"We just treat ranges"

Yes, this is what I actually heard come out of a GP's mouth last time I spoke on the phone and requested a print out of all my thyroid and cholesterol tests.

Since they lowered my dosage by 25 mcg of thyroxine 2.5 years ago, my cholesterol shot way up. I insisted on trying to get back to the level I used to be, which is a lower TSH within the range, but at the end of the low range scale of just above it. When I am there my T4 still remains pretty much the same. It doesn't go into the upper range. That must mean that me metabolising T4 is compromised someway.

I feel 100% better on the increased dosage, and I'm going to have my cholesterol and thyroid profile retested in about 6 weeks time, but I'm dreading the fight I'm going to have at this GP clinic in Hammersmith London. It is frightful. Truly frightful to be told you need to take statins, when I'm slightly over the normal range for cholesterol after years of having a normal range all because they lowered my thyroxine dosage.

Unbelievable, the doctors here. I'm from America and this is almost akin to communist Russia health care if you imagine it at its most bureaucrat worst.

All these crazy ideas of "we treat ranges" Not patients? Or dare I say "people"?

I can't believe the autocratic, less than concerned manner in which we are now treated. Is this their way of driving through privatisation here in the UK? I'm going to have to change GP clinics or go private, because this seems to have become the ethos of our biggest local surgery here in Hammersmith.

17 Replies

  • Agree. Well done, continue to be assertive with them and remember - don't take any levo on the day of the test or the night before. Good luck

  • Well actually if the doc just wants to treat ranges he would be better off working in a testing laboratory. We could just self diagnose, get bloods tested by a robot and if the result is out of range we could be given meds.

    No need for the docs any more. So their salaries could be put to better use in the Nhs..... Maybe they could buy more t3?

    I have just refused to let my doctor test my blood a third time. he tested twice, both results out of range so he wants another set of tests to make sure... No deal. I insisted on seeing someone competent when the receptionist phoned me yesterday.

    I asked her if she thought I was an awkward patient... Then I assured her that with a little more effort I can be absolutely impossible :-).

    Xx. g.

  • What is really frightening is if you register in so you can read this article in Pulsetoday.co.uk. A website for GP's in the UK. They have allowed people other than doctors to comment because of website changes and the comments here will shock you. GP's saying if they wanted to read nonsense comments like those posted by the patients about their thyroxine range problems, they would read the Daily Mail.

    And the matter discussed is that if a new patient comes into the practice and wants their thyroxine renewed and the GP doesn't see in the record an original assessment of why they were on thyroxine to begin with, the suggestion by the doctors who wrote their reviews is to take the patient off the thyroxine for 6 weeks and test for hypothyroidism?!

    Meanwhile we know that if we don't take our thyroid medicine we can become seriously ill. Here are GP's saying take them off it if they are a new patient and can't provide original proof they needed it to begin with? OMG ! Read the comments is all I can say. Scary doesn't describe this situation here enough.

    The name of the article is:

    Dilemma: Doubt over thyroxine prescription


  • Lots of very good replies to the article. Thanks for posting. PR

  • The thing I've realised when reading Pulse, which I do every now and then, is that GPs feel undervalued and overworked. But they have apparently accepted that in many cases an untrained person can do their job as well as they do.

    1) Symptoms are treated individually, never getting to the root of a problem. It's like wrapping an open fracture in a bandage and saying, "There you go, all fixed! You can't see it now!"

    2) Only looking at ranges. See this :

    3) Why haven't GPs jumped up and down and screamed about lab technicians (who have never seen the patient) over-riding their clinical judgement? Don't they find that insulting?

  • I've been thinking about n° 3 for a long time. I Don't understand it, either. I'm sure the UK is the only country in which that could happen.

  • Its the ethos directed by BTA and BTF and RCP

    they simply refuse to listen to patients

    be very very sure not to take your thyroid meds for at least 24 hours if not 48 hrs before a test ensure the test is done early morning so tsh is high and hope they increase not decrease your dose

    your correct that if your on correct level of meds your cholesterol would also be fine and as for statins theres more evidence by the day of their dangers and horrendous side effects

    at the end of the day rather than pay for private gp why not simply use the money to order NDT online and treat yourself

  • Thanks for your advice and insight. I'll follow it as my next test comes up. Here are two comments you might find interesting from the article I linked to above.

    1. Anonymous | 02 November 2013 1:03pm

    "however the clinical advice contained in the article is based on current UK clinical guidance. "

    There is no current UK clinical guidance for the diagnosis and treatment of hypothyroid symptoms.

    There is an opinion piece produced by the RCP and the BTA which is full of factual inaccuracies and does not contain a single piece of evidence in support of the statements made.

    When asked to produce evidence in support of their opinion piece, the RCP and BTA refused.

