App with GP

[Guest guest]

Saw GP this morning to ask if she would increase my levothyroxine. Latest test

results

TSH 3.66

T4 12

As I expected no she wouldn't. She was nice in that she listened to me and went

right back through my records. She said she doubted any GP would increase dose

when levels are within range. She said they treat on test results not symptoms

(not good). She then went on to contradict herself by saying she would ring for

advice from an Endo because I don't look typically hypo i.e. Im slim. Not sure

why she things that is relevent considering she had just said they treat on

blood test results (which have shown I'm hypo). She said she will test bloods

again in 6 weeks.

Im really reluctant to self treat however Im two years into treatment with NHS

now and not getting anywhere. I have decided to wait until next bloods as in the

past my TSH has dropped but then gone back up again by next test. My ferritin

is also low at 15 (although within range) and just noticed by haemaglobin is

12.5 which I think is on the low side. Im going to take some iron supplements

but do you think I should wait until next blood tests before doing this?

Thanks

p.s On the up side my mum has been to see GP today (Fibromylgia but with hypo

symptoms but within range) and GP has agreed to test her T3 and is sending her

to see someone who is currently doing some sort of research on T3.

[Guest guest]

I think you need to show the following recommendations from the

BTA - the BTF, the DoH and the GMC. ONLY the BTA recommend blood test results

only - and take no account of symptoms and signs. Is it any wonder there is

such confusion as to reaching a diagnosis and increasing dosage by blood

results alone.

....the BTF state: " The biochemical results have to be considered alongside

clinical symptoms, and together they determine the point at which the physician

will introduce Thyroxine therapy " .

...the GMC state: " Good clinical care must include: an

adequate assessment of the patient's conditions, based on the history and

symptoms and, if necessary, an appropriate examination; " Doesn't even

mention blood tests

...the DOH state: " Blood

tests are useful in helping diagnose hypothyroidism

but should not be used in isolation and other factors

must be taken into account such as the absence or presence of symptoms. This is

why at present it is considered good medical practice to rely

upon clinical history and examination, in

addition to blood tests, in the diagnosis of this condition.

The BTA state: " The Clinical Committee of the Society for

Endocrinology and the British Thyroid Association recommend the use of

sensitive and specific blood tests as the only method for the precise diagnosis

of thyroid dysfunction and for the monitoring of

treatment with approved medications... " -

also " Currently

the BTA does not hold the view that treatment for thyroid disease, either

under- or over-active, should be commenced if patients have thyroid function

test results within the normal laboratory reference range " .

Under the circumstances, I would send a letter to your GP

stating that you wish to have the following blood tests done to see if any of

them are low in the reference range - fe4rritin, vitamin B12, vitamin D3,

magnesium, folate, copper and zinc. Let her know that you are aware that if any

of them are low in the range, they need supplementing appropriately because

thyroid hormone will not be utilized by the cells properly. Also, tell her that

you need to know whether the mainly inactive thyroxine is actually converting

to the active T3. T3 is the hormone required by every cell in your body and

brain.

Tell your GP that your ferritin level should be somewhere in the

region of 70 to 90 0 and that it is appallingly low at 15.0 and that you need

some form of iron supplement. The reference range for ferritin is 20 to 200 for

women - so how on earth has she not realised how low yours is. Your TSH should

be down to around 1.0 or less when being treated, so it is obvious that you are

either not getting sufficient thyroxine, or it is not converting.

Ask for a referral to an endocrinologist because you need a

second opinion as to whether you would do better by having an increase in your

dosage.

Tell the GP you wish your letter of request to go into your

medical notes and send a copy to the Head of Practice. Ask her/him to respond

to you in writing. When you put things in writing, it often makes a difference.

Always post the reference range for each test so we can see

whether they are at the bottom, the middle or the top of the range. Any chance

you could use your Mum's GP - yours will only cause you more problems.

Luv - Sheila

Saw GP this morning to ask if she would

increase my levothyroxine. Latest test results

TSH 3.66

T4 12

As I expected no she wouldn't. She was nice in that she listened to me and went

right back through my records. She said she doubted any GP would increase dose

when levels are within range. She said they treat on test results not symptoms

(not good). She then went on to contradict herself by saying she would ring for

advice from an Endo because I don't look typically hypo i.e. Im slim. Not sure

why she things that is relevent considering she had just said they treat on

blood test results (which have shown I'm hypo). She said she will test bloods

again in 6 weeks.

