Do I need to see an endocrinologist?

[emerson]

I've posted a few questions on the site as I was just diagnosed this week by blood tests taken by my GP. My TSH was 7.31, that's all I was told. I was given the information over the phone - it was a short call with no explanation really of what hypothyroidism really is. He started me on 50 mgs of Levothyroxine, which he says he will review in 3 months. My question is, is it necessary to involve an endo. or can a GP handle the situation?

[Hidden]

Hi,

It may be that once you have been on Levo for a little while that any symptoms you are experiencing will clear up. If that is the case then your GP can manage your condition. This is often the case. Many people do well on Levothyroxine. Let's hope you're one of them. If not then you may need to see and endocrinologist or come on here again for more information.

Jane x

[Hidden]

Hello Emerson

TSH is the thyroid stimulating hormone which is activated by the pituitary gland in response to the blood levels of T3 (the active hormone). The normal ranges are around (0.4-4.0) (I think) so as you can see yours is above the normal range.

50mcg is a starter dose so when you have your review in 3 months the doctor may well increase your dose according to your blood results. It takes a while for the Levo (T4) to get into your system so this is why they leave you on this dose for 3 months (although many doctors often check again in 6 weeks).

As you probably know hypothyroidism is for life and you will be able to receive your prescriptions free (if you are under 60).

You should feel better once you have started your levo, but if you are still struggling with symptoms after 6 weeks I would try and see if you can get your bloods tested earlier than 3 months.

My opinion is that it is too early in your treatment to involve an endo. If you get to the stage where the doctor won't increase your levo any more and you are still feeling unwell, then that might be the time to think about it.

Hope this helps

Jan

[emerson in reply to Hidden]

Thank you Jan and Jane for your answers as usual they are very informative and very welcome. I suppose I ask because I have an ileostomy and gut absorption problems and also I can't eat a normal diet (I survive on medically prepared drinks), no solids as my bowel cannot digest normal 'food' and I'm worried that somewhere along the line the thyroxine won't being taken into my system correctly. You see I'm very unsure how exactly thyroxine works, maybe the gut health is not important? I would be grateful for any clarification. Thank you.

[Hidden in reply to emerson]

My daughter kind of crunches her tablets then puts them under her tongue. You may find that you absorb them better this way too. Jane x

[shaws Administrator]

Normally, when first diagnosed your next thyroid gland blood tests are around 6 weeks. 3 months seems too long to me although your TSH at 7 is not particularly high. I note your have gut problems as well, so I would phone and make an appointment around 6 weeks and you should see a reduction in your TSH if everything is working well. I don't know if your GP told you to take your medication on wakening with a glass of water and not eat for between half or 1 hour so that your stomach absorbs the hormone. Any supplements take 4 hours after levo.

Some people find it more convenient to take meds at bedtime.You last eat two hours beforehand.

Doctors usually treat straightforward thyroid gland problems unless problems arise they then will refer you to an Endocrinologist.

[emerson in reply to shaws]

Thank you Shaws, I think I'll make that appt at 6 weeks just to see how things are ticking over. Also, I think taking my Levo at bedtime would be more suitable for me as when I wake up I take my first supliment drink of the day plus an awful lot of medication. Thanks again for your help.

[appyalison]

I've been on thyroxine for 27 years. I don't think I've been particularly well medicated but now have so many other health issues that it is difficult to work out which is associated with being hypo. That is, until chedt consultant told me to drop thyroxine level. Gradually felt worse and worse until last week I was really hypo and really ill. Started taking tablets at previous level and after a week I am beginning to pick up - not wrapped in blankets with heating on now. Phew. GPs don't seem to know much but mine would never have made me drop thyroxine level unless I felt I was hyper. Chest consultant will never comment on throxine level agin unless he has found me an endo! Alison

[emerson in reply to appyalison]

