To ultrasound or not?

[soupybp]

I got the chance to speak with the ob/gyn today after he received daughter's new lab results.

With regard to ultrasound, he said that it would not change his plan of attack. He is planning to keep an eye on fT4 and fT3 levels and continue to increase dosage of Armour on a symptom-based approach (not TSH). He didn't feel the ultrasound was necessary based on his plan; however, he said he is open-minded. If I find something that points to further benefit that could be gained, he would love to read it and discuss. He does plan to repeat the antibody testing in a future blood draw.

(I take him at his word on all that - in an appointment with him, I mentioned a medical article I had read in regard to bipolar treatment approaches utilizing thyroid hormone. I subsequently sent it to him, and I know he read it because he later called and discussed parts of it with me - and that directed him into prescribing Armour as opposed to synthetic.)

So what do we gain by ultrasound at this point given his treatment plan? And if there is a good justification, are there good medical/journal articles to point to?

Other updates:

He explained that he is aware of the typical dosing schedule for Armour; however, he wants to be very conservatively with her given the medical history that brought us to his office.

If she has bipolar disorder IN ADDITION TO the thyroid issue, he thinks a slower advancement of dosing (especially since it includes T3) is the least mood destabilizing in rapid cycling/mixed state comorbid BPD. If the symptoms of bipolar disorder are actually thyroid based, it will just be a slower recovery for her. He really wants to avoid her ending up in the psychiatric hospital and missing more school due to destabilized mood.

Based on how she is doing on the 30mg at this point, he is increasing her dose to 45mg. We will see him in 2.5 weeks after the dose change and will discuss a plan for the next increase at that time. If she is adjusting well, he will move along another increment.

Also, after further discussion with the psychiatrist (and her eczema getting so bad she couldn't sleep), the lithium was decreased as well...which is likely to have the effect of improving her thyroid hormone metabolism. We will see him in about 3 weeks as well and expect the lithium to be discontinued if she continues to do well. After 6 days, the eczema does not look angry and she is significantly more comfortable.

We are still about 5-6 days away from trying the first round of progesterone.

[G2G2]

Wonderful having an open minded doctor who also reads what you gave him! While there may be nothing to be immediately gained by an ultrasound regarding Armour dosing, it may be worthwhile to have one as a baseline in the event there are changes to her thyroid in the future.