[Anonymous]

#1020338

After 2 yrs of going to a DO, trying to figure out what was wrong with me, my mother in law suggested an internal medicine doctor. I went to see him, and sure enough after 10 minutes of talking to him he told me I had GD. That was Dec. 05. I had my RAI treatment in Fed 06 and went into hypo May of 06. I was put on levothyroxine 150 mcg for a month. Went back to him a month later, had blood work done, and he reduced me to 100 mcg. Though I was feeling alot better, I still was not feeling all that great, so I called the doctor a month after taking the 100 mcg and asked for blood work again, to see if my medicine needed to be adjusted again. They told me my TSH was still a little high but to keep taking the 100 mcg which I did for another month, I finally decided to call them last week, to tell them I am not feeling any better, they made me an apppoinment the next day. I went in to see the doctor,told him how I had been feeling and some of the symptoms I had been having. He told me he did not take into consideration my weight which I am 5.6′ and 106 lbs and 35 yrs of age. He told me he was going to reduce my dosage from 150 to 100 mcg. I told him I was already taking 100 mcg. I began to worry. He looked at my chart and so oh thats right we did reduce it. He then said well here is what were going to do. I want you to stay off the levothyroine for 3 days, this was Tuesday Aug. 22, He said since my TSH was a little high that being off of the meds for 3 days will hopefully level it out. I really began to worry, but I do not know much about thyroid levels and what they do, or are suppose to be at. This is all new to me! It is Aug. 26, I stayed off of the medicine for 3 days I pretty much feel the same as before, except I noticed a few hypo symptoms returnig, being cold etc. I did start back on medicine today of course. I do want to say that I am in no way knocking this doctor at all he has been really good to me, and takes the time to listen unlike most doctors I have went to. So my question is should I see an endo for my GD?

[Anonymous]

#1076794

Hi okblue,

If your TSH is higher than normal, that typically means your T4 (actual thyroid hormone) level is lower than normal. The two operate on kind of a see-saw — the TSH is thyroid stimulating hormone, which the pituitary produces in response to the thyroid hormone levels it senses in the bloodstream. If it senses too little thyroid hormone, it pumps out more TSH to stimulate thyroid hormone release from the thyroid. When we’re hyperthyroid, our TSH barely registers in a test, because it is trying to suppress thyroid hormone production.

That would mean you would want to take more thyroid replacement hormone in order to bring your TSH levels down.

If this doctor has been good about listening to you, etc., then I would recommend having a discussion to clarify what’s happening right now. Talk this out until you are comfortable with the facts and understand them completely (perhaps your T4 is low, not TSH, for instance). If you find yourself questioning this doctor’s ability to treat you effectively, then you’d be well off to seek another doctor — sometimes an internal med doctor, or even a general practitioner, can be a good choice, but sometimes the fact is that an endo provides you with the highest degree of certainty. That’s not necessarily a function of their specialty so much as it is a function of your degree of comfort with any given doctor’s abilities, knowledge, and willingness to work with you. Examine all your possibilities, because this will be a lifelong relationship. It’s important to have confidence.

Let us know how things work out!

~Ski
NGDF Assistant Online Facilitator

[Anonymous]

#1076795

I’ll try and answer your question and address your issues. Many Graves patients are under the care of an endo, but many also use their Primary Care Doctor. If you trust and feel that you are getting the best care available then you can stick with the first doctor who treated you. You need to remember that you are the one who is in charge of your medical treatment. If you have lost that trust then it could be time for a second opinion. You can’t worry about the other doctors’ feelings. Your insurance company might want a referral to a specialist (endo), if that is the case you need to ask your doctor for that referral. You are entitled to a second opinion and then decide to stay with the refered doctor.

When your TSH is elvaded it means that you are receiving too much thyroid hormone, when it is low you are not getting enough. This is what a lot of doctors use to decide which size pill you need to take. It may be necessary if you go to the endo is see if they will also order a TS4 blood test. Then he could compare the two results to determine which size you need to be one.

Keep us posted and I hope this helps.

Diane B On-Line Facilitator

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