How do I justify a referral to endo from my GP?

[Rambler16]

Have also submitted this in my palpitations post. Briefly, was diagnosed borderline thyroid in 2012/13. Took 50mg levo for a couple of weeks a couple of times then stopped due to palpitations. Tsh then seemed to normalize (maybe because I upped my low iron and b12 levels too). Now pregnant and tsh has jumped from 4.35 to 5.08 in 2 weeks. GP said 4.35 is 'normal' and that I didn't need to be tested. Tried 25,50 and 75, can't seem to get past 25 without palpitations, but think it's risking this pregnancy as fetal heartbeat has reduced in a week from 90 to 60. So I called my GP and left message to be referred to endo today. GP left me a voicemail today asking me to put in writing why I want an endo referral so she can understand and deal with my request. She said 'is it only for the thyroid'. Can someone pls give me some guidance on suggested wording to send to my GP for the endo referral. In lay terms, I feel that the GP has been rather unhelpful throughout, not realising the importance of the thyroid tests esp in pregnancy, I am the one that keeps having to push so how do I justify this referral to her pls?

[Clutter]

Rambler16, There's no point in testing if you don't take the dose your GP prescribed. Your GP prescribed 75mcg because 25mcg was insufficient to bring your TSH <2.0. An endo won't be able to do anything more than your GP has if you don't take the dose prescribed.

High TSH increases the risks of poor foetal development and miscarriage so you should consider taking the dose prescribed and tolerating the palpitations to protect your pregnancy. Palpitations are undoubtedly uncomfortable and can be very distressing but they're very rarely damaging. If you can ride through the palpitations on 50-75mcg for 2-3 weeks you may find they subside when your thyroid levels improve.

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I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

[Rambler16 in reply to Clutter]

Thanks but my GP didn't prescribe 75. I asked for my level to be tested and I asked for a new Levo prescription. 25 was the last one on my records so I could only get that one through the surgery. I had to make an appointment to get the 50 and I saw a locum GP who reluctantly prescribed this. My GP then commented a day later on the phone that my tsh at 4.35 was 'normal' and that I would have 'been ok on 25'. The private fertility doc then said tsh of 5.08 (2 weeks later) is too high and that I need to up my Levo to 75. Had a bit of rectal bleeding so went to A&E and they said heart rate too high at 89 and to cut Levo to 50 or 25. This is why I'm getting confused and wonder if an endo is best option.

[Clutter in reply to Rambler16]

Rambler16, Did the fertility doctor prescribe 75mcg or did you continue on 50mcg the locum prescribed? I got the impression you were taking 25mcg because of the palpitations.

___________________________________________________________________________

I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

[Jackie]

Hi You need T4 and free T3 bloods too. I would say to prove to yourself that you are wrong! Carefully research who you want to see,you can always phone their secs too.

Jackie

[thyr01d]

Oh Rambler I do feel sorry for you. If you write down this history, including both what you were told at A&E and Clutter's point about foetal development and miscarriage, might your GP refer you?

I'm thinking if it is down in writing to the GP that there are these risks, she/he is not going to want to be held responsible if anything goes wrong and will probably be glad to pass you on to someone else.

I do hope you are listened to and looked after.