. I stay nice and warm, and thankfully, I am not having too much trouble with a rapid heartbeat.

The good news is that the endo is giving me another couple of months of the same dose of Armour, though he wants me only taking it six days a week. The bad news is that he apparently missed the fact that I am hyper. The worse news is that it looks like I have gone into secondary hypothyroidism. Here are my test results, taken 28 hours after my last thyroid pill:

T3 -- 2.4
T4 -- 0.94
TSH -- 0.1

Low values like this across all three tests indicate a pituitary gland problem, which the endo totally missed. Now I have to decide if I am going to freak out or not. The worst case scenario is that I have a tumor that is impinging on my pituitary gland so that it is not working. According to http://www.endocrineweb.com/conditions/ ... d-function this is the most common cause of thyroid test values like these. So I should be getting some other tests, including an MRI of my brain, and most definitely should not be cutting back on my thyroid medication.

If there is no tumor, and my hypothalamus function checks out okay, the only recourse is to make sure the thyroid and adrenals are well supplied so that other problems don't crop up. If there is a tumor and that tumor merits surgery, I live in a great part of the country. OHSU across the river in Portland has an excellent brain surgery center, including for pituitary gland tumors. According to their website, only about 20% of pituitary gland tumors are malignant.

So I am trying to decide what to do. Do I go back to my GP? Do I see if my insurance company will let me see a different endo? Do I just wait a couple of months until I have labs again and see what they show?

Thanks for being there--because my husband has been out of work since July 1st, that is pretty much consuming him and he doesn't need me freaking out. I haven't told anyone else but my pastors on Sunday, and they prayed for me. So that was good.

[tex]

Marliss,

IMO, you have assessed the situation accurately, and your endo is either not paying attention, or totally lost. Maybe if you show your GP some literature to back up your interpretation, and ask to see another endo for a second opinion, he or she will oblige. You definitely need an endo who knows what he or she is doing.

I may be looking at the overall picture with a jaundiced eye, but it seems to me that a relatively high percentage of endocrinologists are sadly lacking in professional skills. There are some good ones out there, but we've seen descriptions of quite a few of them here on the board, that suggests that many of them simply don't know what they're doing, especially when dealing with HPA axis issues.

Best of luck with this, and please keep us posted.

Tex

[sarkin]

Marliss,

First - WOW, with a little yikes thrown in; second, I agree with Tex. It's a shame most docs won't do the kind of pondering you're doing, to assess the situation. I hope you get good support from your GP, and start moving toward some of the answers you need.

All my best for great good health (and excellent medical care!) - I have been thinking of you, these past few days, as I try not to be "informative" about health matters where there isn't an eager audience... I found that comment in your recent update timely and every time I keep my mouth shut, I silently thank you...

Love,
Sara

[MBombardier]

Thanks, Tex and Sara. Good advice!

Sara, you're so funny... I do exactly the same thing! I think about you dancing when I start to exercise, and it is very encouraging!

I am so thankful that I can come here and talk about being just a little freaked and people who are used to dealing with chronic stuff can provide a listening ear without having to be educated first, or freaking out themselves because I am mother/daughter/sister/wife/friend.

Love you guys...

[dgshelton]

Marliss - if I were you, I would definitely get a second opinion. I am so lucky to have an endo that is open minded. I have been with her since 1998. She "retired" for a couple of years when her children were young, but even then had me go to an internal medicine doc. that she had call her if there were any problems with her patients. She found that I was producing anti-thyroid antibodies when I was having trouble getting pregnant. It was actually an endo friend that she was discussing my case with over lunch that suggested she test me. She said they went to school together and that they always bounce things off of each other. It is very refreshing to find a doctor who doesn't think they know everything. They are few and far between.

I hope that there is another explanation for your results other than a tumor. I will keep you in my prayers.

Hugs,

[MBombardier]

Y'all asked me to keep you posted, so here is Act III:

I talked to my GP about a second opinion, and he told me that secondary hypothyroidism caused by pituitary malfunction is "uncommon." Well, duh. But he put me in for a second opinion from another endo. I called endocrinology and was given an appointment at the end of November, but there was a cancellation and I saw the new endo today.

She's very nice, but I think she's pretty much establishment. For example, she said that Armour thyroid is hard to manage because the amounts of thyroid actually in it vary. From what I've read, that's old information. She said that my last labs are typical of Armour thyroid therapy, or any therapy with T3 supplementation. According to her, if I had a pituitary problem, I would be having physical symptoms like no periods and breast secretions because growth hormone is the first to go, then the sex hormones, then thyroid, then cortisol because the body tries to protect the cortisol production the most. I will be reading up on this to see if I agree with her, lol.

I'll be doing my labs again this week to see what they are like now. She was totally with me on the hypo/hyper nature of Hashi's, so that's a good thing, but she said that my thyroid is not causing me to retain my weight. She said she has many patients in the same boat, and that if she knew how they could lose weight, she'd be rich.

Thanks for your thoughts and prayers!!

[tex]

She said she has many patients in the same boat, and that if she knew how they could lose weight, she'd be rich.

I hope that's not a sign that she's afraid to treat hypothyroidism.

Good luck.

Tex