Endocrinologist in Europe (not just thyroids)

Hello,

I would like to ask you for some tip to good endocrynologist in europe (I am from Czech republic). My current doctor believes all is fine but I am convinced it is not. My current blood work (I had to pay it by myself) is bellow.

Thyroids:

TSH 1,66 <0,27 - 4,2>

FT4 14,3 <12-22>

FT3 4 <3,1 - 6,8>

T4 total 75,6 <66 - 181>

T3 total 1,1 <1,2 - 3,1>

AntiTG <20 <0 - 40>

AntiTPO <10 <0-35>

(RT3 is unfortunately not measured in Czech)

Other hormones:

LH 1,7 <1,7 - 8,6>

Estradiol 66,5 <28 - 156>

PRL 9,04 <28 - 156>

Testosteron 10,65 <8,64 - 29>

Kortizol 270 <171 - 536>

Also my entire history of tests is here (sympthoms, history included) : allthingsmale.com/community...

So I am looking for some doctor which will be willing to help me and is known with new trends from endocrynology etc. Do you have any tip? I would very appreciate it.

Thank you very much!

23 Replies

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  • Welcome to the forum, Pepous1.

    This is a UK charity so we don't have lists of recommended endocrinologists outside of the UK. However, Dr. Thierry Hertoghe in Belgium is renowned for his expertise in hormonal matters. I'm not sure that Dr. Hertoghe currently sees patients but his clinic employs other endocrinologists under his guidance. I don't have contact details but Google will probably turn them up.

    TSH 1.66 is considered normal for someone not on thyroid medication and your FT4 and FT3 are also within normal range but they are low in range. Generally TSH needs to be over range before a diagnosis of primary hypothyroidism is made.

    Because you have pituitary microadenoma it is possible you have, or are developing, secondary hypothyroidism ie a low normal TSH and low FT4 and FT3 due to pituitary dysfunction (hypopituitarism). It maybe difficult to get a diagnosis until your FT4 and FT3 are lower/below range but you should have your FT4 and FT3 tested again in a few months. TSH testing is a waste of time and resources if you have secondary hypothyroidism and FT4 and FT3 are the only useful values. If you have secondary hypothyroidism your thyroid gland will be healthy but under producing hormone due to lack of TSH from the pituitary gland. Thyroid hormone replacement will be necessary to prevent overt hypothyroidism.

    rT3 isn't commonly tested in the UK either and it isn't always easy to interpret results when members post them. I think it is unlikely you will have high rT3 with low FT4 and FT3 and not being on thyroid medication but I'm not well informed on rT3.

    Your results indicated good ferritin but don't mention vitamin D. Good levels of vitamin D aid conversion of T4 to T3 so it may be worth testing vitamin D 25 OH and supplementing if results aren't replete or optimal.

    B12 under <500 can present neurological symptoms so although you are within range you may want to supplement 1,000mcg methylcobalamin sublingual lozenges, spray or patches to raise your B12 high in range.

    Your zinc was elevated. I don't know whether there is any significance to this but labtestsonline.org.uk may explain it and your other results too.

    thyroiduk.org.uk/tuk/about_...

  • Yes. My thyroid gland is OK it is problem of TSH secreting (secondary I believe). FT3 and FT4 should be I believe over in upper 1/2 of range witch is not. Yes doctors in Czech will not prescribe it that is why I am asking and even willing to travel to UK / Belgium.

    rT3 is according to my informations useful in comparison to FT3. The ratio should be 1:2 or more for FT3.

    Vitamin D I am taking sometimes up to 5000 I.U / day. Not everyday but this will not be my problem.

    B12 good tip never suplemented.

    Zinc was raised due to eating of cod liver few days before the test.

    For doctor Thierry Hertoghe I have read good reviews but he is according to that probably not affordable for my pocket. (remember that if I will be threated outside of Czech I will have to pay all duties/consultations and prescriptions)

    Thank you.

  • Pepous, Czech sounds like UK and most of the world, obsessed with TSH and not caring where in range FT4 and FT3 are. Can you not find a Czech endocrinologist specialising in pituitary problems?

    Any treatment outside of Czech will mean you have to pay for consultations, tests, prescriptions and duties.

    The only other suggestion is to buy thyroid replacement on the internet and self medicate. That's not ideal though as it may lead to other dysfunction caused by the microadenoma being overlooked.

  • Thank you for your words. I am honestly not educated enough about thyroids to be able to self treat.

    My idea was to do consultation with some expert and than buy drugs for example on black market etc. to safe money. And with the doctor just consult periodically the results.

    Also my problem is not just thyroids but also steroid hormones.

  • Pepous, Research the leading Czech teaching hospitals to find a pituitary specialist endocrinologist. I hope you can find someone who is able to help you.

  • You need to have your prolactin checked.

  • Hello,

    my PRL was measured many times. Sometimes increased in early morning than decline after few hours after wake up. That should not be PRL secreting adenoma I believe.

    History of my blood results: allthingsmale.com/community...

    Thank you.

  • The problem with taking thyroid is you'll eventually need full replacement because of the negative feedback that happens to the hypothalamus and pituitary. You would not, longterm, be able to take a small amount because the body adjusts and produces less of its own to compensate. Homeostasis at whatever level your body has been making hormones.

    Taking bromcriptine is unpleasant. Causes nausea, dizziness etc. I know.

