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Suggest Treatment For Hypothyroidism
Posted on
Wed, 17 Aug 2016
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Wed, 17 Aug 2016
Answered on
Tue, 6 Sep 2016
Last reviewed on
Question : I have been on Armour thyroid 30mg for 8 yrs. I haven't had blood tests for almost 2yrs, except for cholesterol. I recently had a CBC & a thyroid panel. The CBC was in the normal range, except for the cholesterol. My TSH was 164.6, T4 - 2.7, T3 - 23. In previous tests the TSH has never been over 4.35, T4 & T3 was in the normal range. I got to see my PA, and I am scheduled to have an ultra sound in 2 weeks. I did get him to raise the Armour to 60mg, but I felt it should be a lot higher. I have also read that a 60yr old woman has over a 60% chance of having nodules. I have also checked with the local endocrinologists for an appointment, and it is almost 2 months before I can see one. Can I find what the suggested treatments and dosage should be ? We are also planning a 2 month vacation for the near future. Should this be postponed, and is there anyway to get treated earlier. I am 68 and stressed out. I have lost confidence in my GP. Thank you !
Brief Answer:
Thyroid
Detailed Answer:
Sorry to learn about your challenges regulating your thyroid.
Moreover, as you have correctly surmized the other major challenge is finding an endocrinologist to treat you promptly, especially with the imminent vacation and grossly elevated TSH.
Most endocrinologists do not recommend Armor to treat the condition you have which is called Hypothyroidism. A medication called levo thyroxine is preferred.
It is not feasible to guide you on an online forum regarding which specific dose to start because this requires a thorough in-person evaluation and several follow up visits over the course of several months.
When I see someone like you in my practice, I typically order the following blood tests in addition to a detailed physical examination:
CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
None of these tests require any fasting and can be done at any time of the day
Thyroid
Detailed Answer:
Sorry to learn about your challenges regulating your thyroid.
Moreover, as you have correctly surmized the other major challenge is finding an endocrinologist to treat you promptly, especially with the imminent vacation and grossly elevated TSH.
Most endocrinologists do not recommend Armor to treat the condition you have which is called Hypothyroidism. A medication called levo thyroxine is preferred.
It is not feasible to guide you on an online forum regarding which specific dose to start because this requires a thorough in-person evaluation and several follow up visits over the course of several months.
When I see someone like you in my practice, I typically order the following blood tests in addition to a detailed physical examination:
CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
None of these tests require any fasting and can be done at any time of the day
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr. Topiwali,
I want to thank you so much for taking the time to respond. You are a very special person and Dr. to even respond. I have all of the tests above, but I only have a single A1c. Everything was in the normal range. I know you can't prescribe the treatment. I am mainly worried on how soon something should be done. I know that 60 mg of Armour isn't going to make much difference. I know I am not going to get any real help from my GP. He is retiring and the PA is working. Is it dangerous to have the TSH that high and T4 & T3 low ? I know there will be nothing else done by my PA. I will have to see an endocrinologist. Could this be life or death or just feel terrible for a few more months. I can't thank you enough for any help. Thank you !
I want to thank you so much for taking the time to respond. You are a very special person and Dr. to even respond. I have all of the tests above, but I only have a single A1c. Everything was in the normal range. I know you can't prescribe the treatment. I am mainly worried on how soon something should be done. I know that 60 mg of Armour isn't going to make much difference. I know I am not going to get any real help from my GP. He is retiring and the PA is working. Is it dangerous to have the TSH that high and T4 & T3 low ? I know there will be nothing else done by my PA. I will have to see an endocrinologist. Could this be life or death or just feel terrible for a few more months. I can't thank you enough for any help. Thank you !
Brief Answer:
Follow up
Detailed Answer:
It is indeed unsafe to run a TSH this high. If I were you I would immediately see an endocrinologist.
Perhaps you could consider going to the ER with these reports and see if they are willing to prescribe a reasonable starting dose of levo thyroxine to you, until such time as you get an an appointment with an endocrinologist.
Alternatively, you could urge your PA to prescribe it for you. Deciding the dose requires the opportunity to thoroughly evaluate you and so I cannot comment on that here
Follow up
Detailed Answer:
It is indeed unsafe to run a TSH this high. If I were you I would immediately see an endocrinologist.
Perhaps you could consider going to the ER with these reports and see if they are willing to prescribe a reasonable starting dose of levo thyroxine to you, until such time as you get an an appointment with an endocrinologist.
Alternatively, you could urge your PA to prescribe it for you. Deciding the dose requires the opportunity to thoroughly evaluate you and so I cannot comment on that here
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I appreciate your concern and care. Do not worry, I have found an endocrinologist that will see me Monday. Your care and concern has helped me to think more highly of the medical profession. It was very refreshing to find a Dr that would actually put another persons care above their own interests. I just hope that there are many more like you. Thank you, again.
Brief Answer:
Best wishes
Detailed Answer:
for good health
Best wishes
Detailed Answer:
for good health
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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