GP response - just as predicted!

[AmandaK]

Two weeks ago I mentioned I have gained weight very suddenly and had TSH and T4 tested, which showed they were in the so-called 'normal' range (TSH - 2.56 [range: 0.3-4.5]; T4 - 12.4 [range: 10-22]).

Yesterday I went to the GP to discuss results and weight gain (which, incidentally, has stabilised, thank goodness).

As predicted I was told it was the menopause, despite the fact that I stressed that many of the symptoms precede the menopause by a number of years (two decades in fact!).

I have now begun taking my temperature on waking using the recommended basal thermometer - so far 96.8; 96.5; 96.4 - yet the GP took no notice of this either.

Can I have permission to scream?

To give her her due, she has asked me to get bloods taken again (including TSH, B12, diabetes) so I will go as early as poss to get bloods drawn (the bloods for the above tests were taken at 4.30pm, so there may be a significant difference).

I asked about testing for T3 but she said that T3 was very difficult to test and was unreliable. Is it worth challenging that viewpoint and if so, how?

Amanda

[susymac]

She's wrong saying T3 difficult to test and unreliable, but thats most likely what she's been told, however it is difficult to get tested simply because it is NOT upto the GP but is upto the lab, if your TSH and/or T4 levels are within range then it is unlikely that the lab will test the T3 even if its been requested. They usually only test if the patient has a suppressed TSH or it has been stated that the patient is on T3 medication. It is pointless even aguing with a GP over this as it is out of their control. Private testing may be your only option if you want it done

[ejh1 in reply to susymac]

Actually, I always get my T3 tested via the GP, who is happy to do it and the lab doesn't complain. I think there it depends where you live. The GP pays no attention to the result though, it is me that requests it from the nurse taking the blood! I use the excuse that the endocrinologist requested it.

[AmandaK in reply to susymac]

The GP stated that it was the lab that would decide whether or not to test to T3, which was part of her argument. I'll see what the results are for the next test - I'll be hotfooting it to the phlebotomy dept first thing tomorrow. I suspect private testing is on the cards.

[Marz in reply to AmandaK]

Dr Peartield was a GP who for many years tried to help patients with thyroid issues. He himself is a sufferer. His feelings are that he was the one sitting in front of the patient with endless obvious symptoms - and not the person in the lab testing the blood. The world has gone mad - and medicine is dominated by blood tests - of course they have a place but are not the be all and end all.

Dr Barry Durrant-Peatfield eventually left the NHS as he felt his hands were tied and he was not able - ' to do no harm to his patients ' - as stated in the Hippocratic Oath doctors take. An honourable man who is still helping so many of us today.

I am grateful to live in Crete where they test everything you request - and you have the printed results in your hands two days later. The UK has a lot to learn. It just gives you a feeling of being involved and also a little control on the outcomes.

[rosetrees]

Your T4 is way too low. fT3 isn't difficult to test, as far as I am aware. It is, however, more expensive than T4. Just a personal opinion, but with T4 that low I would be amazed if your fT3 was anything other than low, so at this point I wouldn't insist on testing. What I would do is politely but firmly insist on a trial of thyroxine to raise your t4. (Who am I kidding, I totally lost it with my stand-in GP to get thyroxine, which he prescribed to shut me up.).

Once your T4 has raised, then insist on a T3 test - as you want to know if your body converts T4 to T3 effectively. This video is well worth watching youtube.com/watch?v=CVXvYrJ...(Not working as expected?) It's a presentation to the Scottish Parliament and it's main focus is conversion from T4 to T3.

[AmandaK in reply to rosetrees]

The presentation is excellent - would it be poss to send me the link so I can forward it to my partner so he has a better idea of the issues. Until my consultation with the GP (at which he was present), he was supporting my assertion that there was something wrong (esp when my temperature was pointing at a low metabolic rate/potential hypothyroidism) but then seemed to be swayed by the GP.

