Advice needed regarding my doctor's advice

[PamBeeslyHalpert]

I think your doctor might be jumping the gun but you should make the appointment anyway. As you mentioned, it wouldn't be until March, so it doesn't hurt to have the appointment on the books, and if you want to cancel later on you can always do that.

But if you do make the appointment, continue to do all the things you are doing to TTC just how you are now, don't see the appointment as the next step, just have it in your back pocket just in case. Maybe book it for even later in the year, since the appointments are usually booked months in advance.

[teambrink]

I think you should go ahead and make the appointment as well. Hopefully you will be lucky enough that you will be able to cancel it, but if not it will be there when you hit the one year mark and you won't have to wait around a few months for one if you need it. Don't let the appointment define you, just think of it as an opportunity if necessary.

[PamBeeslyHalpert]

Jan 20, 2015 6:12:16 GMT -5 @littleliverpill said:

Jan 20, 2015 6:05:29 GMT -5 PamBeeslyHalpert said:

I think your doctor might be jumping the gun but you should make the appointment anyway. As you mentioned, it wouldn't be until March, so it doesn't hurt to have the appointment on the books, and if you want to cancel later on you can always do that.

But if you do make the appointment, continue to do all the things you are doing to TTC just how you are now, don't see the appointment as the next step, just have it in your back pocket just in case. Maybe book it for even later in the year, since the appointments are usually booked months in advance.

OP is on CD1 today. Assuming she doesn't get pregnant or have a very long cycle this month, that would put her in the middle of cycle 9 in March. So yes, that would hurt to have the appointment then if she doesn't want to pursue the RE route prematurely.

You are right, I didn't do the math right at first. It's still too early, sorry.
I still think she should make the appointment for after the 1 year mark though, have it booked since she mentioned it could take months for her to be able to get one.

[expatmama11]

Jan 20, 2015 3:17:18 GMT -5 @emilie818 said:

So it's CD1 for me and I'm entering month 8 of trying. At a recent appointment my GP told me I should consider making an appointment with an RE if I don't conceive after 9 months of trying. I said I thought you were supposed to wait a year and she said she would recommend it a bit earlier due to my age (I'm nearly 34) and my thyroid issues. Doctors usually book up months in advance here, so the idea is that I would make an appointment soon to have an initial consult in March or April if it's necessary.

I'm not sure what I should do. WWYD if you were me? Would you book the appointment or would you wait it out? I guess I am just a bit weirded out that I'm getting this recommendation so early on, and it's my instinct to just be like, "nothing's wrong with me, it's just taking a while." But I also sometimes forget that I am rapidly approaching "advanced maternal age" and that fading fertility is a for-real thing. I want to have at least 2 kids, so if there is something wrong with me (or DH) I would like to know. It's probably also worth mentioning that my insurance covers infertility testing and meds if needed.

Any advice appreciated. Thanks all.

I actually had a similar experience at my yearly appointment in December. At that time I was on cycle 7 and my obgyn asked me if I wanted to start with any initial testing for problems. Even asking about SA for my husband. I told her I wanted to wait until my next US trip in April which should put me right at Cycle 12. Maybe she suggested it bc I'm not living in the U.S. but it made me feel pretty uncomfortable to be talking about it at that point. 

My suggestion would be to make an appointment for closer to your year mark and hope you get to cancel it. I understand that it can take months to get in so it would be unfortunate if you can't get in for several months after your year mark. 
 

[remylove1011]

I think it's jumping the gun. If you think it's going to take super long to get into the RE call and ask how long it takes. I called and was able to schedule for 3 weeks out (which I was shocked about), but it does happen. I would suggest waiting until April and then scheduling, if it does in fact take 3 months to get in. That would put you in June once you actually get in to see the doc.

[expatmama11]

Sorry to hijack this thread but would you guys follow 12 months or 12 cycles?

[longlivetheevilqueen]

Jan 20, 2015 6:24:28 GMT -5 expatmama11 said:

Sorry to hijack this thread but would you guys follow 12 months or 12 cycles?

12 months.

