July 2010

Q. I was diagnosed with Grave's Disease Hyperthyroidism in January 2008 and have been in remission since September 2009. I was on Methimazole (MMI) for 18 months until I was healed completely, thru excellent diet and exercise.

I found a good doctor (endocrinologist) who was cooperative in requesting labwork for FT3, FT4 and TSH levels whenever I told him I wasn't feeling well, (which was usually after each successive MMI dosage reduction.)

He always complied with my request, knowing the labwork would reveal if my new dose was still too high, or not high enough, so that I could keep my FT4 levels within the reference range as I was healing.

It was because of this constant labwork monitoring (sometimes as often as every 2 weeks), that I was able to tweak my MMI dose to as close as ideal as possible, controlling my FT4 levels and keeping myself feeling as well as possible thru my bumpy road to recovery. I would shave down my MMI dosage little by little over time, when it was appropriate to do so, when my bodily symptoms told me it was time, and when the labwork affirmed and backed up what I was experiencing symptom-wise. The point being, that FT3, FT4 and TSH labwork was a vital and indispensable tool in guiding me along my journey to recovery.

Now to my question - I have a friend and co-worker who has been diagnosed with a mild case of HypoThyroidism, (the opposite side of the same coin as HyperThyroidism.) She takes Synthroid medication, but like me, she has gradually been able to reduce her dosage over time as her body continues to heal thru excellent diet and exercise.

Unfortunately her doctor is not cooperative as mine was, he is not willing to grant her request for FT3, FT4 and TSH labwork after she has told him she doesn't feel well, (also usually after a dosage reduction in Synthroid.) This is extremely frustrating because like me, she needs the labwork results to affirm if she has "outgrown" her current Synthroid dose and needs to reduce more or not.

QUESTION: Does a patient who has been diagnosed with HyperT or HypoT, **AND** who has been approved for FT3, FT4 and TSH testing, have the right to demand a FT3, FT4 and TSH blood test from her doctor?

A. Treatment of hypo and hyperthyroidism represents completely different challenges. In your case, the half life of the MMI is short and can quickly lead to changes in thyroid function, and you want frequent monitoring as there is no way to predict how much excess thyroid your gland is making at any one time so the "dose" of MMI is unpredictable and varies - along with potential signs of toxicity and more frequent blood work makes sense.

On the other hand, an underactive thyroid means there is virtually no or too little production of thyroid by the gland and it does not very very much - plus the treatment Synthroid is very long acting and safe without need for close monitoring. The dose of Synthroid is fairly predictable - although it is best to increase slowly every 6 weeks or so on average and blood work on an every 6 week basis until the TSH is in range and you (the patient) feels okay makes sense.

The standard of care would not typically be breached to only check blood work every 6 weeks until stable and then every year or more often is symptoms change.