HELP! My Endo's PA is giving me grief re med dosages based on recent labs.

Hi everyone.

As I've posted last April I found an Endo who is working with my hypothyroidism after years of mismanagement from my PCP (USA) (GP). Until my last visit in Dec 2018 things have been going well. I generally see the Dr every third visit and one of his PA's/NP's for the 2 visits in between.

I have been feeling much better slowly though not optimal.

The Endo added T3 last April and understood my wish to get my TSH below 1.0. I had my cardiologist's blessing for a very low TSH as my pacemaker made related cardiac problems a non-issue. The Endo was fine with this. My cardio visit in Dec 2018 shows a very stable cardiac status. I feel the PA's problem with my TSH # is based on my A-Fib diagnosis and doesn't get that there is no problem here.

Fast forward to my Dec 11, 2018 visit with a PA I had not seen before. At the time my T3 dose was 10 mcg/day-not optimal but I was feeling better.

My T3 at that visit was 2.4pg/ml (range 2.3-4.2 pg/ml). I asked to raise my daily dose of T3 from 10 to 15mcg (we had been bumping it up 5mcg at a time) but she only wanted to raise it 2.5. I disagreed but she was adamant.

Yesterday (2/11/19) I went back for labs and these were the results:

Free T4: 1.6ng/dl (range 0.8-1.8ng/dl). Up from 1.3 on 12/11/18. Have been on 137mcg Synthroid for quite a while.

FreeT3: 2.3pg/ml (range 2.3-4.2pg/ml.) Down from 2.4 on 12/11/18.

TSH: 0.11 mlU/L (range 0.40-4.50 mlU/L.) Down from 1.08 on 12/11/18.

This morning online

she said she might want to lower my T4 dose as my TSH was too low. From everything I have learned from this forum I want the lowest TSH possible. I also said I wanted to raise my T3 dose another 2.5 bringing me to 15mcg/day. This still seems too low but at least it is being raised. I know I can feel better if my meds can continue to increase.

I need help in how to best present my case to her when I see her March 19th. I feel a 'medical skirmish' coming and want to be ready despite what she says. One option I have is to change the appt to be seen by the doctor but I do want to give her a chance. In my opinion she seems stuck on values and not how I feel. My regular PA is on maternity leave or I would see her.

I'm not thrilled with this PA and after this is settled will choose to see other people in the office. But I'd like to keep the peace if possible.

I feel frustrated right now and am waiting for her answer about raising the T3 dose. I'm going to do it anyway starting tomorrow.

It's almost a year and I don't think it should have taken this long to make less than adequate progress. It shouldn't be such a $^%#*!@ struggle to feel good.

Grateful for any help with my 'presentation' to her Mar 19th. I know where I want my levels but she is pushier than I am. I am still lethargic and struggling with some holiday weight gain!

Also I take my meds correctly. I get up at 5-6AM, take my thyroid meds-go back to sleep and wait at least 2 hours before I eat or drink-just to be sure they are absorbed.

I also think that part of the equation involves the fact that I am a nurse and don't just hang on her every word like a sheep.

Just want to mention I am a poor convertor. My thyroid is virtually non-functioning due to being knocked out in 1984 from radiation for larynx cancer. Ir may be (as I learned from greygoose's posts) that if I can achieve an optimal T3 dose and become euthroid I won't need T4.

Thanks for all your help. irina

[m7-cola]

Hi Irina

It makes me very cross to hear that someone who seems to know less than you about your condition is trying to exert this kind of control.

Your main problem seems to be how to manage her! I think the way forward is to ask yourself which is better for your health: coping with a sub standard medic or having a conversation of ‘equals’ with a competent doctor. Go with your instinct. I wish you lots of luck!

[Hidden in reply to m7-cola]

You know. You reinforced for me what my gut is telling me. When I go with my intuition things turn out well.

I have time to call and reschedule with the doctor. I like him a lot. My cardio recommended him and he gives me credit for having a brain.

Sometimes it's easy for me to help others with decisions but I don't always take care of myself.

Thanks m7-cola. 🐱 irina

[MissGrace in reply to Hidden]

Great advice from m7-cola. I’m glad you are going with it - and your instincts. You’re unwell, you can do without a battle against ignorance. No point in debating with someone who thinks a number on a piece of paper is more important than a person.

You say you wanted to keep the peace - but why should you? This is your health. We don’t have time to appease someone with rigid ideas - too busy trying to get well.

Good luck for when you see the doctor. 🤸🏿‍♀️

[vocalEK in reply to MissGrace]

Maybe your doctor can 'splain it to her.

[m7-cola in reply to Hidden]

You are very welcome!

[prussianblue]

I wouldn’t enter any discussions about dosage according to test results. The objective is good health - you feeling well, so that has to lead treatment. The test results will be helpful later to measure your set point in the ranges when you’re properly well. She’s got it the wrong way round, this shows her inexperience, she has a training need that you can help with. Good luck