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Suggestions to cure elevated tsh levels - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Very Good Posted in: Thyroid Problem and Hormonal Problems
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1723 Questions

Doctor :   heelo
Doctor :  
hello
Doctor :  
how can i help u?
User :   My TSH is 5 and a doctor wants to put me on Levoxyl without testing T3 or T4. Also I was tested a few months ago and my TSH was 2.4, so how can I tell him this issue is to controversial to start a lifetime medication?
Doctor :  
ok
Doctor :  
whats ur age/sex?
User :   Female 37
Doctor :  
normal tsh level is 5
Doctor :  
0.5 to 5.0
Doctor :  
and it should be combined with t3 and t4 levels
User :   Yes, I know, however he said he would like to keep it around the 3 range? How can I tell him I am unwilling at this point?

Doctor :   hello
Doctor :  
where are u from?
User :   The bottom line is, he thinks if I get pregnant the baby would be healthier if my thyroid was at a 3 range... I'm concerned about going on a lifetime medication only being subclinical hypothryroid if that???
User :   what does it matter where I'm from?
Doctor :   nothing some areas are low in iodine content so at risk of getting hypothyroidism
User :   what would happen if I tried the medication for 1 month then tapered off? Would my thryroid go back to working normally? And I realized about the iodine thing... my grandmother had a small goiter being from Idaho! I live at sea level in New Hampshire, 15 minutes from the ocean and I eat plenty of fish
Doctor :  
ok thats good
Doctor :  
yes u can take the tablets
Doctor :  
but before that it wpould be better if u get ur t3 and t4 levels done
User :   Then why do they say thyroid medication is a "lifetime medication"? Why is there so much controversy in the parameters of "normal range" TSH? This is really subjective, and I just think this doctor is being reckless with me at this point. Maybe he sees not prescribing medication as reckless, however, he sees that I am resisting this...?
Doctor :  
yes i do agree with u there is much contraversy regarding normal tsh reference range...some consider 0.5 to5.0 as normal but some consider 0.3 to 3.0 aas normal..
Doctor :  
this reduction in the range is to diagnose those people at risk but there is lot of contraversy regarding this and lots of experiments are going on still
User :   what is a normal T3 and a normal T4
User :   So how do you suggest I tell him I am not ready to start medication before trying other alternative lifestyle changes, or closely monitoring my thyroid ranges consistantly for a while? Will he take offense? It's my right to seek other doctor's opinions and have other lab draws from other resources other then his office right?
Doctor :  
T4: Normal Adult Range: 4 - 12 ug/dl Optimal Adult Reading: 8 ug/dl

T3: Normal Adult Range: 27 - 47% Optimal Adult Reading: 37 %
Doctor :   yes u can go for 2nd opinion
Doctor :   as u told just one month back ur readings were around 2.0
Doctor :  
its better u get ur tsh t3 and t4 levels done
User :   I'm really starting to not trust 1st opnions or doctors at his point... My husband was Dx with a varicocele in high school, so we go to a urologist last week who decided to examine my husband right in from of me penis, and finger in the butt... etc... then says he does not have a varicocele... 1 hour later we go to another urologist and he detects the varicocele right away! Then we go for a 2rd opnion for kicks and giggles, because the 2 were so starkly different, and low and behold, this doc finds his varicocole right away too!! So there are 2 docs total in my husbands lifetime that finds the varicocele, and 1 that is a quack... can you believe it?
Doctor :   ok
Doctor :   thats bad
User :   oops I meant a 3rd opinion
Doctor :   but still u cant ignore ur health for any reason
Doctor :  
so next time u choose a doctor who is trustworthy and then meet him for 2nd opinion
User :   Yes, and guess what...? The doctor that I am seeing now that wants to start me on Levoxyl, it was his office that recommended the quack urologists clinic, however, not that doctor specifically... but that office
Doctor :  
ohh okk
User :   I really don't want an advasarial relationship with him, so what do you suggest I tell him about not taking the medication yet?
User :   We may be needing his help with getting pregnant in the future... He is a fertility doctor
User :   due to my husbands varicocele
Doctor :  
yes u can but first u go to 2nd opinion
Doctor :  
then u can ignore 1st doctor
User :   Would he be unwilling to do IVF if need be, if I don't take the Levoxyl?
Doctor :  
i donno about that it depends upon the doctor
User :   Is this going to create conflict with him if he knows I'm getting my blood drawn elsewhere to compare blood work and labs? Would you feel threatened or discomfort with the relationship if your patient was doing this?
Doctor :   it depends upon how u convince him
User :   Do you have any suggestions?
Doctor :   first get ur bloodtest done in other lab and then see the result
Doctor :  
if the results vary then u can show the result to him
Doctor :   this time u go for t3 and t4 levels also
User :   I have a follow up with him in 2 weeks, and sometimes these lab draws take several days, so what do I say if he asks if I started the medication during my appointment with him on the 27th?
Doctor :   ok
Doctor :   u accept for that but dont take untill ur lab results are out
Doctor :  
once the other lab results are out then we can think take next step
User :   So I should let him know on the 27th that I am having further blood work done before committing to any medication?
Doctor :  
but u are afraid that he might not help u later regarding pregnancy
Doctor :  
if h knows that u are cross checking then def he might not like it'
User :   I'm worried about a conflict. And whether he likes it or not, shouldn't he be made privvy if he has misdiagnosed a patient? Us liking each other is really out of the scope if someone has been misdiagnosed, right? Wouldn't you say that he would rather set his ego aside and take the $15,000 dollars for the IVF procedure if necessary in our future?
Doctor :  
yes but i donno how he will react
Doctor :  
after all every human is highly unpredictable
Doctor :  
but he will not loose 0000 dollars so easily also
User :   How would you react? given this information? Would you be upset if a patient wanted results from a different lab?
Doctor :  
may be yes
Doctor :  
but depends upon mood
User :   interesting...
User :   Well, I'm not so sure how this was helpful to me... I could have looked up the clinical questions about thyroid ranges for T3 on my own. You gave really general answers throughout this chat... what kind of doctor are you may I ask?
Doctor :  
the questions u asked me are also general XXXXXXXX
Doctor :  
how will i know the other doctor will react?
Doctor :  
any medical query i can def help u
Doctor :  
but i cannot read the mind of a doctor whom i dont even know
Doctor :  
are u there?
User :   yes
User :   I guess I'm back to square 1
Doctor :  
ok
Doctor :  
but i will give an advice
Doctor :  
u first wait till ur lab results aare out
Doctor :   if he wants u to take levo tab ,u take it and once ur t3 t4 and tsh levels are out i will tell u wether to take levo or not
Doctor :   and convincing the other doctor depends upon u...
User :   I'm not going to take medication until I get the other lab draws because I want to know my baseline without medication
Doctor :  
u have alrerady given blood right?
User :   Do you know what the chances of naturally conceiving are if my husband's sperm morphology is 1% by Krueger testing
Doctor :   ok
User :   Yes, I gave blood, but only at his office. I don't trust his lab right now... I want to go to my other doctor's lab, which is completely different than his, and see what their results show
Doctor :   okk

