Seven Questions to Ask Your Doctor About Hypothyroidism

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When hypothyroidism sets in after RAI or thyroidectomy, or you're diagnosed due to Hashimoto's Thyroiditis, here are some critical questions you should ask your doctor, and some information on how to understand the results.

What is the normal TSH range at the lab you work with?

Different labs have different values for what is normal. The endocrinology community says that normal range is actually .3 to 3.0.

But at the lab my doctor uses, the normal range is .5 to 5.5. A TSH of less than .5 is considered hyPERthyroid, and a TSH of more than 5.5 is considered hyPOthyroid by conventional standards. Other labs might use .35 to 5, or .6 to 5.2, etc., but it's important for you to know the values at YOUR lab. 

What TSH level will you target for me?

This is a very loaded, but VERY important question. Your doctor's answer will tell you her or his philosophy about "normal" TSH. Some doctors believe that getting you into the very top of the normal range is their sole objective, and then the job is done. So, for example, using the 5.5 TSH level from my lab, that sort of doctor believes that getting me to somewhere around there constitutes full treatment.

Other doctors believe that certain TSH levels within the normal range are more appropriate targets. My endocrinologist, for example, believes that women don't feel well (and can't lose weight or get rid of other hypothyroidism symptoms) unless TSH is down between 1 and 2, far below the higher end of "normal." (There are some research reports that have shown that the average TSH of a women without thyroid disease is 1 to 2, so that may be why some women don't feel well at 4 or 5.) She aims to make sure you feel as well as possible within normal range, but finds that on average, women don't feel well at the higher end, so she aims to take it lower.



Some doctors are up on the latest news, and know that in 2003, the American Academy of Clinical Endocrinologists determined that the old .5 to 5 normal range was too broad, and that normal reference range should be 3 to 3.0, meaning that more people are considered to have a thyroid condition. 

And finally, there are doctors who believe that managing your thyroid is a combination of TSH AND how you feel.

These are doctors who treat you like a patient, not a lab value! These doctors might say "well, let's get you into the normal range, see how you feel, and adjust the dosage from there."



What thyroid hormone replacement have you prescribed for me?

Since you probably can't read the writing, you'll need to ask! The issue here is, brand name or generic, and if a brand name, did your doctor specify "no generic substitutions." Brand name thyroid hormone replacement (i.e., Levoxyl, Synthroid, Tirosint for the synthetic T4-only drugs, or Nature-throid and Armour for the natural desiccated thyroid drugs), are considered reliable. Generics can be erratic, and should be avoided for new prescriptions. (Of course, if you're on a generic and doing fine, don't worry about it!)

How quickly can we expect my TSH to return to normal, given the dosage you've prescribed?

What you want to know here, is, is your doctor giving you a teeny bit of thyroid replacement, and intending to see what happens very very slowly, or is he/she going to get you into the normal range as fast as possible. There are reasons for taking both approaches, but it's important to know. Some doctors will put you on a tiny dose, then tell you you'll feel better in two weeks. When two weeks come and go, and you don't feel better, you think something's wrong with YOU. HAH! My doctor put me on a middle-level dose, but told me that it takes a while to get hypothyroid, it takes a while to get back to normal. She said around four months till I'd feel close to normal after starting the thyroid drugs, and she was right.
  How often will you test my TSH until I get back to feeling well and in the normal range?

What you want to hear is that the doc is going to stay on top of getting you into normal range. This means probably seeing you every six to eight weeks for a TSH test, followed up with an adjustment to your dosage, until you're feeling better and TSH results are normal.

After I'm in the normal range, how often do you suggest I come back for a TSH test to make sure my dosage requirements haven't changed?

If the doc says you only need to come back once a year, or even less than that, start wondering. Most doctors recommend every six months in the first year or two, and every year thereafter, or more frequently when necessary.
  If I have questions between appointments, how can I best get in touch with you? Do you return calls yourself, or do your nurses? Do you have an email address for patient correspondence?

Here, you can gauge how available the doc plans to be. And if you have the option of looking for another doc, the response here may help you decide if you'll stay or go. Some docs will return calls themselves, or even answer email. Others will refer all questions to the nurses (who, by the way, often have just as good or even better info, so don't write that off as an option in some cases!) But if you want personalized, hands-on service, listen to what your doctor says here, because you'll get an idea of what to expect.

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