Im really reluctant to self treat however Im two years into treatment with NHS

now and not getting anywhere. I have decided to wait until next bloods as in

the past my TSH has dropped but then gone back up again by next test. My

ferritin is also low at 15 (although within range) and just noticed by

haemaglobin is 12.5 which I think is on the low side. Im going to take some

iron supplements but do you think I should wait until next blood tests before

doing this?

[Guest guest]

Thanks for your reply Sheila. The reference range for TSH was 0.1 to 4 (my TSH

is 3.66)

Range for T4 is 8 - 20 (mine is 12.9).

I dont have the print out for the ferritin I had done.

I could see my mum's GP as she is in the same surgery but I have seen her in the

past and she kept referring to me as being sub clinical because my TSH was below

10. It annoyed me and I got the impression had she seen me originally when TSH

was 9.4 she wouldn't have put me on thyroxine because it was still under 10. I

had magnesium tested 6 weeks ago. It was 0.87 (range 0.75 - 1.05). My

haemoglobin is low too at 12.5 (range 11.5 - 16.5) which is why I think I really

need to supplement with iron. Should I do this immediately or wait until next

test results? Would increasing my ferritin affect TSH and T4 readings?

I always go along to see GP determined to ask for second opinion etc then end up

coming out no better off. Im hoping maybe this endo she is going to ring will

maybe suggest I have a referral.

ne

>

> Always post the reference range for each test so we can see whether they are

> at the bottom, the middle or the top of the range. Any chance you could use

> your Mum's GP - yours will only cause you more problems.

>

> Luv - Sheila

>

>

>

>

>

> Saw GP this morning to ask if she would increase my levothyroxine. Latest

> test results

>

> TSH 3.66

> T4 12

>

> As I expected no she wouldn't. She was nice in that she listened to me and

> went right back through my records. She said she doubted any GP would

> increase dose when levels are within range. She said they treat on test

> results not symptoms (not good). She then went on to contradict herself by

> saying she would ring for advice from an Endo because I don't look typically

> hypo i.e. Im slim. Not sure why she things that is relevent considering she

> had just said they treat on blood test results (which have shown I'm hypo).

> She said she will test bloods again in 6 weeks.

>

> Im really reluctant to self treat however Im two years into treatment with

> NHS now and not getting anywhere. I have decided to wait until next bloods

> as in the past my TSH has dropped but then gone back up again by next test.

> My ferritin is also low at 15 (although within range) and just noticed by

> haemaglobin is 12.5 which I think is on the low side. Im going to take some

> iron supplements but do you think I should wait until next blood tests

> before doing this?

>

[Guest guest]

Was interested to read your post. Have today been reading guidelines to GPs from

RSP ....which are pretty consistent with your experiences. I am diagnosed

hypothyroid and have spent around 10 years in brain fog until finally TSH hit

9.2 and GP agreed to treat - but only to the criteria of getting TSH down to 5

(within current " normal " which everyone laughs at...given Swedish and USA

guidelines). Looking at RCP (or is it RCS?) guidelines, their concern appears to

me to emanate from the view that there COULD be other underlying problems that

may need evaluation. Sheila and everyone on site will discuss the possibility of

T3 and RT3 being underlying add-on problems alongside adrenals etc. Equally

often there is mention of progesterone etc. Personally, I feel quite strongly

that there are so many potential factors that COULD be add-on difficulties in

treatment that I would not wish to treat with NDT or T3 or Adrenal supplement

without also checking on possible links with other aspects. This, in part,

because like you I am not particularly overweight, and hence not completely

typical hypothyroid. It is also because I KNOW I had problems in earlier years,

with progesterone insufficiency and prolactin excesses - further, that

treatments for breast cancer complicated issues with an early menopause

resulting and the immediate cessation of other treatments that I previously

relied on for sanity (progesterone). I personally feel that both I and my GP

will benefit from the guidance of an endocrinologist who can check and establish

whether, perhaps some other aspect of the endocrine and pitutiary and

hypothalamus links may need additional help. Particularly as there are add-on

problems for me personally of potentially increasing risks of cancer recurrence.

