Asking to learn

[Dryski]

Sorry for all the questions but you all have been so helpful. If your hypothyroidism is secondary shouldn't your medication be based on your free levels and not your tsh?

[helvella Administrator]

There's many who would say that is how dosing should always be assessed.

After all, far more people appear to have some degree of impaired pituitary function than has usually been accepted. While a totally non-functional pituitary might be identified, slight reductions in function that end up with less TSH being produced would more likely result in under-dosing.

[radd]

Dryski

Ideally yes, as the TSH measurement becomes redundant in secondary hypothyroidism.

However, to correctly dose secondary or central hypothyroidism one needs an understanding of thyroid physiology that many doctors do not process, and so wrongly continue to use the TSH level as their dosing guide.

[Charlie-Farley]

Hi Dryski

so following on from  helvella and  radd , you may find you need to explain the difference and the significance of the differences in terms of monitoring to which ever doctor you see. As Helvella states (correctly) they should not be managing any thyroid conditions with a pituitary hormone (an indirect measure) - how ar$e about face is that?

Make sure you have some basic information for them to digest - just in case you get a ‘dud’.

[Dryski in reply to Charlie-Farley]

Thanks for the helpful advice. I reminded my new doctor today that I was central hypo because of my pituitary and got my head bit off. No dose increase and no intrest in how poorly I have been feeling. They don't care here in the states. Could be comatose and it wouldn't matter.

[Charlie-Farley in reply to Dryski]

Different doctor time?