Hyperthyroid, But Not Really

[gSOLO]

Two years ago during an eye exam, the optometrist mentioned that I should mention hyperthyroidism to my doctor during my next checkup with regards to how he thought my eyes were bulging out a bit. I've had some symptoms of hyper going back 10-13 years (anxiety, heat intolerance &c). The symptoms while still present, seemed to have died down over the past three years. That is until three months ago, when they started hitting me hard. It is at that time that I decided to look for help.

I recently had a RAIU scan, the nurse said it does not support hyperthyroidism (uptake was really low). I have my next appointment in late December. I guess what I'm asking, what are you all's thoughts on it all. I've read a bit, I can't seem to figure it out, and I'm kind of dreading having to deal with all of this for another two months. Among my concerns, I'm currently in college and have been maintaining a 4.0 GPA; now with this recent flare up, I'm failing a class and doing not so good in another. I've been having a hard time focusing and concentrating on things.

Symptoms:

Fatigue, weakness, weight loss, palpitations, tremors, heat intolerance, sweating, anxiety, sleep disturbances. Dryness, redness of eyes. Blurred night vision.

Diagnosed with Hyperthyroidism (10/19)

Ultrasound; Goiter; Thyromegaly (10/22)

"Isthmus measures .39 cm in thickness. Right lobe measures 2 x 2.1 x 7.6 cm. Left lobe measures 2.1 x 2.5 x 6.5 cm. The gland is enlarged in size and homogeneous in echotexture. No nodules are seen. The thyroid extends into the retrosternal region especially on the right. Blood flow is minimal in both lobes."

"While the patient's somewhat long course, and his goiter would favor Grave's disease as the possible etiology, the minimal thyroid blood flow noted in the ultrasound, did not go along with that."

Lab 10/12

THS: .008 (.45 - 4.5)
T3: 6.5 (2 - 4.4)
T4: 2.6 (.93 - 1.71)

Lab 10/19

THS: .007 (.29 - 5.5)
T3-Total: 189 (80 - 200)
T3: 6.15 (2.24 - 4.08)
T4-Total: 11.96 (4.6 - 12)
T4: 2.36 (.64 - 1.64)
Thyroglobulin ABS: < 20 (< 20)

Lab 10/22

Thyroid Peroxidase AB: 14 (< 35)
Thyroid Stimulating Immunoglob.: 97 (<= 125) [% of baseline]

Lab 11/4

6-hour RAIU: Low - 1% (Unknown Range)

Lab 11/5

24-hour RAIU: Low (Unknown Range)

Thanks for reading. If nothing else, I appreciate you all at least giving it a look.

[Andros]

Two years ago during an eye exam, the optometrist mentioned that I should mention hyperthyroidism to my doctor during my next checkup with regards to how he thought my eyes were bulging out a bit. I've had some symptoms of hyper going back 10-13 years (anxiety, heat intolerance &c). The symptoms while still present, seemed to have died down over the past three years. That is until three months ago, when they started hitting me hard. It is at that time that I decided to look for help.

I recently had a RAIU scan, the nurse said it does not support hyperthyroidism (uptake was really low). I have my next appointment in late December. I guess what I'm asking, what are you all's thoughts on it all. I've read a bit, I can't seem to figure it out, and I'm kind of dreading having to deal with all of this for another two months. Among my concerns, I'm currently in college and have been maintaining a 4.0 GPA; now with this recent flare up, I'm failing a class and doing not so good in another. I've been having a hard time focusing and concentrating on things.

Symptoms:

Fatigue, weakness, weight loss, palpitations, tremors, heat intolerance, sweating, anxiety, sleep disturbances. Dryness, redness of eyes. Blurred night vision.

Diagnosed with Hyperthyroidism (10/19)

Ultrasound; Goiter; Thyromegaly (10/22)

"Isthmus measures .39 cm in thickness. Right lobe measures 2 x 2.1 x 7.6 cm. Left lobe measures 2.1 x 2.5 x 6.5 cm. The gland is enlarged in size and homogeneous in echotexture. No nodules are seen. The thyroid extends into the retrosternal region especially on the right. Blood flow is minimal in both lobes."

"While the patient's somewhat long course, and his goiter would favor Grave's disease as the possible etiology, the minimal thyroid blood flow noted in the ultrasound, did not go along with that."