[Ray]

Jan 20, 2015 6:13:17 GMT -5 @littleliverpill said:

You guys, March is 6 weeks from now.

(ETA: W, my response wasn't directed at you.)

This made me so incredibly happy you have no idea. Fuck winter. 

[Sparkly]

I think you should do what you're comfortable with and know to be right, or you wouldn't be asking the question. Wait your 12 months. I would call to see how far out they are booking and schedule for further out (April/May/June) if need be.

[ghostmonkey]

What is your thyroid issue and is it under control?

[Unknown]

Jan 20, 2015 7:00:57 GMT -5 ghostmonkey said:

What is your thyroid issue and is it under control?

If the answer is its not under control I would start there.

I have multiple thyroid diseases and had a total thyroidectomy and worked with my Endo while TTC. I didn't see the RE until 13m of actively trying (after my surgery). We were TTC a for a few months in 2010, but I didn't count that.

[joy]

My RE told me that I was young (I'm 34).

My sister had both her children after the age of 35 and is considering another. /anecdotes

I wouldn't have called an RE after nine months and I also have thyroid issues. I wanted to know that we exhausted our possibilities without intervention before making that step.

EDIT: Controlling my thyroid was my first goal before even considering RE intervention. I think yours is controlled now?

[gdaisy09]

If the RE truely books out months ahead of time I'd call and just get yourself on their calendar, ask for an appointment near the end of april or beginning of May, you can always cancel. I work for a specialist in a differenct dicipline whose next available appointment is in September of this year, it would be awful to make it to the one year mark and decide you're ready to see an RE just to have to wait another 3 or 4 months for an appointment.

I was refered to an endocrinology last month for my cycles that just won't regulate (I'm currently on just my 4th cycle in 11 months) I ended-up seeing on of the endocrinology fellows, so it was easier to get an appointment. do you see a regular endocrinologist for your thyroid issue?

[daisy818]

I'd probably wait till the 11th month of trying, and then schedule an appt for after the one year mark. The only reason I'd book it early is just because you said it takes a while to get in - you can always cancel.

[brettanomyces]

I agree with PPs about scheduling an appointment now for the one-year mark. If you do get to that point and it does take a few months to get an appointment then you'd be all set and if you end up not needing the appointment you can cancel.

[mlgnumbers]

I don't know where you live, but specialists in my city book 3+ months in advance. No joke. Just to get in with a general practitioner here (when we moved) took 4 months. With that said, I'd go ahead and try this month without booking the appt. If you end up moving on to your 9th month, then I'd make an appiontment for after the 12-month mark. That way, you can cancel if you don't need it, but you don't end up at Month 12 with an additional 3-month wait to get in to the RE.

I've got my FX that you'll get your BFP soon!

[teraiin]

Jan 20, 2015 9:50:43 GMT -5 mlgnumbers said:

I don't know where you live, but specialists in my city book 3+ months in advance. No joke. Just to get in with a general practitioner here (when we moved) took 4 months. With that said, I'd go ahead and try this month without booking the appt. If you end up moving on to your 9th month, then I'd make an appiontment for after the 12-month mark. That way, you can cancel if you don't need it, but you don't end up at Month 12 with an additional 3-month wait to get in to the RE.

I've got my FX that you'll get your BFP soon!

This is exactly what I was going to say. I just scheduled my husbands physical last week and the earliest I could get in was the end of May and that was with me not being picky about appointments.

I do think your doctor might be jumping the gun, however, I don't think it would be a bad choice to call and see how far out they are booking. It would be nice to have yourself on the calendar in case you need it, rather than need it and end up needing to wait ages.

[ghostmonkey]

Jan 20, 2015 10:03:02 GMT -5 teraiin said:

Jan 20, 2015 9:50:43 GMT -5 mlgnumbers said:

I don't know where you live, but specialists in my city book 3+ months in advance. No joke. Just to get in with a general practitioner here (when we moved) took 4 months. With that said, I'd go ahead and try this month without booking the appt. If you end up moving on to your 9th month, then I'd make an appiontment for after the 12-month mark. That way, you can cancel if you don't need it, but you don't end up at Month 12 with an additional 3-month wait to get in to the RE.

