Guest guest Posted May 21, 2010 Report Share Posted May 21, 2010 Sorry you've had a rough week, Dannielle! I've had a lot of thyroid pts this week also. Last one was an elderly lady who for years has been on just Cytomel: she says she's allergic to thyroxine, refuses to take it, so her TSH is useless in monitoring. Of course, other docs freak out at her high TSH, but I just monitor her T3. I just switched her to compounded natural thyroid so hopefully she'll do OK. I definitely treat the fT4 and fT3, not the TSH. I've had a number of women with fT4 0.8-0.9 (technically "normal") with normal TSH, but when I get the fT4 over 1 they do feel better. I also see a lot of people with TSH's way high or way low but fT3 and fT4 normal so you can't always rely on the pituitary-thyroid feedback loop. I myself a while back had a TSH around 0.4 but my fT3 was low and fT4 was fine. I see a lot of people whose previous doctor never checked beyond the TSH and I find a lot of normal TSH but abnl T3/T4. Also keep in mind some people have a normal TSH, normal fT4, but their fT3 will be low (like me!) because they're stressed and don't convert T4 to T3 in the periphery. This is a problem because most peripheral action of thyroid hormone is from T3. Definitely check cortisols...saliva is a great way to do it (I use ZRT lab). If adrenals are fatigued, you must address that to get anywhere with thyroid replacement. That's my two cents. Hope you have a relaxing weekend! Gretchen Gretchen A. Reis MD Wellspring Family Medicine Circleville, OH What are you guys doing when TSH is normal but T4 is low, in this particular case both free and total. or what about when TSH is high but T4 is normal or what about when TSH is TSH is low and the T4 is low.....................but everyting else is normal lab wise on the full pituitary work up........but the pt feels terrible, looks hypothyroid, but then you ercheck and now TSH and T4 are both normal. I am feeling very tired of endocrine this week..................also had a low am cortisol result in a different pt. Finally are you all treating for TSH of 2.5 and above? Thank you all! Dannielle Harwood, MD No virus found in this incoming message. Checked by AVG - www.avg.com Version: 9.0.819 / Virus Database: 271.1.1/2887 - Release Date: 05/21/10 02:26:00 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 22, 2010 Report Share Posted May 22, 2010 Thank you Gretchen! I appreciate your reply in all is different aspects! Dannielle To: Sent: Fri, May 21, 2010 2:21:46 PMSubject: Re: Thyroid Fun Sorry you've had a rough week, Dannielle! I've had a lot of thyroid pts this week also. Last one was an elderly lady who for years has been on just Cytomel: she says she's allergic to thyroxine, refuses to take it, so her TSH is useless in monitoring. Of course, other docs freak out at her high TSH, but I just monitor her T3. I just switched her to compounded natural thyroid so hopefully she'll do OK.I definitely treat the fT4 and fT3, not the TSH. I've had a number of women with fT4 0.8-0.9 (technically "normal") with normal TSH, but when I get the fT4 over 1 they do feel better. I also see a lot of people with TSH's way high or way low but fT3 and fT4 normal so you can't always rely on the pituitary-thyroid feedback loop. I myself a while back had a TSH around 0.4 but my fT3 was low and fT4 was fine.I see a lot of people whose previous doctor never checked beyond the TSH and I find a lot of normal TSH but abnl T3/T4. Also keep in mind some people have a normal TSH, normal fT4, but their fT3 will be low (like me!) because they're stressed and don't convert T4 to T3 in the periphery. This is a problem because most peripheral action of thyroid hormone is from T3. Definitely check cortisols... saliva is a great way to do it (I use ZRT lab). If adrenals are fatigued, you must address that to get anywhere with thyroid replacement. That's my two cents. Hope you have a relaxing weekend!GretchenGretchen A. Reis MD Wellspring Family Medicine Circleville, OH What are you guys doing when TSH is normal but T4 is low, in this particular case both free and total. or what about when TSH is high but T4 is normal or what about when TSH is TSH is low and the T4 is low......... ......... ...but everyting else is normal lab wise on the full pituitary work up........but the pt feels terrible, looks hypothyroid, but then you ercheck and now TSH and T4 are both normal. I am feeling very tired of endocrine this week........ ......... .also had a low am cortisol result in a different pt. Finally are you all treating for TSH of 2.5 and above? Thank you all! Dannielle Harwood, MD No virus found in this incoming message. Checked by AVG - www.avg.com Version: 9.0.819 / Virus Database: 271.1.1/2887 - Release Date: 05/21/10 02:26:00 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 22, 2010 Report Share Posted May 22, 2010 i try to treat based on symptoms and basal body temps for the souls on natural thyroid i use the free thyroxine index{some call it a T7} free t3 and free t4 but ignore the tsh i aslo use he reverse T3 if i am worried about adrenal involvement .. I think souls feel better on natural thyroid and have not had as much of a problem with it as the endo docs claim Thyroid Fun What are you guys doing when TSH is normal but T4 is low, in this particular case both free and total. or what about when TSH is high but T4 is normal or what about when TSH is TSH is low and the T4 is low.....................but everyting else is normal lab wise on the full pituitary work up........but the pt feels terrible, looks hypothyroid, but then you ercheck and now TSH and T4 are both normal. I am feeling very tired of endocrine this week..................also had a low am cortisol result in a different pt. Finally are you all treating for TSH of 2.5 and above? Thank you all! Dannielle Harwood, MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 22, 2010 Report Share Posted May 22, 2010 , I would like to know more about your methods of follwoing/measurinf thyroid. Can I email with you off list? Dannielle Harwood To: Sent: Fri, May 21, 2010 7:40:09 PMSubject: Re: Thyroid Fun i try to treat based on symptoms and basal body temps for the souls on natural thyroid i use the free thyroxine index{some call it a T7} free t3 and free t4 but ignore the tsh i aslo use he reverse T3 if i am worried about adrenal involvement .. I think souls feel better on natural thyroid and have not had as much of a problem with it as the endo docs claim Thyroid FunWhat are you guys doing when TSH is normal but T4 is low, in this particular case both free and total. or what about when TSH is high but T4 is normal or what about when TSH is TSH is low and the T4 is low.....................but everyting else is normal lab wise on the full pituitary work up........but the pt feels terrible, looks hypothyroid, but then you ercheck and now TSH and T4 are both normal. I am feeling very tired of endocrine this week..................also had a low am cortisol result in a different pt. Finally are you all treating for TSH of 2.5 and above? Thank you all! Dannielle Harwood, MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 22, 2010 Report Share Posted May 22, 2010 I generally do what you do. But endocrine always wants a normal TSH and they are the specialists. Are we setting ourselves up for any medical legal issues? what if the pt ends up w a fib or osteoporosis? do we need to get informed consent from these pts who feel good on their treatment despite the low TSH level?  Sorry you've had a rough week, Dannielle! I've had a lot of thyroid pts this week also. Last one was an elderly lady who for years has been on just Cytomel: she says she's allergic to thyroxine, refuses to take it, so her TSH is useless in monitoring. Of course, other docs freak out at her high TSH, but I just monitor her T3. I just switched her to compounded natural thyroid so hopefully she'll do OK. I definitely treat the fT4 and fT3, not the TSH. I've had a number of women with fT4 0.8-0.9 (technically " normal " ) with normal TSH, but when I get the fT4 over 1 they do feel better. I also see a lot of people with TSH's way high or way low but fT3 and fT4 normal so you can't always rely on the pituitary-thyroid feedback loop. I myself a while back had a TSH around 0.4 but my fT3 was low and fT4 was fine. I see a lot of people whose previous doctor never checked beyond the TSH and I find a lot of normal TSH but abnl T3/T4. Also keep in mind some people have a normal TSH, normal fT4, but their fT3 will be low (like me!) because they're stressed and don't convert T4 to T3 in the periphery. This is a problem because most peripheral action of thyroid hormone is from T3. Definitely check cortisols...saliva is a great way to do it (I use ZRT lab). If adrenals are fatigued, you must address that to get anywhere with thyroid replacement. That's my two cents. Hope you have a relaxing weekend! GretchenGretchen A. Reis MD Wellspring Family Medicine Circleville, OH  What are you guys doing when TSH is normal but T4 is low, in this particular case both free and total.  or what about when TSH is high but T4 is normal  or what about when TSH is TSH is low and the T4 is low.....................but everyting else is normal lab wise on the full pituitary work up........but the pt feels terrible, looks hypothyroid, but then you ercheck and now TSH and T4 are both normal.  I am feeling very tired of endocrine this week..................also had a low am cortisol result in a different pt.  Finally are you all treating for TSH of 2.5 and above? Thank you all!  