Lab 10/12

THS: .008 (.45 - 4.5)
T3: 6.5 (2 - 4.4)
T4: 2.6 (.93 - 1.71)

Lab 10/19

THS: .007 (.29 - 5.5)
T3-Total: 189 (80 - 200)
T3: 6.15 (2.24 - 4.08)
T4-Total: 11.96 (4.6 - 12)
T4: 2.36 (.64 - 1.64)
Thyroglobulin ABS: < 20 (< 20)

Lab 10/22

Thyroid Peroxidase AB: 14 (< 35)
Thyroid Stimulating Immunoglob.: 97 (<= 125) [% of baseline]

Lab 11/4

6-hour RAIU: Low - 1% (Unknown Range)

Lab 11/5

24-hour RAIU: Low (Unknown Range)

Thanks for reading. If nothing else, I appreciate you all at least giving it a look.

Oh, wow! Hey, welcome to the board. I love these complicated cases but I know you don't. Hmmmmmmmm; well, the thinking cap must go on here.

First and foremost, you do have TSI which is indigenous to hyperthyroid. The healthy person should have none at all.

What do the test results mean?
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that this abnormal antibody is responsible for causing the person's hyperthyroidism.

http://uimc.discoveryhospital.com/main.php?t=enc&id=1516

My second thought is were you taking any anti-thyroid meds prior to and including the uptake scan? Were you taking any substances such as L-carnitine which is goiterogenic? Something may have skewed the test.

Iodine load (contrast agents) limit uptake as does low endogenous thyroid hormone production.

And I do believe that cancer needs to be ruled out.

http://tinyurl.com/y9zpjjp

With the thyroid being substernal, it does raise some serious concerns.

Now, it's your turn...............what does your doctor have to say about all of this?

Here is another possible cause of low RAI uptake..... (follicular cell damage)

http://tinyurl.com/ye3go8z

I am sorry you are so ill; it is very very hard to concentrate on your studies right now. ADD is often co-morbid to thyroid disease.

[gSOLO]

I really appreciate you taking the time to reply.

I have not been on any medications recently, tho I'll mention that I was taking Paxil for anxiety ~9 years ago. More recently, I was taking a Centrum multivitamin daily, but I don't think that contains any carnitine. A few days prior to my first blood test in early October, I made sure to stop taking it and have not taken it since.

Substernal sounded really odd to me as well. The doctor did not mention it to me directly, but I found it after getting a copy of my records today. Cancer does run in my family (mother, aunt, grandmother) so I guess I'd like to rule that out as well. Diabetes (mother, two uncles) and arthritis as well; those are autoimmune related as well I think, but I seem to be okay on those fronts.

I've not talked to the endocrinologist since my first visit with him two weeks ago. A nurse called and conveyed to me the doctors thoughts today, the results of the RAIU test; the nurse noted that we were still on target to not have another appointment until December. Unfortunately, in addition to just a general anxiety, a ever bigger bit of social anxiety has me hesitant to call back and try to get an earlier appointment, or even to call the doc to talk. It was hard enough for me to make the first appointment, heh.

Anyway. Thanks again. You've given me something to look into, and some more questions and info I can bring to the doctor next time we meet.

[Andros]

I really appreciate you taking the time to reply.

I have not been on any medications recently, tho I'll mention that I was taking Paxil for anxiety ~9 years ago. More recently, I was taking a Centrum multivitamin daily, but I don't think that contains any carnitine. A few days prior to my first blood test in early October, I made sure to stop taking it and have not taken it since.

Substernal sounded really odd to me as well. The doctor did not mention it to me directly, but I found it after getting a copy of my records today. Cancer does run in my family (mother, aunt, grandmother) so I guess I'd like to rule that out as well. Diabetes (mother, two uncles) and arthritis as well; those are autoimmune related as well I think, but I seem to be okay on those fronts.

I've not talked to the endocrinologist since my first visit with him two weeks ago. A nurse called and conveyed to me the doctors thoughts today, the results of the RAIU test; the nurse noted that we were still on target to not have another appointment until December. Unfortunately, in addition to just a general anxiety, a ever bigger bit of social anxiety has me hesitant to call back and try to get an earlier appointment, or even to call the doc to talk. It was hard enough for me to make the first appointment, heh.

Anyway. Thanks again. You've given me something to look into, and some more questions and info I can bring to the doctor next time we meet.

You might have to have that sucker out. Don't be afraid though. Confronting our fears most always has a happy ending; especially with the thyroid.

