<<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.”
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