Doctor frustration

[Red Rock]

Just wanted to give you my 2 cents worth. I can understand your frustration, as that is how I have been feeling with my situation. I felt like since I had this thyroid thing, that I had to be better educated than the doc. However, now that I am with an endo who, I think is super educated and seems to understand everything. (He should with a Ph.D and FACE qualifications) Perhaps I will get real results.

As far as you are concerned, I would go with what everyone has suggested. Keep a record of all of your blood draws and results through time. Yes, its the FT3 and FT4 that show what is and is not happening in the thyroid. I have had to go back and reread some of my med tech books to get a better understanding of all of this. If your intrested look at a Clinical Chemistry book. It might tell you more than you want to know.

I like your idea of getting a second opinon as well as trying to talk to your endo in a reasonable manner.

Hope it all goes well and you can get some resoution.

Red Rock

[indysteel]

Just wanted to give you my 2 cents worth. I can understand your frustration, as that is how I have been feeling with my situation. I felt like since I had this thyroid thing, that I had to be better educated than the doc. However, now that I am with an endo who, I think is super educated and seems to understand everything. (He should with a Ph.D and FACE qualifications) Perhaps I will get real results.

As far as you are concerned, I would go with what everyone has suggested. Keep a record of all of your blood draws and results through time. Yes, its the FT3 and FT4 that show what is and is not happening in the thyroid. I have had to go back and reread some of my med tech books to get a better understanding of all of this. If your intrested look at a Clinical Chemistry book. It might tell you more than you want to know.

I like your idea of getting a second opinon as well as trying to talk to your endo in a reasonable manner.

Hope it all goes well and you can get some resoution.

Red Rock

Can I come to Colorado and se your doc? Maybe he'll give us a discounted rate!

I'm starting to learn what I think I need to know. Elaine Moore's website has been a big help in understanding not just my labs, but where I want my labs to be. I did get my blood drawn today and should have the results in 48 hours or so. How my doc responds to them--assuming they're "off"--will be telling.

[Catrin]

{{{Indy}}} Nothing constructive to say, just sending you good thoughts and hopes this eases soon. I've never had a question about getting copies of my test results.

[indysteel]

Well, labs suggest that I'm still oversuppressing, i.e., the anti-thyroid drugs are putting me into a mildly hypo state. That, unfortunately, is no better for me, especially as it relates to my eyes. My doc asked me to take my dose down again (to 2.5 mg every other day). That's a very minor reduction in my dose (I'm currently alternating between 2.5 and 1.25 mg daily), and I'm not all that confident it's going to do the trick. So, I left a message with my doc's administrator to discuss the possibility of using a block and replace technique. Per that technique, I'd continue to take an anti-thyroid med, but I'd supplement it with a small dose of synthroid or the like. Not only would it get my thyroid levels to a better state, but I've read that it can also be helpful for purposes of remission (which is my ultimate goal). If she's receptive to that, great. If she's not, I'm definitely going to seek a second opinion.

[WindingRoad]

First don't ever feel odd about asking your doctor questions. Any good clinician will be receptive and should not take these questions personally. No one knows you better than you so they need to know what you are thinking in terms of treatment too. It's treating the whole person not just their body.

Am I understanding that the blocking treatment means that your TSH is somehow ineffective at producing T3 and T4? Or something is possibly aberrant about the T3 and T4 making them ineffective?

[indysteel]

First don't ever feel odd about asking your doctor questions. Any good clinician will be receptive and should not take these questions personally. No one knows you better than you so they need to know what you are thinking in terms of treatment too. It's treating the whole person not just their body.

Am I understanding that the blocking treatment means that your TSH is somehow ineffective at producing T3 and T4? Or something is possibly aberrant about the T3 and T4 making them ineffective?

The blocking part of block and replace is the use of anti-thyroid meds to block the production of thyroid hormone. The drugs also help lower the antibodies that cause GD in the first place. In an effort to keep thyroid levels stable, some docs then add in a hormone replacement drug. In my case, such a drug would be used to keep me from going into a hypo state. Block and replace can also help patients from developing a resistance to the anti-thyroid meds. In the end, the approach often leads to more stability and, ultimately, to remission.

The standard wisdom that I've seen is that you use just enough anti-thyroid meds to keep Free T4 at or slightly above the mid-range. In my case, we're having a hard time finding a small enough dose to do that, which my necessitate the use of block and replace. This, of course, is my amateur opinion.

I do agree with you that a good clinician should be willing to answer my questions. My concern with my current doc is that she doesn't know the answers to my questions. Based on comments my doc has made in the past, it would appear that she's focused exclusively on my TSH levels. Once a patient is on meds, TSH is not a reliable number to look at. For a lot of GD patients, their TSH levels remain extremely low even after drug therapy. My understanding is that so long as their Free T4 and T3 levels are good, the therapy is working and they should feel relatively good. My original concern about my doc is that she doesn't seem to be looking at the appropriate lab values. How can she get me where I need to be if she doesn't even know what to look at? Ugh.

[WindingRoad]

I personally would start scheduling an appointment with another doctor. I've found if at all possible, I know it may be hard to find, that younger doctors are more willing to listen these days. I think it has to do with the ways medical schools have changed their approach to therapy and patient involvement. I hope you find some answers soon. It's not fun wondering what to do. Big hugs to you dear.