Here is some reading material for you..........

http://www.annals.org/content/125/7/568.full

And we are on to something here............

Thyroid function tests (TFTs), including thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) levels, were found to be consistent with subclinical hyperthyroidism.

Full article.......... http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1163480/

And this site is extremely credible............

http://www.thyroidmanager.org/Chapter17/ch01s13.html

If I were you (and I certainly am not), I would urge for a referral to a thoracic sugeon. Yes, indeed.

Once again, not to worry. I have known many over the years w/ substernal goiter, they had surgery and are T-Totally fine today.

Keep in touch here and I as well as others will help you best we can. If nothing else, we can be supportive.

[gSOLO]

I hadn't thought until now that the radioactive iodine might not be a treatment option. As a younger person (27) the endo and I discussed that maybe med treatment would work, the other option radiation. I guess surgery is something I should really consider. Thanks again for the links!

[Andros]

I hadn't thought until now that the radioactive iodine might not be a treatment option. As a younger person (27) the endo and I discussed that maybe med treatment would work, the other option radiation. I guess surgery is something I should really consider. Thanks again for the links!

With a substernal goiter aboard, I really don't think radiation or meds are a viable option but do bear in mind that I am not a doctor.

And "remember"; you are going to be fine. This is just a little glitch in your life. We will see you through.

[gSOLO]

Well, I talked with my parents a bit and it appears that my grandfather had hyperthyroidism, tho I'm not sure of the cause. In any case, they described some of the extreme muscle weakness, heat intolerance and weight loss he was going through. I can definitely relate... sigh. He was put on some medication that ended up taking care of things for the most part. But I guess there is a hereditary component, which I haven't mentioned to my doctor, not sure that matters all that much.

With that news, I decided to get a blood check. As with the first one, I paid out of pocket instead of going through insurance/doctor. Anyway, things are getting worse it seems...

Lab 11/17

THS: .005 (.45 - 4.5)
T3: 8.4 (2 - 4.4)
T4: 3.05 (.93 - 1.71)

I'm assuming the doctor wanted to wait two months because it might be silent thyroiditis or something, which is supposed to go away on it's own. It's been at least 4 months now with these symptoms, and from what I can tell, it's happened before so I don't know. I think I want to see if I can make an appointment, but I'm not sure what to say. Maybe, "I got some more info I wanted to share with my doctor."

Meh, this sucks.

[Andros]

Well, I talked with my parents a bit and it appears that my grandfather had hyperthyroidism, tho I'm not sure of the cause. In any case, they described some of the extreme muscle weakness, heat intolerance and weight loss he was going through. I can definitely relate... sigh. He was put on some medication that ended up taking care of things for the most part. But I guess there is a hereditary component, which I haven't mentioned to my doctor, not sure that matters all that much.

With that news, I decided to get a blood check. As with the first one, I paid out of pocket instead of going through insurance/doctor. Anyway, things are getting worse it seems...

Lab 11/17

THS: .005 (.45 - 4.5)
T3: 8.4 (2 - 4.4)
T4: 3.05 (.93 - 1.71)

I'm assuming the doctor wanted to wait two months because it might be silent thyroiditis or something, which is supposed to go away on it's own. It's been at least 4 months now with these symptoms, and from what I can tell, it's happened before so I don't know. I think I want to see if I can make an appointment, but I'm not sure what to say. Maybe, "I got some more info I wanted to share with my doctor."

Meh, this sucks.

Yeah, baby! You are really hyper. With a substernal goiter, this is NOT going to go away. May I suggest you see another doctor? I hope you don't mind my saying that is a stupid thing for that doctor to say? A substernal goiter does not go away. If it does, I never heard of it.

It is interesting about your family history but that only backs up the genetic autoimmune component and won't affect your treatment options.

I think it would be a good idea for you to see surgeon about that substernal goiter. At least he or she could give a second opinion here. Wouldn't you feel more comfortable with that at least?

I am worried.

Nonsurgical treatment of substernal goiter with thyroid hormone or radioactive iodine ablation is almost always unsuccessful; in addition, attempted radioactive ablation can sometimes precipitate respiratory distress, especially in elderly patients.1-2 Thyroidectomy is the treatment of choice in patients who are medically fit to undergo an operation. Some authors state unequivocally that the presence of substernal goiter alone, with or without symptoms, is an indication for surgery.13 Others advocate surgery when there are either significant symptoms, radiographic evidence of tracheal deviation or compression, or progressive enlargement of the goiter despite treatment with thyroid hormone for thyrotropin suppression.3-5,11 Thyroidectomy for substernal goiter can be safely performed via cervical incision in the vast majority of cases.

