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Thyroid UK
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Not sure what to think of GP appointment...

Hi everyone, 

Just had an appointment with a new GP and wondered if I could get everyone's thoughts on it. She has agreed to trial me with 25mcg of Levothyroxine for 8 weeks which is good news. However, she said if my TSH returns to normal range and I either don't feel better or only feel a bit better then she will take me back off it. She has said she won't increase the dosage at all. Basically, only if I go back with my TSH in normal range and feeling 100% will she keep me on thyroxine.

I wondered what people thought of this as to me it seems like if I go back and my TSH has dropped into normal range but is still at the top of the range and I feel a bit better but not 100%, then it would make sense to try a higher dosage? She's been quite clear that she won't do this though. Does this make sense to everyone else and have I just missed something? If so, could you explain the thinking behind it?

Thank you x

35 Replies
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She sounds like she is out of her depth, has forgotten what she learned and is making it up.....

Sorry,     See how you go with 25 and if its clear you need more, ask for a referral to an endo......

Xx g

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I agree with Galathea - this isn't what she should be doing at all. Actually sounds as though she's setting you up to fail. What's your TSH now? Do you have any thyroid blood tests to share?

Edited to add - it's ok, I see them here healthunlocked.com/thyroidu...

If you have symptoms and your TSH is rising, treating hypothyroidism is the way to go.

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That's what I thought. I know 4.4 is only just over range but it seemed to be increasing and I feel worse now than in I did in March.

I really hate GP appointments, I'm sick of being told I'm 'stuck on thyroid', I'm not I just want to feel better, whatever the problem is!! Thank you everyone on this forum for keeping me sane x

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If only your doctor was stuck on anything...

Did she further investigate that high cortisol level? Prescribe iron tablets for that low ferritin?

Don't tell me, she just wanted to throw antidepressants at you...?

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Exactly that! 2 doctors have tried to put it down to depression now!

I actually went with the intention of further investigating the cortisol, not the thyroid, but she seems to think it's not a problem because liver function came back normal. I'm having my stomach scanned to check adrenals aren't enlarged though.

And no mention of ferritin but I started taking iron tablets myself after the first set of blood tests. It's exhausting trying to get their help when you're already exhausted!

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It is. Good for you tackling it for yourself though. You'll need that iron to do the best job of converting levo to T3. 

Sorry this is such a fight x

Take the 25mcg levo and see how you go. If push comes to shove you might need to find another doctor to keep you on levo, and to raise your dose over time.

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Thank you, I really appreciate the advice x

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Cortisol isn't a problem because your liver function is normal?  Where on earth does she think cortisol is made??

As to TSH, you could point out to her that the average TSH of a healthy population is 1.5.

aacc.org/publications/cln/2... ( the mean TSH level in the general population is approximately 1.5 mIU/L)

press.endocrine.org/doi/abs... (mean serum TSH was 1.50 )

ncbi.nlm.nih.gov/pubmed/157... (1.55 +/- 0.78 microIU/ml)

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I'm honestly not sure, she said if liver function was normal then it was unlikely to be an adrenal problem.

Thank you for the links, the last time I mentioned that to a doctor she said I was questioning "how she had managed thyroid for her whole career"... I was trying do hard not to!

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Well, I think someone should question it! Because she obviously knows nothing about it. :(

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Rosetrees there are links between cortisol and liver disease so a liver function test might well show a cortisol problem so the doctor was right.

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I think the key there is "might", not "will".  I have adrenal issues, but my liver functions tests are normal.

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Without wanting to alarm you my gp stopped the levo when my TSH went back into range the following week i felt ill and ended up going to A and E. To cut a long story short i changed doctors and a blood test 6 weeks later confirmed i not only had hashimotos but found it had been untreated for 11 years. maybe getting your antibodies checked first would be ideal to confirm/rule out hashimotos.

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oh my what a horrible experience! I hope you're feeling better now? Thanks for your comment, I had my thyroid peroxidase tested in March and it came back as 14 (<34) which as I understand it, doesn't indicate hashimotos. 

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In and of itself, it doesn't, no. But you can't rule out Hashi's on the basis of one negative test, because antibodies fluctuate. Plus, that is only one of the antibodies involved in Hashi's. There is also TgAB, which - if it is positive - will also indicate Hashi's. Some people have one, some have the other. And others, like me, have both.  

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Thanks, I didn't realise you could have one and not the other. Is there a reason the other one wouldn't have been tested at the same time? Do they not tend to test it? x

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I Don't think they ever test it on the NSH.

My cynical brain says that they Don't do it because it would increase the number of people they have to diagnose.

But it's probably because they are so short-sighted, they only think the money saved on the test in the short-term.

 In any case, it wouldn't make any difference to they way they treat you - certainly wouldn't with someone as brain-dead as your doctor!

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I only have TgAb - at over 100 times above range but they still wouldn't do anything! It can be tested by the NHS - it is done in Newcastle, but it costs 3 times as much as TPO testing - go figure!

