Hey doc, had a question for you regarding my wife. She’s been having metabolism issues for years, slowly building to the point where she is now. She is 5’11", currently in the 230s (if she hasn’t gained more weight, not sure since I am overseas currently). She is very strict with her diet and really doesn’t eat much total calorie-wise, but if she deviates even a little she will gain weight very easily. Losing weight is basically impossible. She went through our PCP in late spring/early summer to have her thyroid checked, doc would only test TSH and T4 levels (she said insurance wouldn’t cover anything more unless an issue were identified). I had read up on this myself, so I ordered a full thyroid panel online. Her numbers were all within ‘normal’ range, though they were on the low end - T3 was barely within normal. Her thyroid antibodies (forget which one) were elevated a decent amount. I don’t have her lab numbers with me, so I am going off memory. PCP referred her to an endo, took from June-ish until mid-December before she was able to be seen. Endo seemed very unimpressed with her symptoms, didn’t seem like she could be bothered to help at all, put her on T4 and scheduled a follow up. She saw no improvement on the T4, however when she first got the prescription we (she and I) had a little miscommunication and she took some T3 I had thinking they were the same drug while waiting for her T4 prescription. She took the T3 for almost two weeks before I realized her scrip was for T4 and not T3 (again, I was overseas going off what she was reading to me over the phone with her dyslexia).
She saw almost immediate results in symptoms while on the T3, but I told her to stop and take the T4 since that was the scrip (and I didn’t have much anyway - it was maybe 30 tabs for free when I ordered something else). She has seen no improvement whatsoever on the T4. She had her follow-up with the endo today (just a little while ago in fact), and I pre-loaded her with asking for a T3 scrip by talking about conversion issues, etc. (as did a PA friend of ours) Endo told her ‘we don’t prescribe T3 any more, unless you’re basically having so many issues that you’re in the hospital already’. Is that true? I’m thinking it’s not, seems like a dumb way to practice medicine.
So to sum up, endo threw T4 at her (didn’t work), refused to even try T3, and completely dismissed her labs that showed elevated thyroid antibodies. At this follow up they took more blood, but she told her they are only going to test TSH, T3, and T4. She (the doc) also told her at the first appointment she didn’t think there was anything wrong with her thyroid, and that if the T4 didn’t help she was going to turf her to a rheumatologist.
Any thoughts on all this? Recommendations?