Guidance after recent GP appointment

[Delly]

I am new to this site, only came across it when googling after a visit to my GP on Friday.

I had a sub total thyroidecomy about 12 years since as I had an over active thyroid and small goitre that couldn't be controlled with medication after an 18 month struggle. I ended up like most hypothyroidism and also hypoparathyroidism. I have been on 2mcg of alfacalcidol (one alpha) since the operation and last August was given additional Dekristol to take twice a month to top that up as wasn't enough. All that now seems fine.

I have also had Levothyoxin which was increased at the outset and I have been taking 175mcg per day for a number of years now although at one stage I was on 200mcg but that was a few years since now.

In March I was called for annual blood tests for medication check and was quite timely as I had been feeling exhausted, aching joints and bruising and bursting blood vessels very easily. I was told my TSH level was 7.2 and was asked to repeat the bloods in June which I have just done. This time my TSH was 2.4. Looking briefly at the screen at the GPs my TSH seems to fluctuate every time I have it taken and the GP has raised a concern that it could be my cholesterol that is effecting the swings and getting that under control may effect my TSH level.

Reading some of the posts on here I am now very concerned I am either being told incorrect information and / or could end up ill if I am prescribed statins.

Is there any evidence of the connection?

The only other long shot I could think of before finding this site is since March I have massively increased the amount of shell fish I eat (started a new job and most days have a salad with sea food of some description). Long shot but I was told years gone by that it contained iodine that would stimulate the thyroid, what there is left of it.

My GP has asked that I repeat the bloods as fasting in 6 weeks time but I really want to get some research and evidence before I agree to any other medication or action.

Eagerly awaiting your guidance and advice

Thanks in advance

Adele

[helvella Administrator]

There is a strong link between cholesterol and thyroid. But usually we think of thyroid affecting cholesterol! Basically, hypothyroidism does appear to cause raised cholesterol.

Statins should not be prescribed to anyone who does not have their thyroid under control.

It seems entirely feasible that large amounts of seafood might be implicated. An area I feel ignorant about.

But do note, a TSH of 2.4. is still higher than many people here would find acceptable. It is common for people to need to be below 1 - but not universal.

Rod

[Delly]

Thanks for your response Rod, I have always been told by a range of GPs that they would always keep me on the minimum dose to keep me at the upper level. In March, the doctor said if it was still above 5 he would recommend an increase.

I am only 42 and ever since the operation have struggled with the weight issue even on controlled diets and exercise regimes. I'd there any guidance on that shows it should be below 1?? This would be a dream for me.

[nostoneunturned in reply to Delly]

What you need is in Dr Antony Toft's book, "Understanding Thyroid Disorders." British Medical Association publication, plus Dr Toft past president of British Thyroid Association so GP can't argue with such an authority. Book only about £5 from chemists/amazon.

Page 88: Dr Toft says:

"Judging the correct dose of thyroxine

Your GP or specialist will usually prescribe a dose of thyroxine that raises the FT4 and TT4 to the upper part of the normal range and reduces the TSH level in the blood to the lower part of the normal range.

Typical results would be a FT4 of 24pmol/l or TT4 of 140nmol/l, and a TSH of 0.2mU/l. In some patients a sense of well being is achieved only when FT4 or TT4 is raised, for example 30pmol/l or 170nmol/l and TSH low or undetectable. In this circumstance, it is essential that the T3 level in the blood is unequivocally normal in order to avoid hyperthyroidism."

Just get the book, show GP the page and there you are - dream achieved!

Apart from this it is good to know as much as possible, check out:

thyroid.uk.org

Also you might not know you have an absolute right to ask for and be given print out of any blood test, your health, your body, no need to glance at the screen any more.... just ask.

[shaws Administrator in reply to Delly]

This is a response from Dr Toft in an article in Pulse online. If you would like a copy of the whole article, email [e-mail].

6 What is the correct dose of thyroxine and is there any rationale for adding in tri-iodothyronine?

The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This ‘exogenous subclinical hyperthyroidism’ is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).

Even while taking the slightly higher dose of levothyroxine a handful of patients continue to complain that a sense of wellbeing has not been restored. A trial of levothyroxine and tri-iodothyronine is not unreasonable. The dose of levothyroxine should be reduced by 50µg daily and tri iodothyronine in a dose of 10µg (half a tablet) daily added.