Prescribed 225mg by Dr S but GP says this is too much. What can I do?

[uptoapoint]

Hi

I have been prescribed 225mg thyroxine privately but my GP feels that this is too much as my TSH level is now below zero.

I have been feeling better on the increased dose although some symptoms - weight gain and oedema - persist. I don't want to reduce the dose I take as I am hoping that I will continue to improve on 225mg..

Can anyone tell me what the protocol is here? Can I tell my GP I don't want her to treat me for hypothyroidism but just see her for anything else that crops up? I hardly ever go to the doctor for anything other than auto-immune related things so this could be a big win for her!

[nobodysdriving]

yes you can take the decision that you will only follow Dr S for your thyroid, I did this!

you might as well, thyroxine is 'dead cheap' on private prescription so just tell your GP you will carry on with your 225mcg dose on private prescription and that he/she may one decide to prescribe it if not you'll stay on private prescription.

However your GP should not deny you thyroid function blood tests, you can still have those via your GP, that is called 'monitoring' and it is more dangerous for a GP to refuse to do them than doing them even though you are taking a higher dose prescribed privately.

[uptoapoint]

That is really helpful - thank you very much.

[shaws Administrator]

Dr Skinner is of the 'old school' learning about clinical symptoms of diseases whilst training as a medical student. This was before the blood tests for thyroid gland became the norm and the TSH in particular for diagnosing. People with clinical symptoms were prescribed thyroid gland hormones (NDT). The normal dose was between 200mcg and 400mcg till symptoms subsided.

This is from a Pulse Online article by Dr Toft who was the President of the British Thyroid Association. Maybe your GP should have a copy:

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.

[uptoapoint in reply to shaws]

Thanks for this. I'll see if I can find the article online and print off a copy for my GP. I am not hopeful though that she will change her mind nor that she will base her diagnosis on anything other than my TSH level. She is a nice woman and I get on with her but she simply ignores my symptoms. I didn't expect to have to battle to get well. It is so dispiriting!