I've got my FX that you'll get your BFP soon!

This is exactly what I was going to say. I just scheduled my husbands physical last week and the earliest I could get in was the end of May and that was with me not being picky about appointments.

I do think your doctor might be jumping the gun, however, I don't think it would be a bad choice to call and see how far out they are booking. It would be nice to have yourself on the calendar in case you need it, rather than need it and end up needing to wait ages.

You can't compare scheduling a routine physical with a specialist consultation.

[teraiin]

Jan 20, 2015 10:07:17 GMT -5 ghostmonkey said:

Jan 20, 2015 10:03:02 GMT -5 teraiin said:

This is exactly what I was going to say. I just scheduled my husbands physical last week and the earliest I could get in was the end of May and that was with me not being picky about appointments.

I do think your doctor might be jumping the gun, however, I don't think it would be a bad choice to call and see how far out they are booking. It would be nice to have yourself on the calendar in case you need it, rather than need it and end up needing to wait ages.

You can't compare scheduling a routine physical with a specialist consultation.

My point was that I was agreeing with mlgnumbers  (since I quoted her) that you can never tell how long an appointment of any type may take. In my area ALL appointments for anything from a GP to a specialist can take 3+ months for the earliest slot. I was in no way comparing a specialist to a routine physical merely that you can't know for sure how busy a doctor's office may be without calling and inquiring.

Edited for clarification and to fix yucky tagging.

[joy]

@emilie818: Wake up, West Coaster and talk to us :-)

[ghostmonkey]

Is your GP handling your thyroid issues?

[Unknown]

Jan 20, 2015 11:52:28 GMT -5 @emilie818 said:

Jan 20, 2015 11:39:14 GMT -5 ghostmonkey said:

Is your GP handling your thyroid issues?

Yeah. Do you think I should be seeing a proper endocrinologist? GP seems knowledgeable about thyroid stuff at least and runs the full battery of tests and looks at the full panel, antibodies, etc. I've only been receiving treatment since Sept and it seems to be a rather run of the mill thyroid issue.

if you just had hypothyroidism I think a GP is perfectly fine, but w/ Hashi's I would go to the Endo. Mainly because you are TTC. You will need more closely monitored during pregnancy and postpartum. If you weren't TTC and your GP has your levels under control I think you would be fine, but pregnancy w/ Thyroid Disease is a different ball game (at least for me).

[joy]

Jan 20, 2015 11:56:53 GMT -5 Unknown said:

if you just had hypothyroidism I think a GP is perfectly fine, but w/ Hashi's I would go to the Endo. Mainly because you are TTC. You will need more closely monitored during pregnancy and postpartum. If you weren't TTC and your GP has your levels under control I think you would be fine, but pregnancy w/ Thyroid Disease is a different ball game (at least for me).

Hmmm...  I'm not emilie, but thanks for this advice, Unknown.  I also have Hashimoto's.  I know my levels need to be watched more carefully during pregnancy and post-partum, but I assumed that my GP could handle that.

Do endocrinologists have more insight than GPs?  Or will they just rely on TSH values, same as GPs?  Teach me things.

EDIT: Yes, I realize endocrinologists are experts in the endocrine system unlike GPs who are more jack of all trades, but I wasn't sure if my GP would overlook something that an endocrinologist wouldn't.  I have no idea - this is all new to me.

EDITEDIT: My GP runs TSH, free T4, free T3 and antibodies with every blood screen.

[ghostmonkey]

Jan 20, 2015 11:56:53 GMT -5 Unknown said:

Jan 20, 2015 11:52:28 GMT -5 @emilie818 said:

Yeah. Do you think I should be seeing a proper endocrinologist? GP seems knowledgeable about thyroid stuff at least and runs the full battery of tests and looks at the full panel, antibodies, etc. I've only been receiving treatment since Sept and it seems to be a rather run of the mill thyroid issue.

if you just had hypothyroidism I think a GP is perfectly fine, but w/ Hashi's I would go to the Endo. Mainly because you are TTC. You will need more closely monitored during pregnancy and postpartum. If you weren't TTC and your GP has your levels under control I think you would be fine, but pregnancy w/ Thyroid Disease is a different ball game (at least for me).