Please read the entire article here................
http://archsurg.ama-assn.org/cgi/content/full/139/6/656

And this.........
http://emedicine.medscape.com/article/849159-overview

Plus this..........
http://www.springerlink.com/content/l75617326188nl47/

You see, you don't want to delay for the more it grows, the more difficult the situation becomes.

I think you will need a thoracic surgeon. Don't be afraid. I know of many who have had substernal goiters and they are at the top of their game today.

[gSOLO]

Just for clarification, the doctor did not mention about anything going away. That's just me trying to rationalize why a two month wait was acceptable. Yeah, I guess whatever the reasoning, it's not really a good thing to just wait and see what happens. It'd be really nice if I could get some sort of diagnosis, so that I at least know what's behind the goings on.

Thanks for the info and the links again. I've got an appointment with the doc setup on Friday. It seems that they had a nifty online form that I can fill out to make the appointment, so that takes all of the anxiety out of the matter. Depending on how the appointment goes, I may start looking around.

I have looked briefly for a surgeon, I have no hesitations going that route if need be. I'm ready to kill this thing and get it over with.

[Andros]

Just for clarification, the doctor did not mention about anything going away. That's just me trying to rationalize why a two month wait was acceptable. Yeah, I guess whatever the reasoning, it's not really a good thing to just wait and see what happens. It'd be really nice if I could get some sort of diagnosis, so that I at least know what's behind the goings on.

Thanks for the info and the links again. I've got an appointment with the doc setup on Friday. It seems that they had a nifty online form that I can fill out to make the appointment, so that takes all of the anxiety out of the matter. Depending on how the appointment goes, I may start looking around.

I have looked briefly for a surgeon, I have no hesitations going that route if need be. I'm ready to kill this thing and get it over with.

I am so glad you have an appt. for tomorrow (Friday 11/20) and we all will be anxious to hear from you.

How are you feeling?

[gSOLO]

Sleep has been getting more of an issue. I'm waking up every couple of hours in the middle of the night, unable to go back to sleep for 15-30 mins.

I've failed a couple tests in one of my classes.

I’m not sure if it’s simply psychosomatic, or if it’s something that has been there for a while but I have just ignored it until now... but I've got a slight discomfort in my neck.

I've been consistently feeling hot more often.

In any case, no real improvement, just things getting worse.

And it seems I wrote down that THS number wrong. It's "<.005" not ".005"

[Andros]

Sleep has been getting more of an issue. I'm waking up every couple of hours in the middle of the night, unable to go back to sleep for 15-30 mins.

I've failed a couple tests in one of my classes.

I’m not sure if it’s simply psychosomatic, or if it’s something that has been there for a while but I have just ignored it until now... but I've got a slight discomfort in my neck.

I've been consistently feeling hot more often.

In any case, no real improvement, just things getting worse.

And it seems I wrote down that THS number wrong. It's "<.005" not ".005"

Eeeeeeeeeeeeeks; that TSH is barely detectable!

Looks to me like Friday is rolling around just in time!! What time is your appt.?

[gSOLO]

10 am Eastern. Today cannot end fast enough, heh.

[Andros]

10 am Eastern. Today cannot end fast enough, heh.

Keeping you in my thoughts and prayers @ 10 AM tomorrow.

Let us hear from you when you are able.

[gSOLO]

The retrosternal stuff is not of a significant level to cause alarm says the doc. The antibodies are within range. Prescribed Methimazole. Next appointment is 1/4/10.

[Andros]

The retrosternal stuff is not of a significant level to cause alarm says the doc. The antibodies are within range. Prescribed Methimazole. Next appointment is 1/4/10.

That is very good news. What does the doctor expect to happen with that? How do you feel about what he said? Do you think you should get a second opinion?

You may find this interesting reading.......

http://tinyurl.com/ykragcm

[gSOLO]

I am to closely monitor my symptoms as the medication is to help with that mostly.

Basically all of the questions I asked of him, and I asked a lot, he seemed to have a good enough answer for me. For the time being, I'm okay with how he has decided to handle things; all the while I'm still holding a preference to get this thing cut out.

Thanks again.

[Andros]

I am to closely monitor my symptoms as the medication is to help with that mostly.

