Prepping for appointments

Over the weekend, I received a package from Dr. Gent in Midlothian.  Thank goodness I’m actually on the waiting list!  It included new patient forms and two items for subclinical thyroid patients.   The first item was a symptom checklist, which yielded a 95% yes response rate from me.  Big surprise.  The other item was a set of instructions on how to take my basal temperature prior to my appointment.  Many integrative doctors follow this method for diagnosing subclinical hypothyroidism, which is also known as Barnes’ Thyroid Test.

The idea with this test is that you chart for 30 days, first thing in the morning.  Normal temperature readings should be 97.8 – 98.2.  If it’s below that, then you likely have a thyroid problem.  I took mine for the first time today and it was 97.68.  Well, that’s interesting.

There is a growing movement and belief that blood tests fail to detect many cases of hypothyroidism. It appears that many individuals have “tissue resistance” to thyroid hormone. Therefore, their body may need more thyroid hormone, even though the amount in their blood is normal (or even on the high side of normal).

So I’ll be charting my temps for the next month in hopes that I will get an appointment with Dr. Gent in October.

Thursday, I have an appointment with my primary care physician to discuss this whole fiasco.  My hope is that she would be willing to treat me.  If not, then I plan to ask for her to run the necessary bloodwork so I can take it to any other doctor, thereby avoiding a wasted appointment.

Most endochronologists will test for TSH, which is the thyroid stimulating hormone.   TSH tells the thyroid gland to release two hormones, T4 and T3. These hormones are released into the bloodstream and travel throughout the body. A lot more T4 is produced than T3. T4 doesn’t do much until it is converted into T3. T3 is what does the ‘magic’, and activates metabolism.  Traditionally, doctors will only test the TSH and T4.  If  these thyroid test results are found to be at “normal” levels, you will most likely be told you don’t have a thyroid problem.  This has been my issue in the past.

As of 2003, the American Association of Clinical Endocrinologists is recommending that the normal range run from 0.3 to 3.0, versus the older range of 0.5 to 5.5. So, according to the new standards, levels above 3.0 are evidence of possible hypothyroidism.  I am curious how many doctors actually use these new levels.  Even worse, you can go to different websites and get different ranges, including Mayo Clinic and other established organizations.

Two websites I really like are Mary Shoman’s thyroid advocacy page and Gina Lee Nolin’s (of Baywatch fame) Facebook page.  Both pages are dedicated to helping people who are struggling with symptoms, poor treatment plans, and lack of medical attention.  I have spent hours looking through them and I can’t tell you how angry it makes me to see that this is a national epidemic, the lack of proper health care and attention to suffering individuals.

I read accounts and pleas from people that sound just like me.

I may be a hypochondriac. I may be looking for an excuse for why I’m 50 pounds heavier than I was 15 years ago.  But I don’t think so.

I truly believe that in my heart of hearts something is wrong.  After 10 years, I know it’s not all in my head.  Taking my temperature this morning may be a bunch of “woo hoo”, but it validated something for me.

So I’m going to be going in on Thursday and asking for the following tests, as recommended by both Mary and Gina’s websites.  Here they are and why:

  1. Free T4 / Free Thyroxine: Free T4 measures the free, unbound thyroxine levels in your bloodstream. Free T4 is typically elevated in hyperthyroidism, and lowered in hypothyroidism. Free or unbound T4 levels represent the level of hormone available for uptake and use by cells. Bound levels represent a circulating hormone that may not all be immediately available, because it is affected by other drugs, illness, and physical changes such as pregnancy. Because the free levels of T4 represent immediately available hormone, free T4 is thought to better reflect the patient’s hormonal status than total T4 (below).
  2. Total T4/Total Thyroxine/Serum Thyroxine: This test measures the total amount of circulating thyroxine in your blood. Thyroxine, a hormone produced by the thyroid, is also known as T4. A high value can indicate hyperthyroidism, a low value can indicate hypothyroidism. Total T4 levels can be elevated due to pregnancy, and other high estrogen states, including use of estrogen replacement or birth control pills.
  3. Total T3/Total Triiodothyronine: Triiodothyronine is the active thyroid hormone, and is also known as T3. Total T3 is typically elevated in hyperthyroidism, and lowered in hypothyroidism.
  4. Free T3 / Free Triiodothyronine: Free T3 measures the free, unbound levels of triiodothyronine in your bloodstream. Free T3 is considered more accurate than Total T3. Free T3 is typically elevated in hyperthyroidism, and lowered in hypothyroidism.
  5. T3 Resin Uptake (T3RU): When done with a T3 and T4, the T3 resin uptake (T3RU) test is sometimes referred to as the T7 test. This test measures the amount of unsaturated binding sites on the transport (binding) hormones. Elevated T3RU is more commonly seen with hyperthyroidism.
  6. Thyroglobulin/Tg: Thyroglobulin (Tg) levels are low or undetectable with normal thyroid function but can by elevated in thyroiditis, Graves’ disease, or thyroid cancer. Monitoring of Tg levels is frequently used to evaluate the effectiveness of treatment for thyroid cancer and to monitor for thyroid cancer recurrence.
  7. Reverse T3: When the body is under stress, instead of converting T4 into T3 – the active form of thyroid hormone – the body conserves energy by making what is known as Reverse T3 (RT3), an inactive form of the T3 hormone. The value of RT3 tests in diagnosis is controversial, as some practitioners believe that the body continues to manufacture RT3 instead of active T3, causing various symptoms that are identified as the so-called “Wilson’s syndrome.”
  8. Thyroid Peroxidase (TPO) Antibodies (TPOAb) / Antithyroid Peroxidase Antibodies: Thyroid Peroxidase (TPO) antibodies, are also known as Antithyroid Peroxidase Antibodies. (In the past, these antibodies were referred to as Antithyroid Microsomal Antibodies or Antimicrosomal Antibodies). These antibodies work against thyroid peroxidase, an enzyme that plays a part in the T4-to-T3 conversion and synthesis process. TPO antibodies can be evidence of tissue destruction, such as Hashimoto’s disease, less commonly, in other forms of thyroiditis such as post-partum thyroiditis. This is the test that I believe I was given 10 years ago at EVMS that the doctor (now gone with my results) told me that I had Hashimoto’s. I remember him saying that my thyroid wasn’t “dead yet” but it may end up that way some day.  Until then, he said, your ranges are normal so you don’t require treatment. It’s estimated that TPO antibodies are detectable in approximately 95 percent of patients with Hashimoto’s thyroiditis.
  9. Thyroglobulin Antibodies / Antithyroglobulin Antibodies: Testing for thyroglobulin antibodies (also called antithyroglobulin antibodies) is common.  Thyroglobulin antibodies are positive in about 60 percent of Hashimoto’s patients.
  10. Thyroid-Stimulating Immunoglobulins (TSI) / TSH Stimulating Antibodies (TSAb): TSH receptor antibodies (TRAb) are seen in most patients with a history of, or who currently have, Graves’ disease. Testing is usually done for a specific type of stimulating TRAb that goes by several different names, including:
    • Thyroid-Stimulating Immunoglobulins (TSI)
    • TSH stimulating antibodies (TSAb)

I am also going to ask for:

    • Iron
    • Ferritin
    • TIBC (Total Iron Binding Capacity)
    • Iron Sat
    • Vit D
    • Vit B12

So there you go.  A lot of blood work is in my future.  If this doctor refuses, then I will have to wait until I can get in to see one of my wait list people.  I hope that is not the case.

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