Endocrinologist in DC area to treat subclinical hypothyroidism?
February 28, 2013 12:24 PM Subscribe
After asking this question, I am looking for a new doctor within an hour or so of the DC area who is willing to treat hypothyroidism with medications that aren't T4-only, and treat based on symptoms.
With a very modest dosage of Synthroid, TSH levels got back within normal range within a month (4.2 in a range of .35 to 4.5), and although my symptoms were completely unchanged, my endocrinologist told me that if I'm still having symptoms, it's not thyroid-related. (His nurse practitioner also said, "You know, I know I feel better if I go to the gym after work instead of going home and eating a bucket of ice cream in front of the couch.")
My psychiatrist disagrees, and wants me to find someone willing to treat subclinical hypothyroidism for depression, preferably with desiccated thyroid hormone. I have not been able to find a single doctor willing to do this. I am happy to travel up to an hour (or possibly more). Help?
With a very modest dosage of Synthroid, TSH levels got back within normal range within a month (4.2 in a range of .35 to 4.5), and although my symptoms were completely unchanged, my endocrinologist told me that if I'm still having symptoms, it's not thyroid-related. (His nurse practitioner also said, "You know, I know I feel better if I go to the gym after work instead of going home and eating a bucket of ice cream in front of the couch.")
My psychiatrist disagrees, and wants me to find someone willing to treat subclinical hypothyroidism for depression, preferably with desiccated thyroid hormone. I have not been able to find a single doctor willing to do this. I am happy to travel up to an hour (or possibly more). Help?
Your psychiatrist, presumably a physician with full prescriptive authority, could arrange that treatment for you if he/she is that strongly convinced that subclinical hypothyroidism is the problem.
If he/she is unwilling to do so because endocrine issues are out of his/her scope of usual practice and expertise, perhaps advising you about treatments for endocrine issues is also out of his/her scope of usual practice and expertise and should color your opinion of the advice. My nurse midwife doesn't make suggestions about the plan of care I've established with my neurologist, nor vice versa.
That being said, there are many endocrinologists who will treat your hypothyroidism based on a combination of symptoms and lab results rather than relying on labs alone. Your current endocrinologist's belief that your treatment couldn't possibly be subtherapeutic, coupled with your sense that the NP in the practice is dismissive or disrespectful, makes it sound like this isn't practice for you. I would find a new practice not on your psychiatrist's recommendation but because you seem clearly uncomfortable with the care you're receiving now.
posted by jesourie at 12:41 PM on February 28, 2013 [1 favorite]
If he/she is unwilling to do so because endocrine issues are out of his/her scope of usual practice and expertise, perhaps advising you about treatments for endocrine issues is also out of his/her scope of usual practice and expertise and should color your opinion of the advice. My nurse midwife doesn't make suggestions about the plan of care I've established with my neurologist, nor vice versa.
That being said, there are many endocrinologists who will treat your hypothyroidism based on a combination of symptoms and lab results rather than relying on labs alone. Your current endocrinologist's belief that your treatment couldn't possibly be subtherapeutic, coupled with your sense that the NP in the practice is dismissive or disrespectful, makes it sound like this isn't practice for you. I would find a new practice not on your psychiatrist's recommendation but because you seem clearly uncomfortable with the care you're receiving now.
posted by jesourie at 12:41 PM on February 28, 2013 [1 favorite]
Is your primary care doctor part of an integrative medicine or functional medicine practice? In my experience, doctors who identify with those approaches are more focused on the symptoms/test results combo (rather than test results alone) and will also order more granular tests from specialty labs. They should also be able to give referrals to specialists who are more open to a variety of treatment modalities.
What was that NP thinking? Of course most people feel better when they exercise as opposed to when they veg out and eat sweets, but you're an adult who already knows that. Christ, what an asshole.
posted by Sidhedevil at 12:54 PM on February 28, 2013 [1 favorite]
What was that NP thinking? Of course most people feel better when they exercise as opposed to when they veg out and eat sweets, but you're an adult who already knows that. Christ, what an asshole.
posted by Sidhedevil at 12:54 PM on February 28, 2013 [1 favorite]
A doctor who prescribes Armour for certain patients is probably a good starting point. I am pretty debilitated at 4.0+ TSH (including obvious physical symptoms, not just "subjective" ones like fatigue, depressed mood, etc.), and my doctor's practice treats anything symptomatic at a TSH of 2+ (and the new "normal" range is .3-3.0). It can help to get more sensitive blood tests beyond just a TSH that show just how much available T3 and T4 you actually have.
posted by availablelight at 3:00 PM on February 28, 2013 [1 favorite]
posted by availablelight at 3:00 PM on February 28, 2013 [1 favorite]
Oh, that link doesn't work anymore--sorry (they're "updating their site" if you go to the root URL). Here's a list of other things to try.
posted by availablelight at 3:32 PM on February 28, 2013
posted by availablelight at 3:32 PM on February 28, 2013
I hesitate to say this but I got my thyroid meds by saying that we were trying to conceive (we weren't).
posted by 26.2 at 9:21 PM on February 28, 2013 [1 favorite]
posted by 26.2 at 9:21 PM on February 28, 2013 [1 favorite]
Also, I would avoid Dr. Joshua Cohen at GW!
I can also recommend Dr. Ace Lipson in downtown D.C.
posted by jgirl at 7:10 AM on March 4, 2013
I can also recommend Dr. Ace Lipson in downtown D.C.
posted by jgirl at 7:10 AM on March 4, 2013
Response by poster: Thanks so much for the suggestions, everyone! In case anyone else is looking for this advice in the future: I ended up going to Dr. Renu Mansukhani, after a very encouraging conversation with her on the phone. At our consultation, she was very thorough, appreciated that I want to be an active participant in my own care, and she even found another issue that my previous endo had not noticed. She is open to T3 combination/ desiccated thyroid hormone and treating based on symptoms as well as labs, which was very difficult to find in an endocrinologist. (FYI: Her clinic centers around weight loss, but she was happy to treat my thyroid issue even though weight is not my major complaint.)
Thanks again!
posted by picapica at 1:51 PM on March 7, 2013
Thanks again!
posted by picapica at 1:51 PM on March 7, 2013
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Try Dr. Renu Mansukhani; she has been a godsend to me.
You can see her as a private patient at that site without all of the other services NCWW offers. They do not accept any insurance at all; you will have to file yourself.
posted by jgirl at 12:34 PM on February 28, 2013