Rheumatology referral

I have been back to my GP with my Blue Horizon blood test results. Contrary to Clutter she said my B12 was not low and my iron was within range but that I could take iron for a month if I wanted to.

I showed her the Pulse article, as also suggested by Clutter, about increasing Levo in some circumstances. The GP said my results don't fall into the bracket of result ranges mentioned in the article.

She says "something else is going on " with me and has referred me to a rheumatologist, but my appointment is not until the end of August. I, of course googled, and am now sick with worry that I have some other horrible disease as well as Hashimoto's. ME, MS, Fibromyalgia -- the list of possibles goes on.

Life is difficult enough with Hashi's. The only thing that keeps me going is the idea that I will find the right treatment for me eventually. I can't cope with some other incurable and untreatable other disease.

15 Replies

  • Unsurprisingly, your GP does not know what she is talking about. Your b12 is low. It is considered that a level of at least 1000 is needed for brain and nervous system health. Anything under 500 is low and will cause symptoms. There is a book by sally pacholok and jeffrey stuart called could it be b12? Get it and read it, the proof is in there as well as information on b12d.org gather evidence and go back. Although your GP has ignored the pulse article so maybe they will do the same with this.

    Your t3/4 are in the bottom of the range instead of the top so they certainly could be better. The article says that people feel well feel when they are at the top of the range or above so I don't know why she is dismissing that and yes your iron is low too. This makes me so angry as she has now worried you when she has evidence of b12 deficiency and a thyroid that needs to be medicated properly.

    If she still doesn't help with all the extra evidence you can provide then you may have to treat yourself can you see another GP in the surgery? They may take the evidence better. The rheumatologist may also realise your symptoms are related to b12 and thyroid and not a rheumatology issue. I'm sure it could still be something else, but to dismiss your symptoms is unhelpful.

    I too have hashimotos and fibromyalgia but since supplementing with b12 I am significantly better and have now changed my thyroid meds. No help from GP. Sorry for the long reply, but other members will probably give you more useful advice. :-)

  • Long reply much appreciated. To be fair to the GP she didn't dismiss my symptoms as being non-existent which is why she has referred me to the rheumatologist. She says I am fixating on my T3 conversion when my blood results don't indicate there is a problem. I am taking b12 supplements and b complex plus selenium and vit E. She is also suggesting I take ante anxiety tablets.

    Just a long time to wait and worry before I see the rheumatologist and no earlier appointments -just checked.

    I am sorry you have fibromyalgia to cope with as well. I am full of admiration for you especially as you obviously also try to help others.

    Thank you.

  • If by anti-anxiety tablets she means something like Valium or an AD, just don't do it. Very hard to get off again and doesn't get to the root of the problem, which seems to be your thyroid.

  • She has given me 10mg citalopram. Says they might make me feel sick.

  • That's not "an anti-anxiety pill" that's a SSRI anti-depressant. I wouldn't take it as there is no evidence that you are depressed or have low serotonin. GPs get extra funding points for prescribing ADs, but there are no blood tests to probe that you need them. Anxiety is a side effect of hypo. I'd ask for a referral to counselling if she thinks you are depressed (and do your nut because she didn't tell you what they were), and take up meditation.

    How is feeling nauseous better than feeling anxious?

    Side effects: drowsiness, nausea, insomnia, xerostomia (dry mouth), and diaphoresis (abnormal sweating). Other side effects include: diarrhea, ejaculatory disorder, tremor, vomiting and ANXIETY (you couldn't make it up)

    Perhaps time for a change to a more trustworthy and clued-up GP, you could email Louise for the list of GPs with a clue.

  • Citalopram is frequently prescribed for anxiety and stress disorders very successfully. The majority of side effects you list are rare.

  • But perhaps not appropriate as a treatment for hypothyroidism.

  • Absolutely not. Merely commenting on the inaccurate information about citalopram.

  • The inaccurate information is from drugs.com. The BNFF add: also hepatitis, palpitation, tachycardia, oedema, bradycardia, postural hypotension, haemorrhage, QT-interval prolongation, coughing, yawning, confusion, impaired concentration, aggression, malaise, amnesia, migraine, paraesthesia, abnormal dreams, euphoria, mydriasis, taste disturbance, increased salivation, rhinitis, tinnitus, polyuria, micturition disorders, hypokalaemia, pruritus; paradoxical increased anxiety during initial treatment of panic disorder (reduce dose). So there you go.