That's what I was thinking- Hashi's moves you from just an under-active thyroid to an autoimmune disease and comes with other things that need to be considered, but I wasn't 100% on that. 

[Unknown]

Jan 20, 2015 12:03:41 GMT -5 joy said:

Jan 20, 2015 11:56:53 GMT -5 Unknown said:

if you just had hypothyroidism I think a GP is perfectly fine, but w/ Hashi's I would go to the Endo. Mainly because you are TTC. You will need more closely monitored during pregnancy and postpartum. If you weren't TTC and your GP has your levels under control I think you would be fine, but pregnancy w/ Thyroid Disease is a different ball game (at least for me).

Hmmm...  I'm not emilie, but thanks for this advice, Unknown.  I also have Hashimoto's.  I know my levels need to be watched more carefully during pregnancy and post-partum, but I assumed that my GP could handle that.

Do endocrinologists have more insight than GPs?  Or will they just rely on TSH values, same as GPs?  Teach me things.

EDIT: Yes, I realize endocrinologists are experts in the endocrine system unlike GPs who are more jack of all trades, but I wasn't sure if my GP would overlook something that an endocrinologist wouldn't.  I have no idea - this is all new to me.

EDITEDIT: My GP runs TSH, free T4, free T3 and antibodies with every blood screen.

In my experience I find that (besides the Endo being more understanding of the endocrine system as a whole) they take it more seriously. I am very sensitive to med changes and need frequent med adjustments (even not pregnant). My Endo had me do monthly blood tests, which is more often that is even required for Hashi's during pregnancy, but my Endo knowing my history felt more comfortable watching a little closer. Both my GP and OB made comments about how I really didn't need to be checked that frequently, I ended up needing 4 med adjustments for the duration of my pregnancy, and my GP or OB would not have kept up with that on their testing schedule.

The Endo is also more equipped to adjust new meds or current med levels if anything comes up during pregnancy. The autoimmune aspect of this can lead to other symptoms (I had heart palpitations and other things that the GP might not look/ask or). My Endo would always check my balance and checked to make sure my hands weren't shaking or other signs that things were amiss.

Not worth the risk, IMHO, especially when things aren't controlled during pregnancy can cause increased risk of m/c and other pregnancy related issues.

[gdaisy09]

Jan 20, 2015 13:36:22 GMT -5 @emilie818 said:

Jan 20, 2015 13:23:08 GMT -5 Unknown said:

In my experience I find that (besides the Endo being more understanding of the endocrine system as a whole) they take it more seriously. I am very sensitive to med changes and need frequent med adjustments (even not pregnant). My Endo had me do monthly blood tests, which is more often that is even required for Hashi's during pregnancy, but my Endo knowing my history felt more comfortable watching a little closer. Both my GP and OB made comments about how I really didn't need to be checked that frequently, I ended up needing 4 med adjustments for the duration of my pregnancy, and my GP or OB would not have kept up with that on their testing schedule.

The Endo is also more equipped to adjust new meds or current med levels if anything comes up during pregnancy. The autoimmune aspect of this can lead to other symptoms (I had heart palpitations and other things that the GP might not look/ask or). My Endo would always check my balance and checked to make sure my hands weren't shaking or other signs that things were amiss.

Not worth the risk, IMHO, especially when things aren't controlled during pregnancy can cause increased risk of m/c and other pregnancy related issues.

Thank you for the info.  I'm seeing GP every 6 weeks or so right now, but I will look up some endos on my insurance.  Would it be weird to go to an endocrinologist for the first time at a point where everything is stable and under control, and just be like, hey, I'm TTC and would like to have someone in place for when I get pregnant?  Or is it worth waiting until I actually get pregnant?

I work in a sub-specialty of a specialty practice, what I've learned here is that seeing a doctor who specializes in your condition means that you're getting current standard of care for the condition that you have.