Doctor :  
u havent given in other lab?i thought u have already given and waiting for results
Doctor :  
ok if he asks u to take tabs then u accept for it but dont take it untill u get the blood report
User :   No, I just left his office today. That is the delemma... I have a follow up appointment with him on the 27th, and I may not have my new results until after our visit, so that is why I was asking you what I should say about why I haven't started the medication yet, without spilling the beans about me waiting for new lab results from a new blood draw from a different lab with the T3 and 4 counts...
Doctor :  
yes
Doctor :  
dont tell him about ur second opinion
Doctor :  
u tell him only if the two lab tests differ
Doctor :  
u accept medication but dont take it untill ur results are out
User :   But what do I say if he asks, "so, have you started the Levoxyl yet?" when I meet with him on the 27th
Doctor :   u tell him no

User :   Then he will say, "why?"
Doctor :  
i havent started i will start from 27th
User :   But I may not start the medication ever...! So, what do you think if I say... "well, I'm concerned that we haven't checked my T3 and 4 from your lab, so I think since this hypothyroidism world is so controversial and still under research, maybe we should check my T3 and 4 first before jumping to a life committment medication....." And within a week of me telling him this, I will have my 1st results back from the 2nd lab that he doesn't know about...
Doctor :   so get ur blood test done as soon as possible as today is just 16th still u have 11 days time
Doctor :  
yes u can tell him but one more thing is if u dont have symptoms u dont have to take levo life long
User :   I don't have symptoms, I don't think... what would be symptoms? And if I took the medication for a few months, then discontinued, would this foul up my thyroid forever?
Doctor :   no nothing will happen even if u discontinue and if u dont have symptoms

User :   The only reason why my TSH was tested is because him being a fertility doctor, has to check all my hormones to see if everything is okay, and so far, everything is, including my uterus, which he injected with a dye today, that killed me, and all other blood work is normal, extremely normal he said
Doctor :  
symptoms of hypo are dry skin ,cold sensitivity,tiredness
Doctor :  
depression
Doctor :  
lump in front of neck
Doctor :  
ohh ok
Doctor :  
even weight gain also
User :   no, none of these symptoms apply to me, I'm happy, normal skin, warm, and energetic... um, and as far as my weight gain, I just need to get to the gym and stop eating my oreos with milk... so if I take Levoxyl I will be skinny again... just kidding
Doctor :  
haha ok
Doctor :  
then coming to varicocele it is treatable if that is the reason for infertilty then he can go for surgery
Doctor :  
then u dont have to worry about sperm morphology also once varicocele is ttreated his sperms will be fine
User :   His sperm was 78 million, motility 62%, and his morphology was 1%
Doctor :   o to 3 morphology is abnormal in Krueger testing
User :   I've read that varicocele does not affect morphology, only count and motility... do you know different?
Doctor :   yes
Doctor :  
varicocele can effetct morphology also
User :   His count and motility were normal
Doctor :  
good
User :   This doctor didn't say the the varicocle would affect morphology, he mentioned that morphology is still a mystery, and no one knows why for low morphology percents....
User :   See, if its his sperm that can't fertilize my egg, why should I go on thyroid medication?
Doctor :  
yes
Doctor :  
i know
Doctor :  
but varicocele can effect morphology
Doctor :  
may be he wants u to take medication because during pregnancy hypthyroidism will be aggrevated
User :   well what is your name or ID number so I can let you know the outcome in 2 weeks?
Doctor :  
my name is dr XXXXXXXX so when u come online u ask for me so that we can discuss about this
User :   I really don't want to start all over with somone else
Doctor :   yes i can undertsand XXXXXXXX
User :   Where are you located?
Doctor :  
i am from india
Doctor :  
bangalore
Doctor :  
are u there?
Doctor :  
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