    Mind says:

    Very common

    (affects more than 1 person in 10)

    dry mouth


    increased sweating

    insomnia (inability to sleep)

    loss of energy

    nausea (feeling sick)



    (affects 1–10 people in 100)


    anxiety and nervousness




    distorted sense of taste


    sexual problems:

    in men: reduced sexual desire; failed erection; delayed ejaculation and lack of orgasm [YC] (this can continue after drug use has been stopped and could last permanently)

    in women: reduced sexual desire; spontaneous orgasm; delayed or inability to reach orgasm [YC] (this can continue after drug use has been stopped and could last permanently)

    increased salivation

    indigestion, abdominal pain or flatulence


    lethargy (feeling like you don’t want to do anything)

    loss of appetite

    loss of concentration

    memory loss


    muscle and joint pain


    pins and needles

    stuffy nose

    tinnitus (ringing in the ears)



    vomiting (being sick)

    weight loss


  • Untl recently I was a Mental Health Case Manager. I am speaking from experience.

  • I am very down and anxious about what is wrong with me but taking a truck load of supplements already so not keen on taking more tablets of any kind. Also have tablets for the dizziness. Not taken anything yet. Trying to sort myself out with some counselling in the hope it will help. And praying that the heavy/full head, headache and dizziness goes away.

  • Your doctor is very ignorant - like so many of them, I'm afraid. I've had to cope with so many like that, myself, which is why I now self-treat.

    Just had a quick peep at your results. And, the frees are very low - far too low for you to feel well, and that is probably why you have symptoms of fibro, etc. But I wouldn't stress too much about conversion at this point. The problem is, you just don't have enough T4 to convert!

    Your B12 is dangerously low. But doctors don't know that. Mine was about the same when I had it tested, and the doctor said it was 'perfect'! But I was losing the use of my right arm. I couldn't drive! I couldn't hold my head still on my neck. I started supplementing 5000 mcg methylcobalamin, and those symptoms went away, but I have permanant neuropathy in my feet and legs, now. So, carry on with the supplements, you might have caught it just in time!

    And, don't worry about your doctors ignorant ideas of 'something else' - a phrase they all trot out at some point or other, because they know nothing about thyroid symptoms. If she won't give you the much-needed increase in dose, buy your own! :)

  • I just want to say you're not alone. I'm in the same position as you. My GP and consultant are now adamant my ongoing symptoms and flare ups are not due to hashimotos and now I'm waiting for a rheumatologist appointment. I'm half pleased that there may be another reason for my symptoms just to prove I'm not going mad or somehow making it up, and half scared that they will find something else or even worse perhaps that this will be a dead end too. I hope you'll have better luck with your rheumatologist and youll find some answers soon to help you get back to health xx

  • Thanks butterfly1408. I only deal with a GP who refuses to refer me to an endocrinologist because my blood tests show everything within range as far as she is concerned. My legs are puffing up, I have the classic myxoedema rubber bands round my ankles look, i keep developing fatty deposits on my feet in great lumps and I dread to think what is happening internally to my arteries and organs. I guess I have to wait and see what the rheumatologist says. Good luck with your appointment too and it does help to know that others are going through the same thing. X

  • Oddly I was just reading this bbc.co.uk/news/health-36713129

    I had an "experienced" GP who couldn't tell the classic symptoms and signs of severe vitamin D deficiency. I would excuse him because I had low ferritin and vitamin B12 levels but the fact that two of the recently qualified staff he employed could recognise the symptoms of severe vitamin D deficiency means I can only conclude he was ignorant. Since then I've heard of lots of GPs who don't recognise signs and symptoms of various vitamin and mineral deficiencies yet specialists in various disciplines know to check for these.

    So it isn't surprising in your case that your GP doesn't know the signs and symptoms of low B12 and ferritin levels.

    GPs are generalists and they aren't taught about optimal levels of nutrients at undergraduate level so they just look at lab ranges without understanding what they mean. At postgraduate level they are only taught about them if they go on specific courses, have a personal interest in something like sports medicine which involves optimal nutrition or there are high profile court cases involving doctors not knowing these things.

    I suggest you take control of your health yourself and self-supplement as required it is less hassle than fighting with doctors.

    This is the info you need on ferritin levels - patient.info/doctor/non-ana...

    There are links within the sources and I suggest you read some of those.

    In terms of supplementing you may need to supplement for more than a month as ferritin levels rise slowly. Though you shouldn't take more than 2 ferrous fumerate a day.

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