[helvella in reply to AmandaK]

The link is:

youtube. com/watch?v=CVXvYrJJ5dU

I have added some spaces to stop HU converting it to an active link - remove them before using it.

Rod

[AmandaK in reply to helvella]

That's great, thank you.

[rosetrees in reply to helvella]

Thanks helvella.

[Hidden]

Hi Amanda, It's infuriating and insulting when the doctor gives you an excuse for not testing T3 which is clearly made up on the spot. She obviously didn't know about testing T3 as her reason is rubbish! But you know that. Our GP actually asked us what T3 is. Hard to believe, and we sat there gobsmacked when she asked us!

I would say that your TSH is too high and your T4 too low. Are you on any thyroid replacement. If you are do not take it before you have your next lot of tests.

Try asking her for the full range of tests - TSH, T4, T3 and thyroid antibodies as well as ferritin, folates, Vitamins B12 and D and intracellular magnesium. That might help to convince her that you mean business and know what you're talking about.

If she has no explanation for your symptoms there is no reason for her NOT to ask for these tests.

Jane x x

[AmandaK in reply to Hidden]

I have had TSH tests on a number of occasions over the years and - the usual story - because they were in range the GP wouldn't even consider any treatment. This is the first time a doctor (in this case a liver consultant) has asked for T4. The tests I'm about to have done will also be testing B12, Ferritin, FSH, FBC and liver function. We'll see what happens.

[Hidden in reply to AmandaK]

Yes, please keep us updated. Jane x

[tegz]

The real McCoy is the T3: Reverse T3 [ratio]. T3 level is a good indicator for over treatment, as discuused here.

If I ever get decent treatment for thyroid- then the first specialist that suggests this will have my vote.

The cost of testing is less than much wasted treatment -and will free up money where it can be shown to be useful in the wider NHS.

I hope the Scots' Petition doesn't get sidelined by the system.

We all know about the pleading that Pharma will pay to inject.

[AmandaK in reply to tegz]

I also wonder if the real issue is that of cost - though as you rightly point out (and which comes across so strongly in the presentation to the Scottish parliament) the cost of testing is less than the cost of treatment and than the outcome of misdiagnoses. Interestingly, the GP I usually go to does not believe in ME/CFS, yet at the same time won't consider that the issue may be to do with the thyroid and with conversion difficulties. Somewhat ironic!

[AmandaK]

Many thanks to all for your helpful comments and advice - I'll let you know how I fare with the next set of tests.

[AmandaK]

Have just returned from the GP (a different one to last time) and it appears I'm the picture of health!

Frustratingly, the other GP only asked for TSH and not T4 (it was supposed to be a comparison with the other thyroid tests done at B'ham QE hospital) so I'm far from pleased.

Anyway, upshot is:

TSH - 2.47 (0.35 - 6.00)

B12 - 878 (191- 663, so off the range!)

Folate - 5.6 (4.6 - 18.7)

Ferritin - 90 (15 - 350)

FSH - 81 (26 - 135 postmenopausal)

Glucose - 4.4 (not sure what that means)

GP's conclusion:

It's the menopause (here we go again...).

The weight gain (7IB in 7 weeks) is not significant.

My basal temperature is normal (since taking my temp, it has been: 36; 35.8; 35.7; 36.3 (headache and beginning of viral infection); 35.9; 36.1; 36.1; 35.8; 36 (have had viral infection for past week so needs to be taken into account).

However, my BP is high: 141 / 95 and has been consistently high over the past year so I'm having to check and monitor it for the next two weeks and if it continues to be high I'll need to be on medication.

The doctor was *very* suspicious - and somewhat aggressive - when I told him I was taking my temperature and especially when I asked for the printout of results. I left the surgery feeling as though I'd been a naughty girl!

[PoppyRose]

... ditto Susymac. I'm told it's the labs. If it;s within the norm despite how you feel they will not test further. Very frustrating and this needs changing!! Although on a couple occasions they have produced them ...?