YANMD, but Let's Talk Thyroid
September 15, 2011 12:33 PM Subscribe
YANMD, but let's talk Thyroid:
So I had my physical exam last week and the thyroid test came out high, like 4.5. They want to retest me in 3 months, but that's because they forgot that I was tested already 5 months ago (because I was having a lot of anxiety and just wondered if the thyroid could be involved).
so: with two tests coming out over 4.0 they're going to want to put me on a low dose of supplemental thyroid hormone (I know this because after the first test came out high that's what they said, but I put it off). BUT I've been doing a little reading and it seems that some "experts" say that you really need to do further testing to see what's going on. That the main test is kind of the last outcome measure, but that doesn't tell you if it's really the thyroid itself that's slow or maybe it's the pituitary or (?)thalamus (I know very little physiology, obviously).
What should I do? I don't know that I want to be in the position of telling my doctor to run tests that he might not be an expert in interpreting (he's a very good internist but his subspecialty is gastroenterology). Should I take the low dose of thyroid? Should I get a referral to an endocrinologist?
By way of background, I am a 60-year-old woman who does not, as far as I can tell, have any clinical symptoms of hypothyroidism. I had my thyroid tested the first time because I was very anxious, which I think is actually a symptom of (among other things) hyperthyroidism. I'm warm not cold (post-menopause). I have a lot of energy. My hair's not falling out. I'm about 30 pounds overweight, though.
Otherwise -- I am being treated for hypertension, which is well under control with medication, and asthma (Singulair).
I'm also quite a hypochondriac and tend toward a lot of free-floating anxiety, so please don't tell me I might have cancer, thanking you in advance.
So I had my physical exam last week and the thyroid test came out high, like 4.5. They want to retest me in 3 months, but that's because they forgot that I was tested already 5 months ago (because I was having a lot of anxiety and just wondered if the thyroid could be involved).
so: with two tests coming out over 4.0 they're going to want to put me on a low dose of supplemental thyroid hormone (I know this because after the first test came out high that's what they said, but I put it off). BUT I've been doing a little reading and it seems that some "experts" say that you really need to do further testing to see what's going on. That the main test is kind of the last outcome measure, but that doesn't tell you if it's really the thyroid itself that's slow or maybe it's the pituitary or (?)thalamus (I know very little physiology, obviously).
What should I do? I don't know that I want to be in the position of telling my doctor to run tests that he might not be an expert in interpreting (he's a very good internist but his subspecialty is gastroenterology). Should I take the low dose of thyroid? Should I get a referral to an endocrinologist?
By way of background, I am a 60-year-old woman who does not, as far as I can tell, have any clinical symptoms of hypothyroidism. I had my thyroid tested the first time because I was very anxious, which I think is actually a symptom of (among other things) hyperthyroidism. I'm warm not cold (post-menopause). I have a lot of energy. My hair's not falling out. I'm about 30 pounds overweight, though.
Otherwise -- I am being treated for hypertension, which is well under control with medication, and asthma (Singulair).
I'm also quite a hypochondriac and tend toward a lot of free-floating anxiety, so please don't tell me I might have cancer, thanking you in advance.
Go see an endocrinologist and get it figured out. Ask your doctor for a referral.
posted by TheBones at 12:56 PM on September 15, 2011
posted by TheBones at 12:56 PM on September 15, 2011
IANYD (I'm not even *A* doctor at this point, but I'm months away - hooray!)
The fact that you're not having symptoms gives you a little more leverage when talking about this with your doctor. Typically, hypothyroidism is not a complicated thing to treat or diagnose. That said, I don't really think going directly to an endocrinologist is the best next step (there's a debate to be had here about rising healthcare costs, but we can save that for another day). If you don't want to take synthroid right now, just tell your doctor as much.
Many things can cause an elevated TSH (even on two separate readings) so it's reasonable to ask for it to be tested again. If you were my patient and you suggested this, I would be amenable to it, but I would also probably bargain with you by saying something like...
"I'm okay with checking it one more time, if we can agree that you'll try a small dose of synthroid for about 6 weeks if it comes back high again. Many times when thyroid hormone declines over several months we don't even notice the changes and we attribute symptoms to natural events (i.e. getting older). Thyroid is also a tricky hormone in terms of symptoms. The symptoms you mentioned in terms of hyper/hypo-thyroidism are the *textbook* symptoms, but the fact is that hyper/hypo-thyroidism can present in a variety of ways. That's why we do the test."
As long as you're tactful, your doctor shouldn't have a problem with you raising questions or concerns. In fact s/he will probably be excited that you're such a motivated patient.
Best of luck!
posted by stuboo at 1:23 PM on September 15, 2011
The fact that you're not having symptoms gives you a little more leverage when talking about this with your doctor. Typically, hypothyroidism is not a complicated thing to treat or diagnose. That said, I don't really think going directly to an endocrinologist is the best next step (there's a debate to be had here about rising healthcare costs, but we can save that for another day). If you don't want to take synthroid right now, just tell your doctor as much.
Many things can cause an elevated TSH (even on two separate readings) so it's reasonable to ask for it to be tested again. If you were my patient and you suggested this, I would be amenable to it, but I would also probably bargain with you by saying something like...
"I'm okay with checking it one more time, if we can agree that you'll try a small dose of synthroid for about 6 weeks if it comes back high again. Many times when thyroid hormone declines over several months we don't even notice the changes and we attribute symptoms to natural events (i.e. getting older). Thyroid is also a tricky hormone in terms of symptoms. The symptoms you mentioned in terms of hyper/hypo-thyroidism are the *textbook* symptoms, but the fact is that hyper/hypo-thyroidism can present in a variety of ways. That's why we do the test."
