1

votes

Not happy about the blood work that was just ordered on my behalf

Answered on August 19, 2014
Created November 17, 2011 at 7:38 PM

Just came back from my doctor, and she ordered blood work for hypothyroid problems that I suspect that I have (I've lost very little weight on Paleo, and I have a lot of the other symptoms). Anyways, she ordered T4 and TSH. Nothing else. No CRP sensitive, and not T3. I checked her blood order paper, there was NO "reverse T3" checkbox in there (but there was T3, which was left unchecked)! In fact, when I told her to check reverse T3, she said that she doesn't know what that is, and that TSH is all I really needed.

So my question is: is this lab work semi-useless to find out if I really have hypothyroidism or not? Or how to properly treat it if it comes back positive?

UPDATE: TSH and T4 came back normal, in two separate blood tests, a week apart. Still, not quite convinced though about the T3/rT3, which were never tested.

UPDATE DEC 1: I got the numbers!! TSH is 1.35, T4 is 1.2. Are they ok, or do they signal some other problem I need to look at?

5e36f73c3f95eb4ea13a009f4936449f

(8280)

on December 02, 2011
at 12:52 AM

Re. the numbers. There should be some sort of reference ranges on the test page. Or you may need to find out from the doctor/lab itself. They're probably ok, but the reference range will tell you. With the usual caveat about reference ranges... http://thyroid.about.com/od/gettestedanddiagnosed/a/normaltshlevel.htm

5e36f73c3f95eb4ea13a009f4936449f

(8280)

on December 02, 2011
at 12:45 AM

Yeah, that's one of the problems with tests and labs today. "Normal" is on a sliding scale. You may be "Normal" compared to the SAD population, but abnormal compared to your parent/grandparent's generation. An example I've heard memtioned in the past is that the testosterone levels today are substantially less than in the grandparents day, but it's still seen as "normal" because most of the population is that way now...

3eca93d2e56dfcd768197dc5a50944f2

(11697)

on December 02, 2011
at 12:15 AM

Thank you Travis. I just got the numbers: TSH is 1.35, T4 is 1.2. What do these look like?

543a65b3004bf5a51974fbdd60d666bb

(4493)

on November 25, 2011
at 09:04 PM

you may find this table useful as well for checking adrenal & thyroid Signs and Symptoms: http://drrind.com/therapies/metabolic-symptoms-matrix There's also good info on tracking body temp http://drrind.com/therapies/metabolic-temperature-graph

543a65b3004bf5a51974fbdd60d666bb

(4493)

on November 25, 2011
at 08:26 PM

you may find this table useful as well for checking adrenal & thyroid Signs and Symptoms: http://drrind.com/therapies/metabolic-symptoms-matrix

543a65b3004bf5a51974fbdd60d666bb

(4493)

on November 25, 2011
at 08:23 PM

that's a shame. looks like you may need to find another doctor who will be sympathetic to your hypothyroid symptoms & concerns. http://www.stopthethyroidmadness.com/how-to-find-a-good-doc/

3eca93d2e56dfcd768197dc5a50944f2

(11697)

on November 25, 2011
at 07:17 PM

Unfortunately they wouldn't give them to me.

543a65b3004bf5a51974fbdd60d666bb

(4493)

on November 25, 2011
at 09:30 AM

may be worth posting up the tsh & t4 numbers (& lab ranges) if you have them

543a65b3004bf5a51974fbdd60d666bb

(4493)

on November 18, 2011
at 09:15 PM

although, this guy has Hashimoto’s & he takes Iodine (& Selenium); see here http://perfecthealthdiet.com/?p=3621 & http://perfecthealthdiet.com/?p=3650

543a65b3004bf5a51974fbdd60d666bb

(4493)

on November 18, 2011
at 09:13 PM

although, this guy has Hashimoto’s & he takes Iodine (& Selenium); see here perfecthealthdiet.com/?p=3621 & perfecthealthdiet.com/?p=3650

543a65b3004bf5a51974fbdd60d666bb

(4493)

on November 18, 2011
at 09:00 PM

although, this guy has Hashimoto’s & he takes Iodine; see here http://perfecthealthdiet.com/?p=3621 & http://perfecthealthdiet.com/?p=3650

3c6b4eed18dc57f746755b698426e7c8

(5147)

on November 18, 2011
at 05:33 AM

Don't tell me he's an endo.