GPs can't possibly stay up to date in the latest for every condition that may come through their door.  While they might be very knowledgeable, many times their training in long term care for specific conditions dates back to when they were in medical school or medical residency.  So there may be new standards that result in better care for you. I think it would be better to establish care and begin building a relationship with a specialist before you get pregnant.


Autoimmune diseases can be tough. patients in our clinic benefit from careful monitoring of their diseases and constant tweaking of their medications to get their levels in just the right place.  They're also more in tune to specific issues that might arise surrounding pregnancy and are better equipped to work with you to manage that. our practice sees many patients that come in having received care from their GPs on therapies that haven't been considered standard of care for years. 

[Unknown]

Jan 20, 2015 13:36:22 GMT -5 @emilie818 said:

Jan 20, 2015 13:23:08 GMT -5 Unknown said:

In my experience I find that (besides the Endo being more understanding of the endocrine system as a whole) they take it more seriously. I am very sensitive to med changes and need frequent med adjustments (even not pregnant). My Endo had me do monthly blood tests, which is more often that is even required for Hashi's during pregnancy, but my Endo knowing my history felt more comfortable watching a little closer. Both my GP and OB made comments about how I really didn't need to be checked that frequently, I ended up needing 4 med adjustments for the duration of my pregnancy, and my GP or OB would not have kept up with that on their testing schedule.

The Endo is also more equipped to adjust new meds or current med levels if anything comes up during pregnancy. The autoimmune aspect of this can lead to other symptoms (I had heart palpitations and other things that the GP might not look/ask or). My Endo would always check my balance and checked to make sure my hands weren't shaking or other signs that things were amiss.

Not worth the risk, IMHO, especially when things aren't controlled during pregnancy can cause increased risk of m/c and other pregnancy related issues.

Thank you for the info.  I'm seeing GP every 6 weeks or so right now, but I will look up some endos on my insurance.  Would it be weird to go to an endocrinologist for the first time at a point where everything is stable and under control, and just be like, hey, I'm TTC and would like to have someone in place for when I get pregnant?  Or is it worth waiting until I actually get pregnant?

I would get established as a patient now. My insurance just changed at the beginning of the year, and since we are TTC#2 I wanted to get established with a new Endo for when I do (hopefully) get pregnant. The first time around I ended up seeing 4 different Endo's before finding one I liked and spoke in terms I could understand. The first two I saw I literally walked out of the office so confused because I had no idea what was going on w/ my body, and one who blew me off saying I was fine (even though I was all kinds of jacked up for years and did end up needing a full thyroidectomy because drs couldn't control me). If I wasn't TTC I would just call my GP if I wasn't feeling well to run some labs, but I will feel more confident going straight to an Endo I am established w/ when I get a +HPT. I know when I started seeing the RE, the first thing she went over was the notes from my Endo, so it could also be helpful if you get to that point.

Just for the record, so you know it isn't usual that Hashi patients need surgery. I have Graves and Hashi's, and had the rare circumstance to not only have them both (usually you have one or the other w/ Hashi's being more common), but they were both active at the same time and basically fighting one another. The reason treatment was so hard for me is because of this, and once my Endo had the Hashi's under control the Graves would kick in and swing me the other way or vice versa. I would have TSH levels go from 7 to .01 in the matter of two days and be on the verge of having a heart attack (Thyroid Storm), and this happened every few months. The pathology came back all kinds of messed up on my Thyroid when it was removed too, so I'm glad I did it and now feel a gazillion times better. I just need to watch if I get sluggish or notice a change in my weight.

[joy]

Awesome. Thank you so much Unknown and gdaisy09. All of this information has been incredibly useful.

::looking up endocrinologists in Philly::

And, thanks @emilie818 for making this thread that I only sorta hijacked.

[Unknown]

@emilie818 joy

I'm certainly no expert or dr, and can only tell you about my experience. Please keep me posted on how you both are doing. I'm always interested in learning new things regarding Thyroid Disease and hearing other people's experiences. Best of luck to you both.