So, if it were me, I would be inclined to find a really good endo who will

evaluate any related factors from your health history, that may need additional

help. Yes, it could well be that you need T3 ...or NDT....but I am sure that if

there are other factors involved you might like to be aware of them and be as

well informed as possible so that you can take appropriate decisions. It DOES

mean doing your own research - Sheila may be able to offer some help on possible

specialists you might consult...as may your GP. But you will still need to do as

much research as you can to be sure the person you are referred to has a good

chance of being able to offer appropriate and relevant advice given your

personal background. Not sure if this helps - if I really can't access help from

the system then I will consider self treating if things are impossible otherwise

- but I would be wary unless I had first tried and exhausted the expertise of

sympathetic practitioners working within the system. Just a personal

perspective...also - feel I should say if you have further queries i may not be

in touch much on the site (I am trying to " wean " myself of the computer - so no

offence personally if I am not responsive to future issues that you may wish to

raise.)

Vicky

>

> Saw GP this morning to ask if she would increase my levothyroxine. Latest test

results

>

> TSH 3.66

> T4 12

>

> As I expected no she wouldn't. She was nice in that she listened to me and

went right back through my records. She said she doubted any GP would increase

dose when levels are within range. She said they treat on test results not

symptoms (not good). She then went on to contradict herself by saying she would

ring for advice from an Endo because I don't look typically hypo i.e. Im slim.

Not sure why she things that is relevent considering she had just said they

treat on blood test results (which have shown I'm hypo). She said she will test

bloods again in 6 weeks.

>

> Im really reluctant to self treat however >

> Thanks

>

> p.s On the up side my mum hasand GP has agreed to test her T3 and is sending

her to see someone who is currently doing some sort of research on T3.

>

[Guest guest]

I would go to see your Mum's doctor anyway - the other doctor

will do you no favours. Explain to your Mum's doctor that if you lived in the

US, as the top of their TSH reference range is 5.0. You would be considered

over the top of the reference range also if you lived in Germany and Belgium as

the top of their TSH ref. range is 2.5 with a recommendation it be dropped even

further to 1.5. I would LOVE to know just where the British Thyroid Association

plucked 0.5 to 10.0 out of the air. Does anybody know if they have EVER given

an explanation for such a figure. I know of no other country in the whole world

who has such a massively wide TSH ref. range.

I would also try writing a letter to either of these doctors

(send a copy to the Head of Practice) listing all your symptoms, your signs,

your basal temperature taken before you get out of bed in a morning for 4 or 5

days. If it is 98.6 degrees F. that is considered normal, if 97.8 (and it could

be MUCH less) this shows your metabolism is not working properly and the most

likely cause is hypothyroidism.

List the members of your family who have a thyroid or autoimmune

disease.

List the full range of thyroid function tests you need i.e. TSH,

free T4, free T3 and tests to see if you have antibodies too your thyroid

(especially as your Mum has a thyroid problem as it comes down the family line.

List also the following blood tests you require to see whether any of them are

low in the reference range and tell your doctor you are specifically asking for

these because if any are low, your thyroid hormone cannot be utilized properly

into the cells. The4se are, specifically, ferritin (stored iron), vitamin B12,

vitamin D3, magnesium, folate, copper and zinc. (When you get these results,

post them on the forum together with the reference range for each test done).

Increasing your ferritin could help lower your TSH as the thyroid uptake

becomes more effective.

Next, tell y our GP you wish to be referred to an

endocrinologist of your choice (you do not have to see the

endocrinologist your GP has chosen - it could turn out to be a waste of her

time, the endocrinologists time and your time as many know little about the

functioning of the thyroid system. Most endocrinologist's specialty is

diabetes. If you need a list of UK endocrinologists our members have

recommended, write to me privately at sheila @ tpauk. com (close spaces)

Ask for your letter of requests to be placed into your medical

notes, and as stated above, Cc a copy to the Head of Practice.

This works in more cases than it does not, so you don't have to

put up with this situation any longer.

Luv - Sheila

Thanks for your reply Sheila. The reference

range for TSH was 0.1 to 4 (my TSH is 3.66)

Range for T4 is 8 - 20 (mine is 12.9).

I dont have the print out for the ferritin I had done.

I could see my mum's GP as she is in the same surgery but I have seen her in

the past and she kept referring to me as being sub clinical because my TSH was

below 10. It annoyed me and I got the impression had she seen me originally

when TSH was 9.4 she wouldn't have put me on thyroxine because it was still

under 10. I had magnesium tested 6 weeks ago. It was 0.87 (range 0.75 - 1.05).

My haemoglobin is low too at 12.5 (range 11.5 - 16.5) which is why I think I

really need to supplement with iron. Should I do this immediately or wait until

next test results? Would increasing my ferritin affect TSH and T4 readings?