3846a3b61bc9051e4baebdef62e58c52

(18635)

on November 18, 2011
at 01:41 AM

Some docs could use a few visits to WebMD for continuing education.

32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on November 17, 2011
at 11:32 PM

I bet doctors love armchair doctors with WebMD degrees. ;)

543a65b3004bf5a51974fbdd60d666bb

(4493)

on November 17, 2011
at 10:38 PM

my doc also had never heard of a rT3 test when i first mentioned it; he knows about it now tho

Medium avatar

(39831)

on November 17, 2011
at 09:58 PM

That's a good point...you wouldn't want to start taking iodide if you have that.

3eca93d2e56dfcd768197dc5a50944f2

(11697)

on November 17, 2011
at 07:43 PM

The blood draw was already done, minutes after I got done with my doctor I'm afraid.

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8 Answers

3
Medium avatar

on November 17, 2011
at 08:12 PM

You can generally infer from a high TSH that you have a low T3. If you get back high TSH and low T4, you probably want to supplement with iodide (and selenium can't hurt, though that would generally correct high T4 and low T3). Carbohydrate restriction tends to lower T3, but in the studies I've read TSH and T4 remain normal, so I think it affects the conversion of T4 to T3 as well as upregulating rT3.

That they wouldn't just test for what you actually want to know directly is of course stupid. I would get the results from this and then find a real doctor. If you go in for new tires and your mechanic does a brake job instead because he thinks that's more important, get a new mechanic.

3eca93d2e56dfcd768197dc5a50944f2

(11697)

on December 02, 2011
at 12:15 AM

Thank you Travis. I just got the numbers: TSH is 1.35, T4 is 1.2. What do these look like?

1
32123f4f25bdf6a7b70c9c2a719386ed

(396)

on November 18, 2011
at 03:31 PM

People....to find out more about thyroid issues, what to test for , where to find good doctors and what is normal and what is not google Mary Shoman. She has written several books and hosts an about.com website and also facebook pages. She is the lay expert on all things thyroid and has many articles on line to answer these questions.

0
5e36f73c3f95eb4ea13a009f4936449f

(8280)

on December 02, 2011
at 12:43 AM

Your mileage definitely varies depending on not only the doctor, but the type of insurance. HMO doctors (nothing against them) don't tend to be able to spend as much time with patients, nor are they always able to keep up with all the latest research. Due to the nature of the insurance, they've got to push a lot of patients through the office in a day just to keep the lights on. They're also limited on the types of tests they can provide that are covered by insurance, so you may need to pay out of your own pocket, make sure and check the costs.

That said, the doctor/patient relationship is a partnership. If they won't work with you, look for another one that will. You've got to be sensitive to the whole armchair MD or hypochondriac situation (like mentioned in a previous comment), but I've found that as long as you aren't confrontational "You're wrong, gimmee gimmee gimee" things work out better. It also helps if from the get go, the doctor understands you expect a copy of all the test results (some may charge a nominal fee for copying). Some do not like to do this, because sometimes there's a lot of interpretation in the results. You really need to understand issues with reading test results.

For me, just like the doctor, time is money. I document and organize issues on a single page/cheat sheet before going to the doctor. I can be a bit of a freak on that (I usually set the stage with the doctor early on so they know I'm a control freak :) ), so your mileage may vary. Just make sure and identify your issue, what you did to resolve, the results, and what you want the doctor to do if they agree with your thoughts/wishes.

0
0242b468fe1c97997749db416c92e7ed

(4528)

on November 17, 2011
at 10:57 PM

From what I understand, Thyroid Stimulating Hormone is a pituitary hormone, so the TSH test should at least tell your doc if you have pituitary gland issues. Unfortunately, it's not so great for diagnosing thyroid issues, though.

