<<Disclaimer: Verify this information before applying it to your situation.>> There was a huge response (almost 40) to my query; all of it positive and supportive. Thank you to everyone; many people wrote long and detailed messages. At times like these I’m reminded of what a wonderful group of people you are. Thank you! ORIGINAL POST (edited) Every time i've had my thryroid levels taken since getting ill in 2001 my TSH has been between 3.0 and 4.0, above the new upper range proposed by the AACE in 2003. My current TSH value is 3.9 (the highest ever). I would like to talk to my doctor about getting treated for hypothyroidism even though my TSH falls below the more widely accepted upper limit of 5.0. That is, I want to do everything I can to minimize fatigue as an issue in my life in the next month. 1. How would you recommend I approach my doctor on this? What should be my 2 or 3 best arguments? And, is this something a primary care physician normally treats? Overwhelmingly, folks thought a TSH of 3.9 was high enough to warrant further testing and treatment for hypothyroidism. There was one lone dissenter. ADVICE FOR DISCUSSION WITH DOCTOR ---TSH Level too high: “The best argument is your TSH test--the 3.9. The argument that 4 or 5 is okay is, I believe, an old one. We've known, since 2001, something different.” “3.9 is indeed very high - the new protocol is between 1 and 2.” “I have a wonderful endocrinologist who wants me to be no more than 1.5 tsh. He says that the 5.0 include population who have undiagnosed hypothyroid people and the range should not be as high as 5.0.” “I did a whole bunch of reseach and discovered that a person feels healthy when their TSH is between 0 and 1.” “You mentioned the levels in 2003. The acceptable levels were lower again last year as many borderline patients were complaining of thyroid issues.” ---Provide printed documentation “Go in with a copy of this research, for starters, I find they respect the printed word and may not have read that journal yet.” ---State that I know my own body enough to know that something isn’t right. “The doctors kept telling me that I was losing hair from stress. Well, I know my body after 40+ years of living in it, and I KNEW it wasn't stress, so I just kept insisting that something was wrong. Eventually all got straightened out.” ---If have one autoimmune disorder, are more likely to have another. (see the autoimmune checklist at: http://www.thyroid-info.com/articles/autoimmune-checklist.htm ) ---Be my own advocate. Be persistent. FIND THE RIGHT DOCTOR A common recommendation was not take ‘no treatment’ for an answer. That is, insist that my current doctor do further testing and treat me for subclinical hypothyroidism. If the doctor refused to do both, folks recommended that I find a different doctor who would. Many said a primary care physician can/does treat subclinical hypothyroidism. But, many others suggested I see an endocrinologist. One person mentioned getting little or no help from their endogrinologists (2 of them!) and was treated much more successfully by their primary care physician. Several said that women doctors tend to listen better. Finally, a few suggested seeing an alternative doctor, e.g. a naturopath. ---a website to find Thyroid Docs: http://thyroid.about.com/cs/doctors/a/topdocs.htm ---One person suggested the following website to find a doctor who knows about the new TSH guidelines: “I would go to the following site and find a doctor who prescribes Armour Thyroid in your area and go talk to him. These doctors seem to know more about what is what than the regular ones. You don't have to take Armour if you don't want to as I am sure they will prescribe something else becasue at least they will know about the new guidelines.” www.thyroid-info.com/topdrs/armour.htm Reasons to consider an endocrinologist over your PCP ---“A PCP can manage your dose, but there are other things - tests, biopsies, little subtle things - that the endocrine specialist will know enough to do. [My endocrinologist] orders my scans, ultrasounds, etc; my PCP orders whatever hormone dose [my endocrinologist] orders. I coordinate the two. Please keep in mind that I am my own best doctor; I'm obsessed with keeping one in touch with the other” ---“If you have more definitive questions about your thyroid management, you may need to see an endocrinologist. Primary care physicians tend to stick to the traditional broader guidelines. Thyroid function relates to a number of other clinical problems--osteoporosis is the one of concern to all celiacs.” ---“yes, the primary care doctor can treat hypothyroidism. Question is how familiar is the person with the latest information. Otherwise, if you need to go to a specialist -- look for an endocrinologist.” ---“generally a primary care provider can monitor this for you. You can see an endocrinologist for a small fortune if you believe you have a difficult diagnosis as I did. I had to travel 5 hours to get to a big enough city!! but I got my Hashimoto Disease diagnosed.” _________________________________________________________________ Express yourself instantly with MSN Messenger! Download today - it's FREE! http://messenger.msn.click-url.com/go/onm00200471ave/direct/01/ *Support summarization of posts, reply to the SENDER not the CELIAC List*