Endocrinology update

I went to the office to review my test results.  I got a copy--that doesn't happen every visit to the doctor (but should, in my opinion).  So my tests say ("normal" range in parenthesis)

T3 = 2.8 (2.0-4.8 pg/mL)

T4 = 1.2 (0.8-1.7 ng/dL)

TSH = 1.33 (0.45-4.50 mU/L)

Vitamin D, 25-OH, Total = 58 (30-100 ng/mL)

D3 = 58 and D2 <4 (no ranges given)

According to the technician, the thyroid untrasound shows improvement and it appears the nodule has decreased in size.  I don't understand the page I have but it says:

Rt. 15.8 x 13.5 x 39.2

RLL 2.7 x 3.6 x 5.3

Lt. 14.8 x 13.0 x 33.4

0

(This is written in a blank area below "Last Exam: 7/10")

Right lobe: heterogenous, measured 16.7x12.1x38.7

Left lobe: heterogenous, measured 15.3x14.3x34.9

RLL 2-3 mm incidental nodule

(This is filled in the form.)

So my understanding from the conversation is that my nodule has decreased in size and my Vitamin D is within the range they want to see.  I am unsure if I am relieved that the thyroid medicine is working or skeptical, thinking that perhaps the MS drug trial (cancer drug) medicine is messing with my thyroid and it would have worked itself out.  Rather than ask that and have the lady look at me like I'm talking about conspiracy theories, I asked if I might be able to discontinue taking the medicine for my thyroid when I am done with my MS trial.  She hedged, but basically agreed that could be a possibility.  Oh, Lord, make it so!

Then, she discussed with me how to take my thyroid medication.  Yes, you would think this was discussed when I started taking it six months ago.  At that time, I was told to take it first thing in the morning (except when I have a blood test for my thyroid) and don't eat for an hour.  Here's the new deal, as shown on my handy instruction page I received today, but was apparently not available during my previous visits:

How to take your thyroid medication

Thyroid medication is very sensitive medication, therefore, in order to get the full effect of your medication the following precautions must be taken:

• You should take your thyroid medication first thing in the morning with a full glass of water and nothing else by mouth for one hour (including other prescriptions/vitamins).
• You should not take calcium, magnesium or iron for a full four hours (these are often in your daily multi-vitamin and most dairy products including yogurt, milk, etc).
• Don't let your pharmacy change your thyroid medication.  It is important that you stay on what has been prescribed to you.

The first issue I have with this is: I take Provigil for MS fatigue.  I take it early in the day so I can sleep at night.  It keeps me awake if I take it too late in the day.  I have been taking it with my Synthroid, but I can take them an hour apart if I take S as soon as I wake up and P an hour later when I'm leaving the house.  (This has all the signs of me forgetting to take P and being totally fatigued all day.)

The other issue I have (don't worry, it's the last one): you're telling me that I cannot have milk, yogurt, or cheese for breakfast.  Let's talk about what I grab for breakfast: cereal with milk and fruit; apple with cheese and a hard boiled egg; scrambled egg with cheese and leftover veggies; smoothie (made with frozen fruit, yogurt, and milk); latte (or coffee with milk); cottage cheese with pears or peaches....  So I asked, what am I supposed to do about breakfast?  She was a little vague but said that since my levels have improved while I was doing (she didn't say it this way but it's what she meant) everything wrong, I should be fine to continue doing things as I have.  Um, okay, I'll do that.