So I went to the gyno for some problems I've been having and for one of them she decided to run some blood work to check my thyroid levels. Well my rheum usually runs them a few times a year because she has suspected from symptoms that there was something wrong with it in the past but nothing ever turned up abnormal. The gyno office called yesterday and told me my TSH was elevated and to call my rheum to see if she wanted to do more tests and all that. Normal range is like 0.5-4 and mine was 6 something. I've asked around a few other places but knew I would get some of the best info here so I have something useful when my rheum calls me back on Monday.
A TSH that is elevated like that likely means you are hypothyroid-- that is, your thyroid is not producing enough thyroid hormone. TSH (thyroid stimulating hormone) is produced by the pituitary gland to get the thyroid to make its hormones, T3 and T4. When thyroid hormones get too low, TSH goes up, so a high TSH generally indicates hypothyroidism.
There are a few causes of hypothyroidism, but a common one, especially for people with AI disease, is Hashimoto's thyroiditis, which is autoimmune thyroid disease. To check for this, you rheumatologist should re-check your TSH, check your T3 and T4, and for anti-thyroid antibodies: Thyroid peroxidase antibody (TPOAb) and Thyroglobulin antibody (TgAb). If you have high levels of those antibodies, it means you have Hashimoto's.
I have Hashimoto's. For me, it has not been a big deal. I've had it for six or seven years now, and all I do is take a Synthroid pill every morning, and I'm fine. I do have to get my TSH and T4 checked every six months or so, because Hashimoto's can make your levels go up and down, and your dose of Synthroid has to be adjusted accordingly. My dose has been tweaked up and down a ton of times.
Once I started on Synthroid, my symptoms went away, and I'm doing fine on that front. Some people have a harder time than I did, but for most people, thyroid hormone replacement is all you need to deal with that.
Let me know if you have any other questions about thyroid problems. It's one thing I'm pretty familiar with!
About the same here with me Ritz. My experience with Hashimoto's is very similar to Derrie's. The only differences being that I've had mine for over 10 years, and that I had to change doctors in order to find it. My old doctor used the TSH blood test only, and when you first start on Hashimoto's, as Derrie says, you'll go up and down with the TSH level. (My thyroid is almost "dead" now.) My doc at the time, never thought a 6 level was bad enough to warrant further investigation. "... it's just elevated a little bit, and that's fine..." I felt like a worn-out old man (still do, but I are one now). If he would have done the other blood tests, he would have found that my T3 & T4 levels were low. By the time I changed doctors, my levels were at dangerous levels. It took me about 3 years to find the correct levels, and we've had to increase my doses a few times over the years, in order to keep up with my failing thyroid gland. I take synthroid and cytomel each day WOF (With Out Fail), even when I had my adverse reaction to a drug, I still took my synthroid, and the first drug I'm taking since "recuperating", is the cytomel. It's important stuff. There are a few "natural" hormone replacements, such as Armour, that might be used instead of the synthetic stuff (hence the "syn" part of the "synthroid" name). The doc also tracks my vitamin D level, since it's very important for hormone absorbtion from the pills. It's no big deal to have it, but it is important to pay attention to symptoms (which are similar to your other symptoms), and to medicate properly with consistent doctor monitoring and consultation. The thyroid regulates just about everything in your body...
I'd like to echo jmail that taking vitamin D and calcium is important when you're on thyroid hormone replacement like Synthroid! Synthroid can interfere with calcium absorption and bone density, and keeping up on your D and calcium minimizes that.
If you don't get it regularly checked, I'd ask to have your Vitamin D level checked, too. When I first had mine checked, three years after I started Synthroid and after I randomly started seeing a new doctor because I'd moved, I was surprised to find my vitamin D level quite low! Now, I take vitamin D and calcium every day.
I'm just catching up here. I'm glad that the gyno caught this. Perhaps now you can finally get some answers out of your rheumy.
Well I finally got a call back today from my rheums office and it was kind of stupid. "She says that from the results from your other doctor your TSH is mildly elevated. She wants you to ask if your primary is comfortable treating it or to have him recommend an endocrinologist." She didn't take any more blood work, check for thyroid antibodies or anything like I thought she would. She, yet again, pushed me off onto other doctors when I'm sure she could have prescribed something. Or why couldn't she have just recommended a doctor instead of making me call and bug my primary? That poor man is probably sick of me calling him about stuff that he says she definately could help me with, she just chooses not to.
You ARE probably better off with an endo keeping tabs on this. GPs can be a bit clueless about endocrinology. It's one of the hardest specialities.
I know it's a pain getting someone else involved for the referral but if you're in an HMO perhaps that's the only way?
Ritz, a few things--
Originally Posted by ritzbit2
First, your rheumatologist was right to refer you to another doctor for management of your hypothyroidism. That's not a rheumatologist's area of expertise. Managing hypothyroidism involves more than just prescribing thyroid hormone replacement-- a doctor has to check your thyroid levels regularly and adjust your medication accordingly. That is why she didn't just prescribe you something. Managing thyroid levels can be twitchy, and it's outside the box of what a rheumatologist does.
Second, your primary care doctor may actually be the best person to deal with this. Hypothyroidism is quite common, and unless you're a particularly difficult case, your primary care doctor is probably perfectly equipped to manage it. My Hashimoto's was diagnosed by a former primary care doctor (who ordered the thyroid antibodies and everything) and is managed exclusively by my current primary care doctor. I have never seen an endocrinologist for it, and unless you and your primary can't get your levels stable, it's probably not worth the trouble of dragging a new, unfamiliar doctor into the picture. So, I would suggest giving it a go with your primary care doctor. When you see him, ask him to check your thyroid antibodies. There is no reason why he shouldn't.
Finally, do not feel bad about "bugging" your primary care doctor-- that is what they're for! Our primary doctors are our first line of defense when something new comes up unless it's very clearly related to what we see the rheumatologist for. Newfound hypothyroidism is exactly the kind of issue a primary care doctor should evaluate first. Then the two of you can decide together how to go forward with treatment or whether to refer you to another specialist.
Keep us posted!
I'm kind of out of it right now so sorry if this doesnt make sense. Called doc and left message and he is supposed to call me back on Monday because he isn't in the office. I have been stressed for the past two days wishing I had decided to take the year off because I might not be able to afford my fall classes. Trying to find some help. and a bit off topic but have any of you ever had a really high pulse rate and pretty low blood pressure? Should I be worried about it? With all this stress and craziness I've been feeling terrible, so I used my home monitor to take my blood pressure to see it I had made it go up like crazy. My normal bp is between 120/80 - 132/85 and my resting pulse is usually 120-130(maybe little higher). When I just took it my BP was 98/65 and my HR was 157. Doesn't blood pressure usually go UP when stressed....? I've also never had my bp go under my norm.
I feel like epic crap.
I can't answer any of your questions, but I just wanted to send you a great big cyber HUG.
I know it's difficult, but try to de-stress. Getting a college education has become very difficult in this country lately.
All I can tell you is to hang in there and keep trying.
LOTS of HUGS,