I with the tiny Cytomel tabs were easier to spit, so I could take my dose in morning and afternoon to adjust for the short half-life, because 3pm-6pm is a s-l-o-w tough time of the day for me, until my second wind kicks in a bit after supper.

Beroul82 is so right about the doc lists; it’s still necessary to check docs out and chose carefully. Might still take trying several docs; lucky strikes are exceptional. And I don’t mean finding one that will obey the patient’s every order, but rather finding one that can work as a team and welcomes the patient’s input. But the lists are still a more targeted aim than the crapshoot choosing a cookie-cutter doc in an HMO network directory or by random system assignment.

I just had an appt with an out-of-network (out-of-pocket) doctor who is certified in family medicine but takes a holistic approach to health care/prevention and is well versed with bioidentical hormone balancing. Wow! What breath of fresh air. First consult – a relaxed 1.5 hours with an in-depth history and great questions about all areas of my life – diet, habits, past and current health issues, social and relationship support network, etc! New Patient health form I had to fill out and bring to first appt was 11 pages long and took over two hours to complete! I am encouraged!

For the most part, we had similar views on the important stuff and the differences were minor. After my lab results come back (this time *with* test results for thyroid antibodies and reverse T3 tests!), we’ll talk again about a trial on Armour or a compounded natural thyroid extract so I can see how that feels compared to the T4/T3.

I was sent home with a new binder with my paperwork, articles, supplement recommendations though I already take nearly the same ones (without a sales pitch, too, though I saw products for sale), and a suggested reading list. I was thrilled to see her recommended reading list was nearly the same as my library of books, including the one we’re using to try to regress the plaque accumulation detected in my husband’s coronary arteries last winter. I’m having my husband see her next week, too. This doctor was recommended to me by the manager of the vitamin/supplement dept of a nearby store, a woman whose opinion I’ve grown to trust in general, perhaps even more now. I’d been thinking about trying her out after my last endo visit in April, and esp when I realized she might be better than the statin-pushing GP my husband goes to.

And this doctor’s practice wasn’t like the other one I considered whose website initially seemed similar in focus, but whose receptionist spent most of the my initial phone call promoting “aesthetic medicine” like face peels and wrinkle-filler (might be a great doc, but I don’t want to sit in a waiting room full of with Botox victims nor have it peddled to me – though I know it’s big biz in this part of the world). Living in coastal San Diego, there are a LOT of independent docs who are waaaaay out from the mainstream, many are a lot farther out than I’m ready to swim. It has to be the right fit and it’s worth the search.

So even if the next doc visit doesn’t go well, keep at it as long as you need to to find the right doc. I know that’s inefficient, but the system works against those of us who don’t leave everything up to the docs, with hypothyroid issues in particular. If you think you’re having it bad, consider that hypothyroid men have to deal with too many docs who see the condition as a “fat, frumpy, depressed middle-aged woman’s complaint”.

Well, actually, I no longer have any intention of seeking self-treatment. When I made my previous comment, I was in a mild manic state, so my judgment was somewhat impaired.

I’m cognizant of the potential dangers of triodothyronine, and as I said before, I would never undertake any action that might endanger my life. Even in mild states of mania, I always come to my senses when dealing with actions that might have a long term impact on my health. I suppose I’m lucky in that regard.

Based on previous blood lab work, and because I suspect the conversion of T4 to T3 hormones is impaired, I still have a preference for Cytomel. But, should my request for Cytomel be granted, I will only agree to begin with a small dosage, no more than 50mg. And, to ensure my safety, I will also request close monitoring, which the prescribing physician will doubtlessly demand anyway. However, I’m also amenable to using other thyroid medications.

As it happens, I’ve discovered a few suitable internists specializing in treating conditions that are of some concern. And, since I’m feeling well enough to satisfactorily fulfill most of my daily responsibilities, I see no reason to take drastic actions. I just need to find a way to sustain an equilibrium in my moods. And with my recent adjustment in my medication (as of today), I feel like I’m closer to that equilibrium.

Again, thanks for your concern. I’m eager to hear more about your progress.

So, although patient reviews are somewhat helpful, it’s difficult for me to abandon my skepticism. To be sure, there seem to be some excellent physicians on Shoman’s list. It’s just that I’ve had too many encounters where the physician failed to live up to the praise of former patients.

Like I said, I’m still considering visiting a physician, but this time, my standards have to be higher. An impeccable background and published work on the subject are the most highly desired among other qualities. I’m tempted to arrange a consultation, and make a trip out of state to see someone like Fava or Nierenberg, whom might also be able to refer me to an internist or endocrinologist that meets my standards. But, I fear it might take more than the allotted time to go over my case history.

As for the use of Cytomel, I would be very reluctant to exceed the doses administered to subjects of previous studies. At this time, I’m too obsessed with longevity and the quality of life.

And, the effect that triodothyronine has on brain bioenergetic metabolism:
http://www.ncbi.nlm.nih.gov/pubmed/16946176?ordinalpos=143&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

As an added note, two of the authors of both studies, Maurizio Fava (Massachusetts General Hospital and Harvard) and Andrew Nierenberg (Harvard), are quite renowned in the field of psychopharmacology. Combined, both men have contributed to over 400 journal articles.

Well, first off, don’t give up hope of finding someone who can help yet. There are lots of doctors out there who are willing to work with patients who have hypothyroid symptoms but “normal” blood levels.

Mary Shomon has a really good list of thyroid doctors on her site. It’s also worth asking around on the patient advocacy sites and the thyroid yahoo groups for recommendations. In addition, I believe the guy who wrote the pages into the connection between bipolar disorder and hypothyroidism is still in practice.

I would be more cautious about using a T3 prep than I would be a T4 prep. T3 is the active hormone, so you are more likely to experience adverse effects from taking too much. T4 has to be converted to T3 in the peripheral tissues, and the body is better at regulating how much it needs (conversion problems not withstanding).