Positive gp appointment. Any thoughts?

[Saraband]

Good morning! I'm reposting these results with an update after my gp appointment this morning.

(I'll post separately about the ferritin)

I've only seen my gp once before (we've not been here long), when she suggested looking at thyroid levels in response to my fatigue and other symptoms. The first results indicated TSH above normal range (5.9 range .35 - 4.94) and Free T4 12 (range 9 -19). Although the above-range TSH level was flagged, I was concerned at the clinician's note on the result which suggested re-testing in 3 to 6 months - I've been feeling progressively worse for months and really didn't relish the prospect of a summer of exhaustion and low mood. So I had my own tests done through bluehorizon, which are shown above.

I felt somewhat despondent when I saw them, imagining that the gp might feel unwilling to respond to them. I was quite wrong.

Having established what led me to use that company, she was totally comfortable with using the results and will be scanning them into my records. She was pleased that the TSH and free T4 broadly corroborated her results and explained that based on her initial results, she would have been calling for antibody tests which I had now provided.

We had such a positive discussion in which she asked me what my reading about underactive thyroid had taught me and what I was thinking about how I'd like to proceed. Somewhat timidly, since I'm still such a novice with this really, I suggested that while the T4, free T4 and T3 were in range, what might be normal within range for one person may not be so for another and I wondered if I might benefit from being in the higher normal range. She completely agreed that it might be possible and again asked me if I had any thoughts on how I might like to proceed, saying that some people prefer to try to manage this through diet. Since I'm already managing my prediabetes through a very low-carb diet I said I was concerned at trying to achieve both through diet and she agreed. She did explain that in her view it's more difficult to manage thyroid problems through diet (and she explained why she thinks that but for the moment at least, I've forgotten what her reasons were.)

I'm struggling to understand the antibody information. My gp explained that my antibody results are fine but will be a useful benchmark when I'm retested, as an indication of what, if any, deterioration there may have been.

She said that the only medication she is permitted to prescribe is Levothyroxine and we agreed on a 3-month trial on 50mg levo followed by retesting and review. I thought it significant that she put it this way - offering the possibility that there may be other medications which are beyond her remit. I didn't pursue this today but it may prove useful in the future.

Given the difficulties that so many people report on this forum, I am delighted with how open and inclusive my gp has been. I felt she was working with me all the time and there wasn't a shred of a suggestion that my getting a set of private tests was anything but a positive addition to the information she had available.

Of course, since I am still very much a novice with thyroid issues, I can't really know if I'm doing the right thing in going for a trial on levo and I would still appreciate any thoughts from those with far more experience than I. But I certainly left the surgery feeling encouraged and hopeful!

[shaws Administrator]

You have had a really nice fruitful appointment. If I was a betting woman, I'd think either your GP or someone close has hypothyroidism. Your TSH is nearly 2 points above the range, so thyroid gland is struggling a bit.

A trial is a good idea but I think 12 weeks might be a bit long before another blood test. Usually it is 6 to 8 weeks. The BTA guidelines state not to be diagnosed until the TSH is 10, so it's good she's prescribing at nearly 2 points above the top of the range.

Levo should be taken on an empty stomach with one full glass of water and wait about an hour before eating as food interferes with the uptake.

Take levo after the blood test and not before as results will be skewed. We recommend a gap of approx 24 hours before blood test. Ask for B12, Vit D, iron, ferritin and folate to be tested next time too.

[Saraband in reply to shaws]

Thanks Shaws, I was very pleased. I too, wondered if she had a personal connection with hypothyroidism. (She mentioned before that she couldn't cope without her hrt which left me thinking she knows how some hormonal issues really feel.) Your input re how best to take levo is very helpful. As for re-testing sooner than 12 weeks, I was thinking I'd bring it forward: 3 months of tablets is exactly 12 weeks but assuming they prove helpful I don't want a gap between finishing these packets and getting another prescription - and I can't get that til I see her again, after the next results have come back. So I'm going to allow at least a fortnight for that.

I do have results for the other levels you mention - all tests from this month:

* Vit B12 361 (deficient <140, Insufficient 140-250, Consider reducing dose >725)

VitB12 is included in the sup I take (menopace original): 9 micrograms

Natchip suggested my level may be on the low side?

* Serum folate 35.90 (8.83-60.8)

* Vit D 147 nmol/L (<25: deficient, 25-50: insufficient; 50-300: adequate; >300: toxicity) I supplement this at 5000iu plus 5 micrograms from menopace supp)

* Iron 144g/l (120-155)

* ferritin 235 (20-150) flagged by Blue Horizon as high. Gp will retest in 3 months

Any advice would be helpful.

[Saraband in reply to shaws]

Shaws, this is a very basic question - do I assume from your advice re taking levo and waiting an hour before food, that this also includes the all-important first cup of tea in the morning? Trivial, I know, but I want to get it right - and I don't want to wait for the tea if it's not necessary! Thank you

[shaws Administrator in reply to Saraband]

Yes, it includes tea - this is an excerpt from a previous post:-

It was my consultant that pointed out the milk issue (as it contains a lot of calcium) and having a drink with milk in it only 30 minutes to 1 hour away from thyroid meds can, and does, hinder absorption.

healthunlocked.com/thyroidu...

and

Recommendations for Use

You can still drink caffeine-containing beverages if you take levothyroxine, as long as you do not ingest caffeine at the same time as your medication. Your doctor will most likely direct you to take levothyroxine on an empty stomach with a full glass of water and to avoid eating and drinking anything other than water for an hour afterward. To avoid any interaction with caffeine, allow six hours to pass, if possible, between the time you take levothyroxine and the time you drink coffee or another caffeine-containing beverage. To avoid any fluctuations in your day-to-day absorption of levothyroxine, maintain a consistent time schedule for taking both your medication and for ingesting caffeine, suggests “Pharmacy Times.”

livestrong.com/article/5223...

You could take your thyroid hormones at bedtime if you wish.

[Saraband in reply to shaws]

Thanks Shaws. I actually take my tea black but reading through the thread you highlighted has been really helpful. I'm going to try taking it when I wake in the night - I invariably wake around 4am so it could work very well.

[mrsm49]

FYI being hypothyroid can cause yr blood sugar to rise. Hopefully once yr treated this will go down for you.

[Saraband in reply to mrsm49]

Mrsm49, thank you for this information. That's an encouraging thought!