Originally Posted by waves

Please ask her for a referral to an endocrinologist. Even a good internist could handle it but endocrinologist is exactly the "right" specialist.

FT4 (free T4) is usually tested because it is what the body can use. Even if T4 is normal, part of it can be bound by pathogens or other substances that essentially render it unusable. The free fraction might still be low. If repeat testing shows TSH is persistenly elevated AND Free T4 persistently low, then a hypothyroid condition is present. Also useful/common is a test for Hashimoto antibodies -- if positive, thyroid parameters must be rechecked periodically and eventually you'd need supplements.

You can also have a complete thyroid panel out of pocket for about $50 through an independent lab if they won't script it or insurance gives you a hassle. Not sure if that would cover Hashimotos.

I've had T4 low before but it was transient. I think I had TSH high once but also transient (and T4 was fine). I was given Synthroid (T4) and Cytomel (T3) when my values dropped due to Carbamazepine. My TSH was fine. My internist made a written note to the doctor who prescribed the thyroid meds, saying that she felt it was dangerous to supplement, because it risked eventually shutting off my thyroid. The endocrinologist I saw said there was no reason to supplement -- reference ranges are statistical, if a person is slightly off but symptom-free, the only recommendation was to retest.

The other side of the coin/my pdoc's perspective. Subtle symptoms can include mood-cycling. My pdoc felt supplementation could help my cycling. That approach is however controversial. No way to tell if it did help or not, either, as I was taking gobs of psych meds.

waves