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Does anyone know why/when doctors started using 25mcg as the starting dose?  When I started on thyroxine 2.5years ago, 50mcg was the usual starting dose.  25mcg will do little or nothing I would have thought

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Yes I had thought a typical starting dose for an adult was 50-100mcg. Maybe I'm just being paranoid, but it does feel as though she has agreed to this so she can say 'look, it didn't work so it can't be thyroid' just to shut me up.

I've decided to order a blue horizon blood test before I start taking anything as I realised yesterday that if my TSH had continued to increase as my last blood tests had shown, then taking thyroxine now may just reduce it to what it was in March. In which case, I would go back to the gp and she would say it hasn't changed your tsh so it can't be thyroid and I'm taking you back off thyroxine. Does that make sense or am I really just going nutty? x

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But, the good news is... 25 mcg might actually raise your TSH! I Wonder what she would make of that! lol

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I assume she would take that as concrete evidence that it's not a thryoid problem!

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Well, she'd be very, very silly, then!

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Ofelia,

it does make sense, and how hypocritical of a doctor to use your health and wellbeing just to make a point, but, not unheard of, and if your gut is telling you she might be up to no good, that would be a sign to find someone else

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rosetrees - my one of many muppet GPs put me on 25mcg to shut me up and to prove that I wasn't hypo.  Apparently this dose is for those over 50 years old.  His empty little head stated that cos I didn't feel better I therefore wasn't hypo.  You couldn't make it up!!

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This is exactly what I think is happening in this case :/ I hope you got help in the end! x

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Ofelia - read as much as you can and if you have to go it alone so be it.  Life's too short to be pleasing a GP, it's you who has to live this life.

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don't waste another couple of years figuring out if you have a thyroid problem, find a doctor who will ask about your symptoms and run better tests, the longer you suffer with thyroid disease, the more problems you could end up with

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25mcg is likely to make you feel worse as the pituitary detects the additional T4 and producs less TSH thus instructing the thyroid to reduce production of T4 etc.

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All posts v interesting to me - I have a Drs appointment tomorrow  to review my thyroid situation and get results of latest blood test . I have been on 50mg Levo for hypothyroidism for just over a month now and really don't feel any better . The only change is I am not so tearful as I was when I last went to the dr when she tried to start me on anti d's. Her words were ' I don't think this is anything to do with your thyroid I think you're depressed' I've suffered from depression before and I know that wasn't what I was feeling . Anyway I didn't start on anti d's but I'm worried that because I still don't feel better ( still tired beyond tiredness and feeling really foggy ) she might suggest them again . 

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Why do they always try to pin it on depression, without any assessment of depression?! I hope the appointment goes well, I'd be interested to know what your GP suggests x

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Ofelia - GPs receive QoF points for managing each health condition, a diagnosis of depression earns them lots of points.  More points equals more income for the Practice and thus more money in their pay packet.

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ive been referred three times to the local mental health team then they cannot find anything wrong and refer me back to the gp who still says i have a mental illness and that thyroid is fine as bloods are within range and they wonder why the health service is falling apart (i am a nurse my-self)

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Dr's work for us. FIRE HER, and don't waste another minute worrying about what she may or may not do, just try to get better :). I got rid of two dr's last year, and I had never done that before, it felt AMAZING, and furthermore, BOTH my pri and gyn, could not handle it, both offices CONTINUALLY called until I told them they had been replaced (which I had made clear earlier) im not saying im gloating about it, but, I guess it must bother them a little that they are not the ones in complete control, I stand behind my choice and am much happier for it, my primary was refusing to listen to me for years and when I started on NDT without her knowledge and she saw my tsh results, had a fit, i told her she should have listened to me and not the numbers. my gyn was waving my hormones over my head forcing me to come to the office for a prescription after taking it for a year, she was in her 30's  -im not going to have a 30 year old female dr refuse me something that helps me, so i found a late 60's male gyn who wrote the script with 12 refills without batting an eye, they work for us! you already don't feel very well, don't give her any more of your time by stressing about her one bit. there are compassionate dr's still, ask the secretary about the dr before making an appointment, ask around to friends and look at reviews online when looking for a new dr, you will wish you had gotten rid of him/her years ago, furthermore, bring  your empty bottle of levo to the new doc, they aren't going to go calling the old doctor most times. im pretty sure your dr is bluffing about not refilling it, they do that a lot 

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I started on 25 mcgs when I was provisionally diagnosed in Aug 2013 (very low FT4/FT3 tests, mid range TSH - around 1.2, oodles of symptoms). I did feel a bit better on it although my TSH remained the same and my FT3/4 levels dropped. They upped my dose after 8 weeks and did the same until I was on 100 mcgs levo (when my FT4 and FT3 finally started to rise into the normal band and my TSH also started to drop below 1)

However I was only diagnosed after moving GPs; if your quack is not treating you properly then I'd suggest you look at moving too

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