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Dr. David
Dr. David, Other
Category: Endocrinology
Satisfied Customers: 45619
Experience:  Experienced physician, undergraduate studies at MIT, studied Engineering, qualified to answer your questions.
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I think I have an issue with hypothyroidism but my doctor

Customer Question

Hello, I think I have an issue with hypothyroidism but my doctor will not send me to an endocrinologist b/c my lab results are within the reference range (barely).
JA: Have you seen a doctor about this yet? What medications are you taking?
Customer: I have seen my PCM who is a P.A. about it and I take only birth control.
JA: Anything else in your medical history you think the doctor should know?
Customer: I have a strong family history of hypothyroidism, and 1st degree relatives with autoimmune disorders, celiac disease and insulin resistance
Submitted: 8 months ago.
Category: Endocrinology
Customer: replied 8 months ago.
I had my free T4 and TSH tested in June 2016. They were 0.91 ng/dL and 1.17 mcIU/mL respectively. When I had them tested again in September they were 0.80 ng/dL and 2.36 mcIU/mL. The reference range used for free T4 is (0.76-1.46) and for TSH is (0.358-3.74). In my opinion this seems like a pattern indicating that my thyroid is breaking down. My fasting glucose is normal (92 mg/dL) . Cortisol, RT3 and TBG have not been tested (because my PCM does not think its necessary because and I quote, "nothing is wrong with you.") My Eosinophil count is high (7.1% with a ref. range of 0.2-5.9) and my ABS eosinophil count is high (0.42 x 10(3)/mcL with ref. range of 0-0.4) and my vitamin D is low (21.9 ng/mL with ref. range of 30.00-100.0)
Customer: replied 8 months ago.
Posted by JustAnswer at customer's request) Hello. I would like to request the following Expert Service(s) from you: Live Phone Call. Let me know if you need more information, or send me the service offer(s) so we can proceed.
Customer: replied 8 months ago.
my insurance works on a referral system and my PCM is a P.A. and she will not put in the referral to see an endocrinologist about this b/c all my lab results are within the normal reference range though just barely so
Expert:  Dr Stan replied 8 months ago.

Hello this is Dr. Stan and I will assist you with your question today. I am board certified and I have 40 years of patient experience. I will be happy to help you today. I'm sorry you are having this problem. What type of symptoms are you having that make you feel you are Hypothyroid? Has an RA test been done?

Expert:  Dr Stan replied 8 months ago.

I will initiate the phone call.

Customer: replied 8 months ago.
I have gained weight (13 pounds in 2 weeks--this has happened 2x now), my hair is falling out, nails breaking, low energy, cold all the time, joint pain. Yes I was tested for RA when I was 19 and I have no RA factor
Expert:  Dr Stan replied 8 months ago.

I agree that you should see an Endocrinologist. Can you call your insurance company and explain what is happening. They must have a customer service representative you can speak with. I don't think your problem is hypothyroidism, but you may have an Adrenal or Pituitary problem that needs to be worked up.

I am available to answer any additional questions you may have. Thank you for allowing me to provide assistance. I hope your medical problem(s) are resolved soon and you feel better. If you find the information I provided helpful, please rate me with 5-Stars. Thank you

Customer: replied 8 months ago.
what makes you think it is adrenal or pituitary and not hypothyroidism if my TSH level has more than doubled within 2 months and my free T4 has fallen?
Customer: replied 8 months ago.
my insurance works via a referral system. no referral from PCM = no coverage. most endocrinologists do not allow self-referrals nor do they allow for no referrals.
Expert:  Dr Stan replied 8 months ago.

Your lab results don't point to thyroid at this time even though the numbers have changed, they are still in the normal range. Adrenal, because of the weight gain, lethargy, and feeling cold. Just because your PCM won't write the referral, you may still be able to get one based on your symptoms by calling customer service. It's worth a try.

Customer: replied 8 months ago.
Only PCMs can write referrals in the system I have. My TSH level DOUBLED. DOUBLED. my free T4 is 0.04 over the MINIMUM. are you kidding me that you don't think that's a thyroid-related problem? are you even an endocrinologist? do you even know the difference between a functional range and a reference range? or have ANY perception of the fact that what is referenced as "normal" may not be normal for someone who is my height and weight. THERE IS SOMETHING WRONG.
Expert:  Dr. David replied 8 months ago.

This is Dr. David

I am another expert here.

in some patients, it can be very normal for your TSH levels to vary between 0.3 and 3.0 range and be normal. it is the job of your pituitary gland to adjust the levels of TSH hormone depending on how much thyroid hormone your thyroid gland is producing.

endocrinology doctors don't tend to worry about TSH levels "doubling" from 0.91 to 2.36. we don't look at it that way.

these changes don't point to a "breaking down" of your thyroid gland.

you can ask your doctor for more blood test to check for anti thyroid antibodies such as anti thyroid peroxidase antibody and anti thyroid globulin antibodies to see if these are elevated which can be a sign of autoimmune hashimotos thyroiditis which can inflame the thyroid and cause your levels to go up and down.

let me know if you have questions.