    The suggestion on that other forum has been made to modify your diet so you are not relying on a lot of carbohydrates, especially simple carbs. That sounds like good advice. Czech cuisine tends to be quite stodgy in carbohydrate rich foods like dumplings, noodles and stuff like that. I'm Hungarian but have Czech friends and the foods are really heavy duty in carbs. Even worse than Hungarian food. I guess it was a good diet when there was no heating in houses and people had to walk outside in the cold a lot of the time. It generates body heat. If you are outside doing physical labour for several hours every day, then it's great. But the diet is maladaptive to current living conditions. Eliminate sugar and flour based foods. Eat natural foods in their natural state and your blood glucose fluctuations will cease. It's healthier for good hormone production.

  • Yes Czech food as you say is carbs based. I tried PALEO for few days but got sick of it and was not able to keep the diet long enough to allow my body to adjust to it.

  • You can't just shift your diet from one thing to another overnight. It takes time to reduce the sugar (you will have cravings for months) and carbs. You don't need to eliminate everything, just modulate intake. The WHO says 2 teaspoons of sugar per day. Good luck.

    Just don't start your day with sugar and flour products. You set yourself up for up and down of glucose and insulin for the rest of the day. Start off with cheese and toast or eggs or ham or whatever you prefer. Sardines or herring.... whatever. Start with something that sticks and doesn't end up making you feel like your eyeballs are going round and round in your head two hours later.

  • The best would be some doctor in Germany / Poland / Austria which neighbour to Czech republic.

  • Dr Hertogue in Belgium is the very best if you can afford him

    However i simply do not understand why even in czech republic no doctors know about Central / secondary /pituarity hypothyroidism

    can you import natural dessicated thyroid and self treat

  • Thank you for reply. I dont want to self treat becouse I am scared of that something will get wrong and I will be alone at that.

    But I simply believe that Dr Hertogue for sure is not the just one good doctor. There are others but they just are not that good at marketing.

    Do you know what are the cost of Dr. Hertogue treatment?

  • Becouse there probably is some cheaper alternative than DR Hertogue becouse of his promoted name. Also the probability he will have time to me is very small.

    On the other hand if he will prescribe me something than it will be easier to convince some Czech doctor to follow that treatment.

  • 'more lean' - are you a bodybuilder?

    My dad had acromegaly from a pituitary tumour, unfortunately growth hormone also affects the heart so you should get that checked out for peace of mind. J

  • No, I am not bodybuilder but I am sporting regullarly. I am also going to gym but mainly for health benefits.

  • glad to hear that!

  • Dr. Thierry Hertoghe in Belgium is no longer seeing patients on a regular basis. There are, however, several doctors trained by him working in his office in Brussels. I have no idea how long their waiting list is.

    I am a patient of his sister's, Thérèse Hertoghe, who used to work in his practice, but now has her private practice just outside of Brussels city centre. She has a one year waiting list, but works with this cancellation system, meaning every time someone cancels an appointment she calls the next person on her waiting list. That works OK if you live nearby, but less well if you don't live in Belgium, I imagine, as sometimes the appointments are offered on very short notice (from one day till the next).

  • Thank you. And what are the costs?

  • There's also one of his students working in Paris, Dr Dalle. But I believe he is quite pricey, too. You could try googling him. He speaks English.

  • I can only tell you about the doctor I have been to myself:

    Dr. Thérèse Hertoghe (Thierry's sister) charges 160€ per session, and then you have to add labs (ca 200€ for the first time, when they check everything, from your thyroid to your adrenals and anything in between; then maybe about 100€ a year in follow-up labs). Once you are well adjusted on your meds, it is enough to come once every 9-12 months for follow-up.

    TH speaks excellent English.

    She is very open-minded, and will prescribe Armour or Erfa (whichever you prefer), hydrocortisone, estrogen,testosterone, progesterone...of course, some of those meds are not reimbursed, at least not in Belgium (for instance, NDT is not, as it is considered "organ therapy"), and NDT is quite pricey...

  • I will pm you.

  • Hi, I can see others have mentioned Dr Thierry Hertoghe, so you are aware of him and no need to pm you.

    We have been seeing Dr Thierry Hertoghe for the past 18 months. He will be unavailable for most of 2015 but there are several other drs in his practice who have been trained by him. The current charge is E230 per appointment 1hour for one of the other drs. He runs a training school for hormone therapy so it might be worth checking his website to see if he has trained a doctor nearer to your home or call the clinic - some of the secretaries are very helpful but there is one who has a bad attitude so persist with your enquiries.

    Our experience has been that endocrinologists are just not trained in how to treat multiple hormone deficiencies and this is why we eventually went to Dr Hertoghe (we live in Ireland). We basically wasted two years going to endocrinologists in ireland and UK and getting nowhere. Your symptoms sound very similar to those of my teenage son and Dr Hertoghe has helped him enormously. Because Hertoghe is so busy now we will be seeing another doctor on our next visit.

    We too felt that going to see Hertoghe would be too expensive, but it has been worth every cent as my son is so much improved in health, vitality and psychologically. Some of the medication is very expensive - HGH especially - but you don't have to buy everything he prescribes and if you have your health back it is probably worth it.

    As far as your diet is concerned, I would agree that a very high carb diet will probably not help you get well. My son was told to cut out all processed food, gluten, sugars, caffeine and to eat a largely paleo type diet, containing sprouted seeds and grains, if possible. This can be very difficult to maintain but a diet high in good protein, fresh veg and good quality fats has helped him very much. If you can maintain that type of diet for 4 or 5 days out of 7 then you will be doing something really good for your health.

    Good luck

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