Please would you read this letter I have wrote to my gp...

[lare73]

Feedback would be appreciated,... I do not feel the magic ten minute appointments are enough to point all this out and my memory is poor too so tend to forget a lot when in there so thought a letter was a good choice.

Dear Dr H

I am writing to you with regard to my current medical issues that I am seeing you regularly about. I felt it best to write it all down as the appointment slots are time limited and I am aware I probably take up too much time. I would be grateful to have this letter put on my medical file please.

I am not sure if you have received my ultrasound results yet. I was told I have a cyst/nodule on the left thyroid lobes albeit small. I assume the next step would be a needle aspiration under US. Although the radiographer asked if I had had a radioactive uptake test yet? I still have issues with a very hoarse voice, coughing small streaks of blood and discomfort on swallowing on the left hand side. I am very concerned about this, grateful it is small but also aware that things need to be ruled out quickly here, I'm sure you understand.

After a week of the trial of thyroxine I have had a subtle improvement. I am still very fatigued but the major slumps in the afternoon are not as severe and I have had one or two days where I did not have to sleep, which I feel is massive progress. All other symptoms are the same, however they are no worse which is a first, they are as follows;

Fatigue/drowsy exhaustion, cannot get up in the morning, need naps which is not conducive (have a baby and toddler so very debilitating)

Recovery time after minor activity is ridiculous.

Heavy aching eyelids

Weight gain

Swollen tongue, hoarse voice, discomfort when swallowing, gum issues.

Low morning temperature, (average 35.7)

Heavier periods, loss of libido

Very cold when others are warm

Major Hair loss.... Re growth breaks before it grows.

Skin problems, dryness, spots, small lumps in scalp and itching.

Muscle and joint pain and aches, mainly, hands, hips, pelvis, back and knees.

Poor memory, recalling words, speaking fluently can be a task.

Regular headaches and some agitation.

There are other minor niggles but these a the main issues.

I am 40 years old and have no quality of life at the moment, I cannot enjoy my children and give them what they require due to feeling so unwell. I was due back to work as a theatre scrub nurse after my maternity leave at the beginning of may but have been off sick. I do not feel capable of working or safe to do my job, which upsets me greatly as I love what I do and am keen to get back to work.

I have since our last appointment researched endocrinologists in the area and the one I am referred to at St James does not specialise in thyroid. Thus, I felt it a waste of everyone's time to go down that route. So, I have asked around done more research and would ask that you refer me to a Dr Richard Pope, he works privately at the Yorkshire Clinic, he is a consultant endocrinologist and has an interest in thyroid disorder and comes highly recommended. I enclose his details, I have contacted the clinic and they accept faxed referrals.

The Yorkshire Clinic

Bradford Road

Bingley

BD16 1TW

Tel: [phone]

Fax: [phone]

On reflection the referral to Dr Skinner is not doable as it is in Birmingham and travelling and child are is an issue for me. I do appreciate your patience here.

I have been speaking with fellow health professionals about my issues, and have had some very good advice regarding blood tests etc. this was a response I was given for guidance and on looking at my results and the connection with thyroid I think it makes good sense.

'Regarding your blood test results. Forget the tSH - this is very

controversial. For anybody not taking thyroid hormone replacement your free

T4 should be above the middle of the reference range and it should be around

17/18. Yours is FAR too low. Ferritin is dreadful and you are in dire need

of iron injections. Ferritin is your stored iron and it is right at the

bottom of the range. It should be around 90 to 130 - but definitely above

70. Speak to your doctor as a matter of urgency about this it is

likely to cause you harm. B12 is also too low - B12 should be right at the

top of the range. It would help if you took 1000mcgs sublingual B12 (Solgar

is a good brand) daily. Vitamin D is in urgent need of supplementing.

There is insufficient thyroxine to convert to the active T3. T3 is required

by every cell in the body and brain to make them function. You are in dire

need of T3, in combo. with T4, preferably in natural thyroid extract.'

Based on this and my own research I would like to request a trial of t3 replacement. I am happy to trial it and see how it goes.

I understand my TSH level sits in the 'normal range' and you did mention that this could be a pituitary issue, although nothing further was mentioned about testing and ruling this in or out.

I am sure you aware that there is much research regarding normal TSH levels in thyroid patients.

My TPO level is 28, so slightly under range but have again read any over 20 shows autoantibodies are attacking my thyroid.

I am currently taking prescribed ferrous fumerate for the ferritin, but I know I am not fully absorbing it as I have diarrhea and chronic stomach cramps when taking it, I am persevering but think its an issue. (I do have Crohn's disease). So I would like to try the iron injections to get my levels up to an optimum level.

I am still taking prescribed folic acid too.

In addition I am taking the suggested b12 sublingual supplement and multi vitamin.

I am concerned with my vitamin d levels, there is again a connection with low levels and thyroid and wondered if a course of strong supplements could prescribed please.

9 Months postpartum

Long term depression on medication - 30 mg citalopram - no issues

Crohn's disease - quiet no meds.

Concerned about TTC

Very concerned about weight and associated health issues that I am now at high risk of.

Mother has hypothyroidism and type 2 diabetes.

Son has juvenile idiopathic arthritis and Crohn's disease.

I have been unwell since the birth of my son, which gets worse daily. I have been seeing a doctor since March 2013 and feel it is a very slow process to get to bottom of my problems. I understand my Blood results do not necessarily match my symptoms, but my symptoms are real and I am devastated that I feel so unwell. My family and friends are concerned and it was my mother who told me to see a doctor as she could see I was heading down the same road she was on and did not want me to get as sick as she did before her thyroid diagnosis. She did not seek medical advise until she was very very poorly.

I am due to see you on the 11th June in surgery. I will have to ring the surgery to request a new sick note as the current one runs out on the 7th June, as I need to give advance warning to my place of work of my absence due to them needing to cover my shifts.

I am very grateful for your time and patience, I appreciate you are very busy, hence why I wrote it all down, it also helps as my memory is terrible and I always forget to say things or time runs out during my appointments.

[rubysjules]

Hi lare73.

this is a very comprehensive letter and written so well its great. i am newly diagnosed so cant comment on any tests really except this letter describes me to a t!!

I have been on ferrous fumarate for 2 years after i was found to have no iron or stores, no thyroid was mentioned at this time!! I to struggle with it i am prescribed 3 times a day but if i take 3 then i have horrendous stomach cramps, dizziness and diarrhea too. I have started on 25 mcg of levo last week. am off sick for 4 weeks as had labrynthitis and very low potassium caused by high bp! had hospital admission last week as bp was nearly 200 and i was shaking and couldnt walk! my gp has been ok but still says that my levels (T4 is 10 range is 11-14 i think) are not bad enough to make me ill!! however sevela people on here have disagreed with this!

Juliex

[Stourie in reply to rubysjules]

I hope that your gp never has thyroid problems with t4 at 10 or maybe I hope she does.!!!

Jo xx

[lare73]

My gp is nice but does 'dither' so thought if I gave her the information in written word she would hopefully digest better, and make decisions. Hoe ou feel better soon x

[alangardner]

what a brilliant letter - including reference to your colleages medical advice - I would love a copy for my future reference -- I only hope your gp will read,digest and take everything on board....that way you may well get the optimum treatment and CARE that you need......and if that happens please advise help others in the future...once again well done [ brownie points on the way ] ...lol alan

[lare73 in reply to alangardner]

Thank you, I have edited it slightly, after some advice. But the bones of it are the same. Feel free to take a copy. It is now with doctor so it wait n see time

[cal1971]

Excellent letter- I hope you get the help that you need. Best wishes.