I feel your pain. I'm currently going through the excruciating process of finding a doc who will order the proper testing for my own mystery symptoms. I had an appointment two days ago with a endocrinologist who finally tested everything but the kitchen sink, so I may have finally found my doc. Keep searching. If your current M.D. won't run the tests you want/need, move on to the next one. It's frustrating, and not particularly fun, but it'll be SO worth it when you find a doc you can work with.

0
543a65b3004bf5a51974fbdd60d666bb

(4493)

on November 17, 2011
at 10:52 PM

The tests ordered are not useless, just not comprehensive, but every little bit helps. I sometimes see it as a journey to educate some of our Doctors.

At least she ordered the TSH which is a good starting point. & depending on the result could make your next tests easier to get.....If your TSH is outside the normal lab range then your Doctor has to investigate further (order more tests).

In my experience (in Australia) its not so easy to get more tests when your TSH falls within the normal lab range.....because then you are....normal? & there's nothing wrong with you.

My experience was 'normal' TSH. However i still convinced the doc to do fT3 & fT4 which also both fell in the normal lab ranges. I then paid for an rT3, which came back very high. At last i had found a test which backed up my symptoms, vindicated at last, no thx to the docs.

5e36f73c3f95eb4ea13a009f4936449f

(8280)

on December 02, 2011
at 12:45 AM

Yeah, that's one of the problems with tests and labs today. "Normal" is on a sliding scale. You may be "Normal" compared to the SAD population, but abnormal compared to your parent/grandparent's generation. An example I've heard memtioned in the past is that the testosterone levels today are substantially less than in the grandparents day, but it's still seen as "normal" because most of the population is that way now...

0
13a44ea00b0c9af0b6d0f3d5f5c2cfca

(7223)

on November 17, 2011
at 09:29 PM

I would find a new doctor as soon as possible. My physician and I don't have to agree on absolutely everything, but if s/he is ordering blood work and refuses to order the tests I request which are within the realm of what s/he is looking for that would be the end of our professional relationship.

3846a3b61bc9051e4baebdef62e58c52

(18635)

on November 18, 2011
at 01:41 AM

Some docs could use a few visits to WebMD for continuing education.

32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on November 17, 2011
at 11:32 PM

I bet doctors love armchair doctors with WebMD degrees. ;)

0
9530dbed146bb4bf9307a4e4c1dde896

on November 17, 2011
at 08:49 PM

When you find a dr who will listen to you and knows what the heck they are doing, I'd get a test for Hashimoto's antibodies also. That can manifest as hypothyroid but is really a whole other animal to tackle!

543a65b3004bf5a51974fbdd60d666bb

(4493)

on November 18, 2011
at 09:00 PM

although, this guy has Hashimoto’s & he takes Iodine; see here http://perfecthealthdiet.com/?p=3621 & http://perfecthealthdiet.com/?p=3650

Medium avatar

(39831)

on November 17, 2011
at 09:58 PM

That's a good point...you wouldn't want to start taking iodide if you have that.

543a65b3004bf5a51974fbdd60d666bb

(4493)

on November 18, 2011
at 09:15 PM

although, this guy has Hashimoto’s & he takes Iodine (& Selenium); see here http://perfecthealthdiet.com/?p=3621 & http://perfecthealthdiet.com/?p=3650

543a65b3004bf5a51974fbdd60d666bb

(4493)

on November 18, 2011
at 09:13 PM

although, this guy has Hashimoto’s & he takes Iodine (& Selenium); see here perfecthealthdiet.com/?p=3621 & perfecthealthdiet.com/?p=3650

0
E7e57f3e3a156df4072ca85d463f8ed3

(358)

on November 17, 2011
at 07:41 PM

If you haven't gone for the blood draw yet, check the T3 box yourself!

3eca93d2e56dfcd768197dc5a50944f2

(11697)

on November 17, 2011
at 07:43 PM

The blood draw was already done, minutes after I got done with my doctor I'm afraid.

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