As long as you're tactful, your doctor shouldn't have a problem with you raising questions or concerns. In fact s/he will probably be excited that you're such a motivated patient.
Best of luck!
posted by stuboo at 1:23 PM on September 15, 2011
Yeah, I'd see another doc. FYI, it's possible to have high TSH and hyperthyroidism at the same time; see: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1656593/
posted by trevyn at 1:35 PM on September 15, 2011
posted by trevyn at 1:35 PM on September 15, 2011
Anxiety and insomnia were my major symptoms of undiagnosed and untreated hypOthyroidism. It is completely and foolishly wrong to read lists of symptoms and conclude that you can't have hypothyrodism because you are anxious.
I'll bet that your anxiety will clear right up within two or three months of starting thyroid medication.
See an endocrinologist as soon as possible. Consider accepting the fact that your current physician knows way more about medicine than you do.
Note that a TSH reading over 3.0 is above the normal range, even if your lab is still listing the old normal range. One reading of 4 and another of 4.5? I can't believe you think your doctor should ignore that, especially given your symptoms.
posted by artistic verisimilitude at 2:47 PM on September 15, 2011 [3 favorites]
I'll bet that your anxiety will clear right up within two or three months of starting thyroid medication.
See an endocrinologist as soon as possible. Consider accepting the fact that your current physician knows way more about medicine than you do.
Note that a TSH reading over 3.0 is above the normal range, even if your lab is still listing the old normal range. One reading of 4 and another of 4.5? I can't believe you think your doctor should ignore that, especially given your symptoms.
posted by artistic verisimilitude at 2:47 PM on September 15, 2011 [3 favorites]
It sounds like they only tested your TSH level, get that referral to an endocrinologist that everyone is suggesting here but get your levels of T4 and T3 first. Ask for a printout of the TSH, T4, and T3 lab results and take it with you to the endocrinologist.
They want to retest me in 3 months, but that's because they forgot that I was tested already 5 months ago
They didn't "forget", they simply didn't read over your medical records in great detail. You need to be familiar enough with your own medical records (which might include bringing some notes and printouts with you) to point out things like this.
posted by yohko at 3:18 PM on September 15, 2011 [1 favorite]
They want to retest me in 3 months, but that's because they forgot that I was tested already 5 months ago
They didn't "forget", they simply didn't read over your medical records in great detail. You need to be familiar enough with your own medical records (which might include bringing some notes and printouts with you) to point out things like this.
posted by yohko at 3:18 PM on September 15, 2011 [1 favorite]
my general doctor got me to an endocrinologist as soon as I needed a follow up test.
It sounds like this is where you are--you now need a specialist.
posted by calgirl at 4:17 PM on September 15, 2011
It sounds like this is where you are--you now need a specialist.
posted by calgirl at 4:17 PM on September 15, 2011
Response by poster: I e-mailed my doctor and here's what he e-mailed back:
"Tsh is borderline high, and you are clinically normal. Your pituitary
is having to work a litlle harder for you to remain normal. We don't
treat that , nor do you need to see an endo. We watch that and see if
it gets better or worse over the next few months. Dr. y."
(maybe it was lower than 4.5, I'm thinking now. I should get the actual numbers from them.)
thanks, everyone
posted by DMelanogaster at 1:21 PM on September 16, 2011
"Tsh is borderline high, and you are clinically normal. Your pituitary
is having to work a litlle harder for you to remain normal. We don't
treat that , nor do you need to see an endo. We watch that and see if
it gets better or worse over the next few months. Dr. y."
(maybe it was lower than 4.5, I'm thinking now. I should get the actual numbers from them.)
thanks, everyone
posted by DMelanogaster at 1:21 PM on September 16, 2011
Get tested again. I tested "borderline low" and my doctor was ready to put me on meds for the rest of my life. I don't have any symptoms of low thyroid, and they were so casual about telling me this(I didn't even know they tested my thyroid and then they called me at 7am one morning to tell me they had faxed the rx to my pharmacy) Anyway I didn't fill the prescription and got tested at my next physical a year later. Test came back completely within normal range, but the nurse told me that normally people do not go on meds after one test anyway, that they would do follow-ups.
posted by fromageball at 1:49 PM on September 17, 2011
posted by fromageball at 1:49 PM on September 17, 2011
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(1) I'm assuming that 4.5 is your TSH reading, right? I know that every lab has a different scale, but my internist would not have put me on any medications IF I had those readings and had no symptoms of hypothyroidism. It would help if you listed the result and the scale they are using.
(1.5) However, if your test 5 months ago was, like, 4.1 and your test this time was 4.5, it's possible that they're concerned about the change in numbers, which is why they want to retest you in 3 months rather than start you now. It's possible in three months that you could be at 5.0 or higher - an increase in TSH values is one thing that triggered my doctor's recommendation to start taking synthetic thyroid hormones.
(2) When I started taking the synthetic hormone, I was retested after 3 months. At that point it would have been pretty clear if something other than my thyroid was the problem. It seems to me that, once a high TSH reading is seen absent any other indicators (and again, AFAIK your reading is not generally considered to be "high" absent any other symptoms), the first step is to try synthetic hormones.
(3) Putting aside all of that, if you aren't comfortable with a specialist in gastroenterology interpreting your results, then by all means ask to speak with an endocrinologist. Also, all these questions should be questions that you can feel comfortable asking your doctor - if you're not comfortable with your internist, maybe this is the time to switch "Can you explain why you think I should take thyroid drug absent any symptoms? Could a high TSH reading be caused by X, Y, or Z?" etc. are pretty typical questions for me to ask my dr.
posted by muddgirl at 12:50 PM on September 15, 2011 [1 favorite]