Dannielle Harwood, MD No virus found in this incoming message. Checked by AVG - www.avg.com Version: 9.0.819 / Virus Database: 271.1.1/2887 - Release Date: 05/21/10 02:26:00 -- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined. This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2010 Report Share Posted May 24, 2010 I know some of you guys don't want to hear this because endocrine doesn't have many procedures(they do thyroid bx/s at the least) but it's ok to ask an endocrinologist to help you out. Doesn't mean you have to send them your pts all the time. But if you do send them a few, I'm sure you'll find one who will be happy to chat with you and give you some guidance. Most of them are so swamped with DM's pts these days. They're certainly not starving for consults but they do have more experience with thyroid than any of us out do. Ellen Kennedy, Jim wrote: > First case, is or has the patient taken T3 lately? see this when that is the case. takes weeks to months to correct after they stop. > TSH high and T4 normal subclinical and will become hypothyroid, esp if antibodies high. I try to treat, but some refuse so you have to keep checking. > Both low, you can check a TRH, I would bet hypopit, I would treat. Is there a CT of the pit.? > I try to try to 2.5, if feels fine up to 4.5 just keep checking. > ________________________________________ > From: [ ] On Behalf Of Dannielle Harwood [dharwood100@...] > Sent: Friday, May 21, 2010 12:25 PM > To: > Subject: Thyroid Fun > > What are you guys doing when TSH is normal but T4 is low, in this particular case both free and total. > > or what about when TSH is high but T4 is normal > > or what about when TSH is TSH is low and the T4 is low.....................but everyting else is normal lab wise on the full pituitary work up........but the pt feels terrible, looks hypothyroid, but then you ercheck and now TSH and T4 are both normal. > > I am feeling very tired of endocrine this week..................also had a low am cortisol result in a different pt. > > Finally are you all treating for TSH of 2.5 and above? > Thank you all! > > Dannielle Harwood, MD > ________________________________ > > > > > ------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2010 Report Share Posted May 24, 2010 This is beginning to sound more like naturopathic care than conventional medicine to me. Salivary testing is not reliable. And can you please define for me " adrenal fatigue " ? I think you're treading on some fuzzy territory. And you could be in for some medical legal issues as an MD doing this stuff. My two cents. Ellen Thomson wrote: > > great questions i do chk tsh in pts on asthma steroids nsaids and > aspirin and in pts over 60 > Re: Thyroid Fun > > I generally do what you do. But endocrine always wants a normal TSH > and they are the specialists. Are we setting ourselves up for any > medical legal issues? what if the pt ends up w a fib or osteoporosis? > do we need to get informed consent from these pts who feel good on > their treatment despite the low TSH level? > > On Fri, May 21, 2010 at 2:21 PM, Gretchen Reis < > greis@... <mailto:greis%40wellspringfamilymed.com> > > wrote: > > Sorry you've had a rough week, Dannielle! I've had a lot of thyroid > pts this week also. Last one was an elderly lady who for years has > been on just Cytomel: she says she's allergic to thyroxine, refuses to > take it, so her TSH is useless in monitoring. Of course, other docs > freak out at her high TSH, but I just monitor her T3. I just switched > her to compounded natural thyroid so hopefully she'll do OK. > > I definitely treat the fT4 and fT3, not the TSH. I've had a number of > women with fT4 0.8-0.9 (technically " normal " ) with normal TSH, but > when I get the fT4 over 1 they do feel better. I also see a lot of > people with TSH's way high or way low but fT3 and fT4 normal so you > can't always rely on the pituitary-thyroid feedback loop. I myself a > while back had a TSH around 0.4 but my fT3 was low and fT4 was fine. > > I see a lot of people whose previous doctor never checked beyond the > TSH and I find a lot of normal TSH but abnl T3/T4. Also keep in mind > some people have a normal TSH, normal fT4, but their fT3 will be low > (like me!) because they're stressed and don't convert T4 to T3 in the > periphery. This is a problem because most peripheral action of thyroid > hormone is from T3. > > Definitely check cortisols...saliva is a great way to do it (I use ZRT > lab). If adrenals are fatigued, you must address that to get anywhere > with thyroid replacement. That's my two cents. Hope you have a > relaxing weekend! > > Gretchen > Gretchen A. Reis MD > Wellspring Family Medicine > Circleville, OH > > > > What are you guys doing when TSH is normal but T4 is low, in this > particular case both free and total. > > or what about when TSH is high but T4 is normal > > or what about when TSH is TSH is low and the T4 is > low.....................but everyting else is normal lab wise on the > full pituitary work up........but the pt feels terrible, looks > hypothyroid, but then you ercheck and now TSH and T4 are both normal. > > I am feeling very tired of endocrine this week..................also > had a low am cortisol result in a different pt. > > Finally are you all treating for TSH of 2.5 and above? > > Thank you all! > > Dannielle Harwood, MD > > No virus found in this incoming message. > Checked by AVG - www.avg.com Version: 9.0.819 / Virus Database: > 271.1.1/2887 - Release Date: 05/21/10 02:26:00 > > -- > M.D. > www.elainemd.com > Office: > Go in the directions of your dreams and live the life you've imagined. > This email transmission may contain protected and privileged, highly > confidential medical, Personal and Health Information (PHI) and/or > legal information. The information is intended only for the use of the > individual or entity named above. > > If you are not the intended recipient of this material, you may not > use, publish, discuss, disseminate or otherwise distribute it. If you > are not the intended recipient, or if you have received this > transmission in error, please notify the sender immediately and > confidentially destroy the information that email in error. > > Attachment: vcard [not shown] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2010 Report Share Posted May 24, 2010 Why do you say salivary cortisols are not reliable? do you have a reference or clinical experience which makes you say this? kathySent from my Verizon Wireless BlackBerryDate: Sun, 23 May 2010 21:44:22 -0700To: < >Subject: Re: Thyroid Fun This is beginning to sound more like naturopathic care than conventional medicine to me. Salivary testing is not reliable. And can you please define for me " adrenal fatigue " ?I think you're treading on some fuzzy territory. And you could be in for some medical legal issues as an MD doing this stuff.My two cents.Ellen Thomson wrote:>> great questions i do chk tsh in pts on asthma steroids nsaids and > aspirin and in pts over 60> Re: Thyroid Fun>> I generally do what you do. But endocrine always wants a normal TSH > and they are the specialists. Are we setting ourselves up for any > medical legal issues? what if the pt ends up w a fib or osteoporosis? > do we need to get informed consent from these pts who feel good on > their treatment despite the low TSH level?>> On Fri, May 21, 2010 at 2:21 PM, Gretchen Reis < > greis@... <mailto:greis%40wellspringfamilymed.com> > > wrote:>> Sorry you've had a rough week, Dannielle! I've had a lot of thyroid > pts this week also. Last one was an elderly lady who for years has > been on just Cytomel: she says she's allergic to thyroxine, refuses to > take it, so her TSH is useless in monitoring. Of course, other docs > freak out at her high TSH, but I just monitor her T3. I just switched > her to compounded natural thyroid so hopefully she'll do OK.>> I definitely treat the fT4 and fT3, not the TSH. I've had a number of > women with fT4 0.8-0.9 (technically " normal " ) with normal TSH, but > when I get the fT4 over 1 they do feel better. I also see a lot of > people with TSH's way high or way low but fT3 and fT4 normal so you > can't always rely on the pituitary-thyroid feedback loop. I myself a > while back had a TSH around 0.4 but my fT3 was low and fT4 was fine.>> I see a lot of people whose previous doctor never checked beyond the > TSH and I find a lot of normal TSH but abnl T3/T4. Also keep in mind > some people have a normal TSH, normal fT4, but their fT3 will be low > (like me!) because they're stressed and don't convert T4 to T3 in the > periphery. This is a problem because most peripheral action of thyroid > hormone is from T3.>> Definitely check cortisols...saliva is a great way to do it (I use ZRT > lab). If adrenals are fatigued, you must address that to get anywhere > with thyroid replacement. That's my two cents. Hope you have a > relaxing weekend!>> Gretchen> Gretchen A. Reis MD> Wellspring Family Medicine> Circleville, OH>> >> What are you guys doing when TSH is normal but T4 is low, in this > particular case both free and total.>> or what about when TSH is high but T4 is normal>> or what about when TSH is TSH is low and the T4 is > low.....................but everyting else is normal lab wise on the > full pituitary work up........but the pt feels terrible, looks > hypothyroid, but then you ercheck and now TSH and T4 are both normal.>> I am feeling very tired of endocrine this week..................also > had a low am cortisol result in a different pt.>> Finally are you all treating for TSH of 2.5 and above?>> Thank you all!>> Dannielle Harwood, MD>> No virus found in this incoming message.> Checked by AVG - www.avg.com Version: 9.0.819 / Virus Database: > 271.1.1/2887 - Release Date: 05/21/10 02:26:00>> -- > M.D.> www.elainemd.com> Office: > Go in the directions of your dreams and live the life you've imagined.> This email transmission may contain protected and privileged, highly > confidential medical, Personal and Health Information (PHI) and/or > legal information. The information is intended only for the use of the > individual or entity named above.>> If you are not the intended recipient of this material, you may not > use, publish, discuss, disseminate or otherwise distribute it. If you > are not the intended recipient, or if you have received this > transmission in error, please notify the sender immediately and > confidentially destroy the information that email in error.>> Quote Link to comment Share on other sites More sharing options...
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