Basically all of the questions I asked of him, and I asked a lot, he seemed to have a good enough answer for me. For the time being, I'm okay with how he has decided to handle things; all the while I'm still holding a preference to get this thing cut out.

Thanks again.

Good deal; we like happy campers around here. We will play it by ear!

[gSOLO]

I got a letter in the mail today, the endocrinologist I've been seeing will no longer be working at the office that I go to. I guess I'll be getting a second opinion on everything, which is a good thing maybe.

It's been two and a half weeks on medication and I haven't noticed much of a difference if any at all. So it probably hasn't had enough time to do anything; that or the dose is too low or it's some thyroiditis and I'm not actually producing too much hormone, or something else. I don't know. Anyway, no change in symptoms.

I got a copy of my uptake test.

11/4/09-11/5/09
"There is essentially no radioactivity projecting throughout the thyroid gland."
6 hrs: 1.0% uptake
24 hrs: 0.7% uptake

Notes from 11/20:

"The patients near-nonexistent uptake on the nuclear scan, as well as his diminished blood flow on the ultrasound study, have strongly suggested a thyroiditis entity as the main contributor to his hyperthyroidism. As such, I had elected to monitor his status for a month, as he would have a strong chance of spontaneous resolution with this entity."

As I guessed, the wait was in hopes that it would fix itself. Interestingly, he said one month, when the actual appointment was two months, but I made the earlier appointment myself. Anyway...

"He continues to be hyperthyroid on clinical ground and recent free hormone indices point out the same. This could be due to the hyperthyroid phase talking longer to resolve, or due to the uptake study being potentially falsely low, due to exogenous iodine uptake."

Exogenous iodine, I guess that means consuming too much iodine? Even tho they didn't ask me to, I switched to non iodized salt a bit more than a week before the uptake test. I don't think I eat anything out of the ordinary that would cause me to have too much iodine, and my eating habits haven't changed much since, at or around the time this all started.

I failed one of my finals last week, have another final next week that I'll try to do somewhat decent on. Now that the school semester is just about over, I'm developing an apathetic attitude about it all. It's still affecting work but, whatever, I just hope something happens between now and spring semester starting.

Just going to keep taking the medication, deal with the symptoms, get a blood test between now and Christmas, and then just wait for my appointment on the 4th.

[Andros]

I got a letter in the mail today, the endocrinologist I've been seeing will no longer be working at the office that I go to. I guess I'll be getting a second opinion on everything, which is a good thing maybe.

It's been two and a half weeks on medication and I haven't noticed much of a difference if any at all. So it probably hasn't had enough time to do anything; that or the dose is too low or it's some thyroiditis and I'm not actually producing too much hormone, or something else. I don't know. Anyway, no change in symptoms.

I got a copy of my uptake test.

11/4/09-11/5/09
"There is essentially no radioactivity projecting throughout the thyroid gland."
6 hrs: 1.0% uptake
24 hrs: 0.7% uptake

Notes from 11/20:

"The patients near-nonexistent uptake on the nuclear scan, as well as his diminished blood flow on the ultrasound study, have strongly suggested a thyroiditis entity as the main contributor to his hyperthyroidism. As such, I had elected to monitor his status for a month, as he would have a strong chance of spontaneous resolution with this entity."

As I guessed, the wait was in hopes that it would fix itself. Interestingly, he said one month, when the actual appointment was two months, but I made the earlier appointment myself. Anyway...

"He continues to be hyperthyroid on clinical ground and recent free hormone indices point out the same. This could be due to the hyperthyroid phase talking longer to resolve, or due to the uptake study being potentially falsely low, due to exogenous iodine uptake."

Exogenous iodine, I guess that means consuming too much iodine? Even tho they didn't ask me to, I switched to non iodized salt a bit more than a week before the uptake test. I don't think I eat anything out of the ordinary that would cause me to have too much iodine, and my eating habits haven't changed much since, at or around the time this all started.

I failed one of my finals last week, have another final next week that I'll try to do somewhat decent on. Now that the school semester is just about over, I'm developing an apathetic attitude about it all. It's still affecting work but, whatever, I just hope something happens between now and spring semester starting.

Just going to keep taking the medication, deal with the symptoms, get a blood test between now and Christmas, and then just wait for my appointment on the 4th.

So, there is no more mention of the retrosternal goiter?

I am very very worried.

