TSH, T4, T3

[cn1705, MSN]

I am new to nursing and I work at a weight loss clinic. When new patients come in we do a CBC, lipid panel and TSH. We Only look at the TSH and by that we determine if they have a thyroid problem. Now here is my question... when looking at just the TSH and not looking at the T3 and T4 could we be misdiagnosing patients? I was only under the impression that JUST TSH is not reliable. My patient is a poster child for hypothyroidism. After the TSH came back normal, I mentioned she could do further testing. She did and her T4 was normal, but her total T3 is low. Since her TSH is normal they just brushed if off and said I should have never mentioned the T3 and T4 because that was just unnecessary. Can't a low T3 indicate hypothyroidism? I guess I'm just need opinions. What is the standard for diagnosing a thyroid problem and should we be testing more then just the TSH? Thanks!

[TheCommuter, BSN, RN]

This is the precise reason why endocrinologists should be diagnosing and managing thyroid disease instead of other physicians (family practice docs, internal medicine docs, bariatric surgeons, etc).

Once upon a time I was treated by both an endo and a family practice doc, and the endo was better able to see the big picture. Even though my TSH was low normal, the endo could recognize that I was becoming hypothyroid due to my signs and symptoms in addition to the other labs.

[nyla75]

Seriously,

"This is the precise reason why endocrinologists should be diagnosing and managing thyroid disease instead of other physicians (family practice docs, internal medicine docs, bariatric surgeons, etc)."

I have Hashimoto's thyroiditis, all labs were normal, dr.s refused to listen to my symptoms, until I grew a GOITER, lol. Finally found a dr. who was smart enough to check for antithyroglobulin antibodies. So yes, the bigger picture should always be looked at.

[cn1705, MSN]

Thanks for the comments. It is super frustrating, I feel like me saying something to them wouldn't even matter. I guess I'll just tell my patient to go to an endo. Just hope that doesn't get back to my bosses. Just trying to be a patient advocate :/

[lepew]

I have low normal TSH levels also and exhibit pretty much all the s/s of hypothyroidism. Fortunately I found a dr who treats me based on symptoms and not numbers!

[Kooky Korky, BSN, RN]

You are good for being a patient advocate. However, if you want to keep your job, you can't be arguing with your bosses - especially telling the pts they need to see an Endocrinologist. Someone will very quickly inform your employers and you will be shown the door. Some patients will even be angry if you undermine their confidence in the doctors.

I am not saying you are wrong, only telling you that you are on a perilous course, however laudable re: patient advocacy. I hope you are in a progressive setting and will be appreciated, but I don't think there are too many of those settings. I hope I am wrong.

Is there any doctor at your clinic who is sympathetic toward your concerns? Any doc you can get into your corner?