Hi Elaine,

I wrote not too long ago, but I'm writing again because I finally saw my new endo since my old one left town back in April.  She had already recommended I go back on PTU through her nurse on the phone in June after my labs showed TSH going ever so slightly below their "normal" to 0.31 (I did not start taking PTU again.)  So I didn't hold back and tried to discuss all my concerns with her honestly.  Essentially what she shared with me was that my 'symptoms' of being slightly hypo are so vague that they could be attributed to other things.  (See my most current labs below.)  Even though she recognizes me as being in remission now, she would prescribe ATDs again in a heartbeat if my TSH went below 0.4 again.  I asked about block and replace and she said it is extremely risky and not at all proven to be effective.  She said if I refused to take ATD's they might have to list me as being non-compliant or something like that.  I tried to discuss the fact that since my antibodies tend to stimulate my thyroid, my TSH will always be lower than that of others', and it's my FT4 and FT3 that matter more.  She said that if my TSH is low, then it is telling us that, regardless of what the 'normal' range is for them, my FT4&3 must automatically be high for my body's needs.  I'm afraid I may have come off as a bit confrontational at first, but then again some of her responses were discouraging to say the least.

In the end, she said that she might be willing to do bone density and heart tests to make sure my body wasn't suffering damage due to hyperthyroidism, and if not, withhold ATDs even if my TSH is a little low.  And at least she does look at TSI usually to predict remission.  She said she does respect the opinions of the ATA and AACE, but I have trouble finding strong research from them to back myself up sometimes.  She said that while the ATA and AACE have different normal reference ranges for TSH, every lab is different, and she tried to explain to me in a bunch of scientific jargon why that is acceptable.  Maybe I could try bringing in your book, but I have the feeling that even that would not be good enough for her.

Bottom line is, I may not want to continue to see her, but I'm reluctant to break of all ties to an endocrinologist if I don't have to.  Perhaps especially if I do try to get pregnant within the next year or so.  Do you know of any ATA or AACE literature that would be helpful in this case?  This isn't particularly urgent since I don't have another appointment scheduled with her for 6 months, and the way my labs are looking, it's possible I've gone from hyper to slightly hypo- or hopefully euthyroid permanently.

One more thing by the way, is there any evidence of hot weather causing the thyroid to produce less?  I'm in Austin and we are having the hottest summer on record with this being our 58th day so far over 100 degrees Fahrenheit.  Thanks!

6/08/09: TSH: 0.31, FT4: 1.0, FT3: 3.0

7/20/09: TSH: 1.24, FT4: 1.0, FT3: 3.2, TSI: 102%

08/07/09: TSH: 0.47, FT4: 0.9

Amy