I am in Ottawa, Canada. Had another appointment with my Endo.
Seriously, I am beyond frustrated, like many of you.
So.... I have Hashi's. I see this Endo every 3 months.
The Endo said I am ok, get that ok. Total bunk folks.
I am on the following meds:
Synthroid - 50 mg
Cytomel - 5 mcg
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My thyroid:
TSH - 0.06 - I take Cytomel
Free T4 - actual 15 (range 11- 23)
Free T3 - actual 3.6 (range 3.4-5.9)
Both results are in the bottom 1/4 of the range.
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The Endo said she would increase my Synthroid to 75 mg per day.
She cancelled the Cytomel. Sigh.
The Cytomel increased my free T3 by 5. So cancelled my Cytomel which is so wrong.
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I have candida and mold in my body, so that compromises my conversion. I am treating both with stuff, and that will compromise my uptake of my thyroid meds.
Sigh.
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I believe I require a significant increase in both Synthroid and Cytomel to offset the stomach issues.
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What do you all think dear loves?
Blessings to you all, thank you for your assistance.
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ASkepticalConsumer
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TSH (range 0.35 - 5.0) Both tests were done when I was taking 5 mcg, sometimes I snuck another 5 mcg, more often towards Oct, so could that have driven down my TSH, below?
July was 0.27 Oct was 0.06 - down further
Free T4 (range 11-23)
July was 11 Oct was 15 - increase Went from 25 to 50 mg Synthroid
Free T3 (range 3.4 - 5.9)
July was 4.7 Oct was 3.6 - big drop down even though I increased the Cytomel
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I find this frustrating.
My thoughts are that my stomach is in bad shape which can compromise the conversion - this corresponds to more symptoms.
LT3 is about 3x as potent as LT4 in suppressing TSH. So, 10 mcg LT3 will have the same effect as 30 mcg LT4. Your results suggest your pituitary is not producing as much TSH as it should (for your fT3, fT4 levels).
The stomach has nothing to do with conversion, not sure where you are getting these ideas from. You have scope to increase your dose, at least until fT3, fT4 are mid-interval and then take it more cautiously.
Don't know why your TSH seems to be declining, do you have other health problems?
My understanding of conversion is that the conversion of any pill/supplement in the stomach can be negatively influenced by the state of the stomach and mine is not good due to candida, SIBO and mould exposure.
My TSH - declining? Would that not mean the TSH numbers increase up to and above the 5.0, mine are going the opposite direction down to 0.
jimh111, I do have enough prescriptions that I am increasing both the synthroid and the cytomel in increments to see what my body does. I change every 3 weeks or so.
I have been in a mould infested NEW house for 6 years due to a major design error by the builder. The builder has been forced to remove the mould and now fix the error and rebuild my basement.
My husband did Great Plains organic urine tests. Both came back showing much mould and all the different type of moulds. In a way good, cause it meant our bodies were working to remove the mould.
We took an allergy test for mould, but both were negative.
Took breathing tests which showed us both with asthma for the first time in our life.
The issue is that I want to do a lawsuit against the builder for damages but also for negative health impacts. Using non "big pharma" doctors or processes are not necessarily helpful.
I can only sympathise. Why is it us mere mortals can look at results and know they are too low when super educated and qualified endos can't?? I doubt there's more than a handful of members here who haven't been hurt by the actions of an endo. They are ignorant and in too many cases uncaring. To be fair to them, which many don't deserve, we often see a diabetes specialist who knows little or more likely nothing about the thyroid!! Why are they willing to see thyroid patients when they have so little or no knowledge of the thyroid? On one occassion, having waited seven months to see an endo, he told me he was unable to help me as my problems were outside his field of expertise. Top marks to him for his honesty. Should he not have refused to see me and make sure I was referred to an endo that could help me instead of letting me wait seven months!! My big question is why are they treating patients when they know virtually nothing about the thyroid. Which leads to my second question, why are there not many more trained thyroid specialists for us to see??
why are there not many more trained thyroid specialists for us to see??
Because thyroid isn't 'sexy', and - apparently - diabetes is. That's the explanation I heard. And, therefore, less doctors want to train in thyroid. And no-one can force a doctor to specialise in something he doesn't want to specialise in.
But, even if there were more doctors interested in thyroid, they would still only have the same, very limited education in thyroid. Which is where the trouble starts. What they learn is med school about the thyroid is mostly all wrong. And, if there are no teachers to teach them correctly, they're going to be as useless as every other doctor where thyroid is concerned. It's a viscious circle. And no-one wants to break out of it.
You are 100% correct. I believe that the thyroid is underserviced because it is more a female issue. The total incompetence of Endro's everywhere confirms this.
