Under attack, and fighting back.

After I hit "publish" yesterday, I looked again at this sentence: "Next step: an appointment with an endocrinologist, to take place in two months (I guess he's busy)," and thought, no. That's not good enough. It was the generalist who had made the initial appointment for me – how's that for service? – so I decided to call myself to advocate for moving the appointment forward. The receptionist put me on hold for a minute and returned to ask if I could come in that afternoon. Yes!

So I went. Good thing I had studied those Guidelines last night, because the best part of the meeting was when he started to say, "Well, it's recommended in a report prepared by the American Thyroid Association that – " "Oh, in this?" I interrupted, lifting my pencil from the notes I'd been taking on the back page and showing him the front of my printout. "Yes, that!" he laughed, pointing out one of the study's authors. "He's a great doctor and a good friend of mine!"

The second best part: at the end of the hour-long rendezvous, the good doctor himself took my coat from the rack, held it for me to step into, and then opened the door for me to pass through. Speaking of service ....

But those two parts were not the only good ones. In fact, all of the meeting was good, and I feel a lot more positive about managing this.

Like the generalist, the endocrinologist too was shocked that I had never been given a reason for the underlying cause of the hypothyroidism and set about doing the tasks that a doctor should have done when I was seventeen, like performing an ultrasound of my thyroid to further refine the diagnosis. There is evidence of inflammation in response to the anti-bodies, but only as would be expected given their presence, nothing worse. No goiter.

The best approach, he thinks, is to increase my medication dosage to push my TSH to a very low level, 1.2 or less, before pregnancy, which would give me a buffer of thyroid hormone so I have enough to share should a little creature begin drawing on my body's resources. I'll now be taking 25 micrograms more than before, for a total of 225 micrograms, which is about twice as much as would be expected for somebody of my weight. (I like to impress however I can.)

In six weeks, I'll go back for retesting of the hormone levels and, if necessary, another dose readjustment to further decrease the TSH. He'll track me even more closely immediately after pregnancy begins to make sure everything remains well-balanced.

The only thing that I'm not sure I'll be able to comply with was his request, made with a wink, to be the first to know should I see that elusive second line. I'll probably keep Gilles in the appropriate place in line for that one.