There is generally poor efficiency of iodine uptake and thyroid hormone synthesis and excessive hormone production is due to the large mass of metastatic tissue (116). The inefficient thyroid hormone synthesis is at least partly due to relative iodine deficiency in tumor tissue and the presence of abnormal thyroglobulin (117). Other abnormalities may however be present in the complicated process of thyroid hormone synthesis in carcinomatous tissue. For instance, there is evidence that expression of the TSH receptor in carcinomatous thyroid tissue may be absent or low (118) In many cases clinical symptoms are caused by T3 toxicosis with suppressed serum TSH, and normal or low serum T4 (116,117,119). :sad0047:Uptake of radioactive iodine in metastatic tissue may be low in the absence of normal thyroid tissue and is often absent when the thyroid gland is still present. The metastatic pattern of this type of adenocarcinoma is as is usually found in thyroid adenocarcinoma patients, that is predominantly in bone, lung and mediastinum.

Here you will find the entire article..................
http://www.thyroidmanager.org/Chapter13/Ch-13-2.htm

[gSOLO]

No mention of the retrosternal thing, other than to say it didn't extend that far down so wasn't much to worry about. I didn't push the questioning on the issue.

Since there are no nodules, would that mean that the whole thyroid might be just one big chunk of cancer, or otherwise the whole thing is affected evenly?

Meh, I thought I had asked him all of the questions that needed to be asked, but who knows.

Thanks again.

[Andros]

No mention of the retrosternal thing, other than to say it didn't extend that far down so wasn't much to worry about. I didn't push the questioning on the issue.

Since there are no nodules, would that mean that the whole thyroid might be just one big chunk of cancer, or otherwise the whole thing is affected evenly?

Meh, I thought I had asked him all of the questions that needed to be asked, but who knows.

Thanks again.

Tsk; that is a hard question. The article I provided seems to imply that if there is cancer, the gland is resistant to nuclear uptake.

I do hope you are going to get another opinion. It is better to be safe than sorry. Even sometimes a third opinion.

[gSOLO]

Medication doesn't seem to be doing anything. Both T3 and T4 have gone up. Next appointment in two weeks. Merry Christmas.

Lab Results 11/17/09:

TSH: <.005 (.45 - 4.5)
T3: 8.2 (2 - 4.4)
T4: 3.05 (.82 - 1.77)

Lab Results 12/18/09:

TSH: .005 (.45 - 4.5)
T3: 9.4 (2 - 4.4)
T4: 3.9 (.82 - 1.77)

[Andros]

Medication doesn't seem to be doing anything. Both T3 and T4 have gone up. Next appointment in two weeks. Merry Christmas.

Lab Results 11/17/09:

TSH: <.005 (.45 - 4.5)
T3: 8.2 (2 - 4.4)
T4: 3.05 (.82 - 1.77)

Lab Results 12/18/09:

TSH: .005 (.45 - 4.5)
T3: 9.4 (2 - 4.4)
T4: 3.9 (.82 - 1.77)

So, what is the name of your med and what dose are you on? Clearly, it is NOT working...................yet. Egads.

How are you feeling?

And a Wonderful Holiday to you as well!

[gSOLO]

Methimazole, 10 mg twice a day. It kind of makes sense that it's not working, if I'm not producing too much hormone. But I don't know.

Aside from increased mental havoc, I'm doing about the same.

[Andros]

Methimazole, 10 mg twice a day. It kind of makes sense that it's not working, if I'm not producing too much hormone. But I don't know.

Aside from increased mental havoc, I'm doing about the same.

Looks to me like doc should put you on 10 mg. of methimazole 3 times a day and have you come in for labs in about 4 weeks or maybe even 3 weeks.

Did you ask your doc why the med has not budged the numbers?

[gSOLO]

Oh, I hadn't been back to the doctor yet. I go back in two weeks. I did the thing I had been going periodically; paying for lab tests out of pocket.

I'll be sure to try and get a clear idea on what he thinks is going on. Plus I'll be seeing another doc not too shortly after that for a second opinion.

[Andros]

Oh, I hadn't been back to the doctor yet. I go back in two weeks. I did the thing I had been going periodically; paying for lab tests out of pocket.

I'll be sure to try and get a clear idea on what he thinks is going on. Plus I'll be seeing another doc not too shortly after that for a second opinion.

Yep; if you want to get what you really need these days, it would appear we have to pay out of pocket. Yet they will do ever test known to man that is NOT relevant.

So so glad you are getting a second opinion.