You are very aware and everyone here thanks you for your public service!
Dear greygoose, you are correct. The old saying "follow the money" is the essence of all investigations into every topic.
Here in Canada, we have no private medicine. The state educated doctors seem to have less knowledge than doctors in other countries (based on my medical experiences in 10 other countries) and limited to 0 interest as they are state paid and reviews mean nothing.
Unless there is evidence of harm, doctors can't change prescriptions without the patient's consent. You don't have to agree to your endo discontinuing the Cytomel.
Possibly you could contact this endo and let that person know that you disagree with the change and you want the Cytomel reinstated and the Levothyroxine increased to 75 mcg because you want to find out if this would make you feel better. I agree with jimh111. It looks like your hypothalamic pituitary axis is not functioning.
My endo in Toronto finally got my dose to 150 mcg Levo and kept wanting to reduce the dose because TSH was very low. I refused. Eventually she declined to see me anymore and my GP has continued prescribing 150 mcg without argument. After several years of fooling around with different doses of Cytomel and Levo, it was obvious that my hypothalamic pituitary axis is the issue. Even when she lowered my doses to a point where I was extremely hypo, the TSH was still very low and nonreflective of the fT4 and fT3 results.
Since the majority of patients have Hashimoto autoimmune disease, those of us who don't are seemingly unrecognized outliers.
Bear in mind that Synthroid absorption is approximately 80% on an empty stomach. Cytomel is almost 100% and food is not an impediment to absorption. Probably you'd be better off with 10 mcg Cytomel.
Keep lobbying for your health. I know it is very frustrating. At least you have 3 monthly appointments which means you have more opportunities to argue your case.
Greetings! I am in Ottawa. I have a Nurse Practitioner in Oshawa who treats me for menopause and she does dispense Cytomel and Synthroid without question. She is my backup which I am going to have to rely on given the useless Endo.
NPs can be absolutely wonderful. I get my "thyroid fix" from an NP as well. I don't see a doctor unless I absolutely have to, especially now, that they don't allow my son to accompany me and back me up. I'm glad you have an NP.
Here you go. What is most interesting is that the clinic blends both modern medicine with bioidentical hormones and other naturopathic approaches - rather rare. It works great for me. Aysha is the Nurse Practitioner.
Oh, dear lord!!!! I'm in Winnipeg and I have run into the same issues for the last 30 years. Before that I had the most awesome doc ever; just took him for granted until I had to deal with the incompetence, ignorance, arrogance and condescendence of those docs who followed. It brings me to tears to think how little I appreciated that doctor. I just thought that's how a doctor is supposed to be. And I still think that but can't find a doctor who is the doctor they are supposed to be. Good luck!
FYI: The American Thyroid Association (2022 ATA Virtual Alliance for Thyroid Patient Education Health Forum) is Saturday, Nov. 19, 2022 from 12:00 PM - 1:15 PM EDT/9:00 - 10:15 AM PST. Registration is free. Past years some virtual attendees have been able to give the presiding doctors a earful during breakout sessions! They were from some big name medical centers too.
There is an excellent resource right there with you in Canada. The website is called Thyroid Patients Canada. I subscribe to her newsletter. Memory escapes me at the moment but I know she’s a medical Dr. maybe even an endocrinologist herself - she also has Hashimoto’s. Nothing like an endocrinologist that has to deal with a disease and knows what it’s like from the inside! Totally 180 on what works and what doesn’t work - more than that she knows why endocrinologist perform so badly - when it comes to thyroid disorders. Highly recommend finding that newsletter and educating yourself on what to say and do when it comes to dealing with an inept endocrinologist. Or better yet finding your own way to better health.
Another great source of how to find balance and perhaps heal the thyroid is Dr. Alan Christianson he’s in the US. Another endocrinologist that has himself had Hashimoto’s. Dr. Alan Christianson does sell his own brand of herbal remedies etc., but he gives away a lot of very good information especially when it comes to what to eat and what not to eat - iodine being a principal bully on the block when it comes to making the thyroid sick. (In the US we have iodized salt that if removed / replaced May very well be the end of many Hashimoto’s problems.) Take a look at your iodine intake - Most foods have iodine - some more some less. If we are also getting supplemental iodine that’s hidden for instance in prepackaged foods, and we don’t eliminate toxins easily, then iodine can build up and become a toxin on its own, which most likely will attack the thyroid. Dr. Christianson has written a book called Thyroid Reset, that talks about how to do a 30 day experiment if you will, on removing foods that are higher in iodine. Highly recommend.
