Today I got my 2nd opinion, this time from a reproductive endocrinologist named Dr. Grellet, a private-practice physician in Los Gatos, CA. Her specialty is helping women with fertility and thyroid issues.
Dr. Grellet cares, and most importantly, she keeps up with current research. Without my asking, she rattled off medical journal articles and studies -- from memory.
She disagrees with the previous endocrinologists I have seen on two major points. One, she said TSH should be between .3 - 3.0, NOT .5 - 5.0. This is the diagnostic TSH level, as revised by the AACE (American Association of Endocrinologists), in 2002. Dr. Grellet said she has never met an endo who does not currently utilize the new standard (apparently she hasn't met anyone from Kaiser). Furthermore, she said if you are pregnant, your TSH should ideally be between .3 and 1, or your baby runs a higher risk of cognitive impairment.
The "treatment" level of TSH should be between 1 and 2, and if you are pregnant, even lower -- ideally between .3 and 1, according to Dr. Grellet. The "diagnostic" TSH levels, as revised by the AACE (American Association of Endocrinologists), in 2002, is roughly 0.3 to 3.0. The "treatment" TSH level they recommend is 1.0 to 2.0 for titrating (adjusting thyroid medication levels). However, many patients feel better between 0.3 and 1.0.
Two, she does not believe in Levothyroid, a generic synthetic T4, for treatment, particularly if you are pregnant or trying (this is what I have been taking). The reason is, although it is less expensive, the efficacy of the generic can vary by a very significant amount (as much as 50%). The goal is to stabilize your thyroid, hard to do if the strength of your drugs changes.
More stable, she explained, is Synthroid (a brand of synthetic T4). She believes Armour (a brand of whole dessicated thyroid) is not as desirable because the absorption varies, again making it difficult to titrate.
In addition to switching me from Levothyroid to Synthroid, she also prescribed a synthetic T3 called Cytomel. T4, she explained, is the stored form of thyroid hormone, while T3 is the active form. The stored form must be converted to the active form before it can be used. The story gets complicated from here, but the theory is, some people respond better with added T3. Dr. Grellet said research -- and her patients' personal experiences! -- indicate the majority of hypothyroid women feel more mentally alert and have more energy overall with added T3, particularly Hashimoto's patients (those who also make the antibodies). Since I am making both ATA and TPO antibodies, and I had a miscarriage, and my thyroid was pretty stressed by my pregnancy, and I didn't "feel" better with Levothyroid treatment only (even though my TSH went to 1.9, normal), she felt I may benefit from the additional T3.
She agreed with my other endo about getting a TSH test as soon as you discover you're pregnant, and then again every 4-6 weeks during the pregnancy (every 4 the first trimester). She even handed me a whole stack of lab forms so I wouldn't need to call each time.
She also agreed with the other endo that I should NOT take a kelp supplement. Kelp is essentially an iodine supplement, and too much iodine can actually make hypothyroidism worse. L-tyrosine is fine, calcium, prenatal or multi-vitamins are fine (if not taken concurrently with thyroid meds of course) but not kelp.
And it's ok to eat one serving of soy once a week, but don't eat a lot of it. The same goes for other goitrogens. If you do eat it, try to eat the same amount regularly so you can keep your dosage even.
I'll keep updating. My first lab test will be 6 weeks from now, unless I get pregnant first!
Update 5/5: ovulated 4/21, but no pregnancy. :( Maybe too soon -- my TSH was 7.7 only 3 weeks before. It takes a while to titrate (6-8 weeks I think).