Hi Alison, thanks for your reply. I too have a list of medical complications and to be honest my GP said he thought my symptoms where down to anxiety until I mentioned that being an ex-radiographer I knew enough to suggest that my symptoms could be hormonal or even down to my thyroid. I think that's why he tested my thyroid in the end. The other tests he did also showed that my CRP (inflammatory markers) where up - and to think I left the surgery that day feeling a fool. It just proves that that the doctor isn't always right. x

[appyalison in reply to emerson]

Yes, don't I know it. The cough I had for a year was not 'serious'. That's why I've had a major cancer scare with the lung surgeon thinking I had secondaries in the lungs. Brilliant! Still waiting for definitive answer on exactly what I have to add to the list. It is really too easy to tell people they are anxious. So would they be if they had so many issues and symptoms. Beginning to pick up again after chest consultant decided I should drop the thyroxine level. Never again. Having bronchoscopy Wednesday and gastroscopy and colonoscopy in the pipeline. Fingers crossed for us all. I am shocked at how little doctors seem to know about thyroid illness. Good luck Emerson. Alison

[emerson in reply to appyalison]

I'm sorry to hear Alison that you have been having so many awful (and scary) problems. Doctors, especially GP's I find, can be so dismissive (and incompetent almost). It really is an uphill struggle with all but one of the GP's in my practice and it's so difficult getting an appt you rarely end up with the one you prefer.Fortunately I have an excellent surgeon who has dealt with most of my problems and he's got such a lovely way with him - he actually makes you feel welcome to his surgery. I'd be lost without him. Why can't the rest treat us with the same dignity?

[emerson in reply to emerson]

Sorry. Alison meant to say good luck with your test - hope all goes well. x

[REMZ1]

After 3 years of telling my doctor my thyroid was packing up I was eventually diagnosed with hypothyroidism in 2017. I was started on 50mcg a day with blood tests every 6 weeks to check my thyroid levels and after each test my dose of Levo was raised in 25mcg increments until my levels were at the right level. Tbh the symptoms i had before diagnosis have never gone away just lessened (except weight gain. That has continued despite being a healthy option eater and only eating once a day). The fatigue and lack of motivation and drive kept me out of work for 2 years and after 7 months in a new job my symptoms have come back full force and im signed off again and I have anaemia now to which is common with hypothyroidism. The doc did the general TSH and T4 tests and everything looked normal to them. I had to push for a Free T3 test which has come back normal apparantly. So far the doctor hasnt treated the anaemia or made any reference to the thyroid and anaemia being associated and has ordered a further blood test in a month to see if my red and white blood cells are back to normal and if not a referral to Heamotology will be made. They also requested a stool sample incase the anaemia is due to internal bleeding which isnt evident outwardly. So to summarize, im menopausal, anaemic and hypothyroid. The three go hand in hand, ive had my levothyroxine upped by 25mcg on just 2 days a week, no meds for the anaemia (but they hope that will be improved by next months blood test - with no treatment? Really? ) and no dot connected between anaemia and the thyroid but instead look for internal bleeding which isnt showing itself in any other way. When i asked the doc why i feel so rubbish like i did before diagnosis i was told the condition has knocked my coping mechanism.

In short my friend, i would say beyond initial diagnosis, unless yr doc has experience with endocrinology i personlly think hypothyroidism is too complex for the family doctor. When you have to prompt them to go deeper and do a free t3 test because the t4 is looking good then i think its fair to say the gp knowledge of the endocrine system in its entirety is beyond their capabilities. The thyroid controls the endocrine system. So anything your hormones control is dependant on how well yr or broken the thyroid is. Id also say that when the thyroid has a council (national thyroid council uk) to supprt its complexities its safe to say the general gp can diagnose and treat a treatment responsve case but if its treatment not fully responsive, they flounder around like fish out of water. I think at the latter state a referral to an endo should be matter of cause. I also think that to treat the thyroid successfully they need to find why it broke in the 1st place because otherwise you only ever treat the symptom and not the cause wich means they get lots of money contiuously whilst your quality of life goes down the pan.

Just my opinion based on my own experience though.