    When asked who the authors of the opinion piece are (in the interests of transparency) the RCP and BTA refused to say.

    When asked to provide evidence of any literature review conducted, the RCP and BTA refused to say.

    The RCP do not adhere to their own rules on producing "guidance".

    The RCP repeatedly refuse to engage with patients and ignore those patients who have highlighted the inaccuracies/lack of evidence in the RCP's opinion piece.

    Any GP with a modicum of intelligence would see the RCP's opinion piece for what it is (a biased opinion piece) and go directly to the literature in order to get a well-informed overview of the situation.

    2. Anonymous | 02 November 2013 2:06pm

    NICE wrote to me stating that they DO NOT have national guidelines for hypothyroidism and that a doctor should use his or her own judgement in consultation with the patient.

    I wonder if the authors of the above read the ‘Guidelines for the Use of Thyroid Function Tests’ where they say,

    “The document should be considered as guidelines only; it is not intended to serve as a standard of medical care. The doctors concerned must make the management plan for an individual patient.”

    “Routine thyroid function testing has been available for more than thirty years. Therefore, it may seem surprising that the quality of evidence to support the recommendations in these guidelines is generally poor.”

    “There is a real need to conduct new studies that conform to the rules of evidence based medicine in order to provide answers to some common but contentious issues in the use of thyroid function testing.” (UK Guidelines for the Use of Thyroid Function Tests (July 2006) prepared by the Association for Clinical Biochemistry, the British Thyroid Association and the British Thyroid Foundation)

    As for side effects, the authors of the paper below found very few even on exceptionally high doses of thyroid medication.

    In a trial by Bauer et al on depression, they treated with high dose thyroxine and supraphysiological doses were given to euthyroid patients with major depression. “Side effects were surprisingly mild and no complications were observed at all.

    Bauer M, Hellweg R et al

    Neurophyschopharmacology ISSN 0893-133X 1998 vol 18, No6, pp. 444-455.

    Thyroid-antibody-positive women were given a trial of thyroxine to prevent postnatal depression. Note the marked increase in the incidence of biochemical hyperthyroidism, but this was not accompanied by any clinical symptomatology.

    Research study carried out by Harris and others including John Lazarus FRCP, entitled, ‘Randomised trial of thyroxine to prevent postnatal depression in thyroid-antibody-positive women’, the researchers stated that, “in the active group there was a marked increase in the incidence of biochemical hyperthyroidism, but this was NOT accompanied by any clinical symptomatology.” The authors stated, “The difference between the rates of occurrence of biochemical hyperthyroidism between the placebo and active groups is high significant.” The researchers had induced ‘chemical thyrotoxicity’ in a large number of postpartum women.

    (Harris B, Oretti R, Lazarus J, Parkes A, John R, Richards C, Newcombe R, Hall R. Randomised trial of thyroxine to prevent postnatal depression in thyroid-antibody-positive women. Br J Pshchiatry (2002)180:327_330).

    These are but a few of the medical papers that contradict the content of the Pulse article.

  • ..yes and many of those so called experts are on the payroll of Big Pharma ....

  • I am sure you are aware that raised cholesterol is harmless and indicates low thyroid hormones :-)

    Wishing you success with your Docs - am sure you will show them the way - or the door !!

  • Think you have hit the nail on the head Karen with the driving through privatisation bit.

  • Thanks for your replies. You know, it was in the states that your Doctor is one of the most significant people in the life of yourself or your family. How far it has come over here from that reality. But confidence and trust in your own doctor is about 80% of getting and keeping well.

    How can the way they have changed things here ever be anything but a recipe for disaster. Always a different GP.

  • I work for the NHS & the terrible wasteful way it is run makes me wonder whether privatisation might not work better!!

  • What the GP's don't seem to understand is that if they were to become private doctors, their communication skills would have to improve tremendously as well as their regard for their patients on a long term basis not a 10 minute quickie.

  • I don't know about that, I have a friend who lives in the US and she is always complaining about how awful her various doctors are. I was really surprised that she should be so dissatisfied when she is paying for her medical care. I was always of the opinion that if you pay you get exactly what you want but it doesn't seem that way for her.

  • I have on here a few times said that we cannot sustain the current funding system for the NHS. It's a sacred cow that no politician will risk change ,so care and treatment gets worse.The producers give us what they decide we should have which is not what as consumers we always need. If we paid by some insurance type of system we would expect respectful treatment and not tolerate ignorance and neglect.

  • You are spot on about your cholesterol. When I was really hyper my cholesterol was the lowest it has ever been. Now I'm 'in range' - well I would I say I'm heading now towards being hypo by my doc doesn't agree :( - my cholesterol has shot up.

    I tried statins - for a week! Felt so dreadful I stopped and have been refusing them ever since.

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