I could go on and on with the number of doctors that when they find themselves having to deal with Hashimoto’s, also find themselves in the exact same position we are in - dealing with doctors that either won’t do anything or can’t. Oddly enough they come up with answers on their own - outside of mainstream medicine! I would not wish this malady on any person inside or outside of mainstream medicine (having dealt with it myself for 30 years). Nevertheless it bears repeating: there’s nothing like an endocrinologist that they themselves have to deal with Hashimoto’s. They come up with some amazing remedies - that really work.
When you get tired of the frustration and fighting with doctors / Endocrinologists’ Unenlightened (and 30 years of experience says we have little hope in winning many of those battles), you may be happy to hear that there are other ways to get better.
"I have no formal medical or scientific education beyond high school chemistry. I am self-taught through immersion in thyroid scientific literature from the 1950s to the present." Quote from thyroidpatients.ca/2019/04/... made by Tania Smith. As far as I know, she is a professor of communication. However, whatever her profession, she is a Canadian advocate for thyroid patients, especially those who need additional T3. And we sure need advocates.
From my experience, you are right, some doctors, who have thyroid issues themselves, are much more sympathetic and sometimes better educated on the matter. I had two of them in my lifetime and both were excellent.
If you can get your hands on the book "Lucky Dog" by Sarah Boston DVM you will laugh your way through the Canadian medical system with a veterinarian oncologist who has thyroid cancer. At least she made me laugh out loud and nod along. Her way of dealing with a very serious matter in an equally humorous way is so refreshing and such a good way to approach the appalling ignorance, arrogance and complete disregard of patients by Canadian doctors. I find that laughing about all this every now and then helps me cope so much better. It helps me focus on what my needs are and take my focus off the misbehaving doctors. If I don't do that I will become extremely bitter, which does not serve me well.
The Canadian medical system is beyond useless and 0 focused on the patient because they are all unionized employees and could not care less about patients. There is no negative consequences because well, patients have no choice. I also believe the Cdn medical school is sub par as Canada has no medical innovation etc.
I also know that in most western G21 countries there is a harmonious blend of modern and naturopathic approaches. In Ontario Canada, the College of Physicians and Surgeons is on a vendetta against non big pharma organizations. I am currently helping my Nurse Practioner fight off the college.
Here's a funny story: I had a really good MD in Saskatoon, who also teaches Integrative Medicine at the University of Saskatchewan. He specializes in hormones and was very thorough in his approach and very informative. He gave me a short list of supplements to take and what companies to choose for each and why. I then saw an endo in Winnipeg, who had stated that I should bring along all meds (prescribed and otc) and supplements. As I put the bottles of supplements on his desk, he shook his head and said, "When I look at this, I already know everything here is wrong." He then went on a lengthy rant about naturopath and their dangers. I listened patiently (as a good patient always should ) and when he seemed finished, I said quietly, "It was an MD not an ND who suggested those to me." He quickly picked up one of the bottles, glanced at it briefly and said, "Yes, this is really good for your thyroid." What we obviously learn from that is that the effectiveness is not in what you take but who tells you to take it (NOT!). It is extremely difficult for me to respect a doctor like that.
By the way, the College as well as CMA is far too powerful for my taste. They forced the one good endo here in Winnipeg to close practice (or have her license pulled). I hope your NP can defeat them, but they seem to be picking off the good ones one by one. I lived in Germany for a couple of years and doctors there were definitely integrative.
Canada is particularly vulnerable to bad medicine because we have no private medicine to challenge the state employee medicine. Canada's health care is communist in format; centrally planned, managed and rationed.
My ND referred me to an Endo in the Toronto area. He fired me because I challenged him to test for free T3 T4. He said he only tested for TSH.
Many Canadians patronize US doctors, which I am planning to do.
Thank you for the quote. Sometimes memory does not serve…😊. I do enjoy her spot on advocacy for thyroid patients and for her research. She once described T4 / T3 treatment as like two uneven crutches that helped us get where we needed to go until a real cure came along. I whole heartedly agree.
She sure puts a lot of work into her writings. I appreciate her efforts to explain things and, of course, her advocacy.
Hahaha! Yes, once the thyroid is "gasping for air" the brain checks out occasionally (for me "occasionally" is an understatement). Many times, I have looked for my memory and found it waving at me from afar. I cannot count on it.
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) and when he seemed finished, I said quietly, "It was an MD not an ND who suggested those to me." He quickly picked up one of the bottles, glanced at it briefly and said, "Yes, this is really good for your thyroid." What we obviously learn from that is that the effectiveness is not in what you take but who tells you to take it (NOT!). It is extremely difficult for me to respect a doctor like that.
endocrinologist 
Blood results and endocrinologist advice 
Appointment with endocrinologist 
Endocrinologist
