New Doctor: What would you do in my shoes?

[Inana]

Hi Everyone,

I have just come back from the new doctor, and I am back to square one, although, to be honest, I never left square one. He spoke about TSH, and T4, and the "normal range" again, and seemed to be clueless about T3. He kept on telling me that it could be other issues, and not the thyroid because of the "normal ranges" from tests taken in January, and then he told me that it could be psychological.

Then he prescribed me Mirtazapin 30mg and told me to increase my Levo to 37.2mcg. He did not take any tests. He said he would take them in two weeks on the 4th of August. He thinks that my symptoms could be lack of sleep!

I am trying to view things from his perspective. He is trying to look at everything. Then he told ME that I focus too much on blood tests, to which I replied with incredulity that it is THEM (doctors) who trust tests and ignore symptoms.

My husband said that he thought the doctor and I were going to fight. Anyway, I told the doctor that I'm self medicating in two weeks if he doesn't help. He also said that:

1. You can test your thyroid and blood tests any time of the day and it makes no difference whether it is morning or not

2. You test every two to four weeks not 6.

This all took me by surprise since I just looked at a studies saying the opposite.

Why do I keep going to doctors and giving them a chance? Anyway, I will try out this new dose of Levo because the previous 25mcg didn't help. I'm probably not going to take the Mirtazapine. Does anyone have experience with Mirtazapine?

[humanbean]

TSH has a circadian rhythm, meaning that it varies throughout every 24 hours. Since doctors treat on the basis of TSH any sensible patient is going to test when it is to their advantage, and that is as early in the morning as possible. The evidence can be found in this paper :

reboundhealth.com/cms/image...

Look at the graphs on page 2. The highest TSH during normal surgery hours is before 9am. Getting a test done in the afternoon is likely to give a TSH result which is lower than it would be first thing in the morning.

The degree of variation does differ from person to person. If you look at the graphs on page 3, one of the subjects had a TSH which varied from about 1 at the lowest and rose to about 3.5 at the highest. Another subject had TSH which varied from 0.5 up to about 2.0.

There is also some (very poor quality) research suggesting that fasting has an impact on TSH as well. So that is another reason for testing early in the morning. Who wants to fast for hours during the day?

One issue your doctor seems to have is assuming that any result within the reference range - anywhere in the range - is as good as a result at a different part of the range. This is simply not true.

Patients on this forum know that there is a huge difference in how well someone feels with a TSH of 4.4 and a TSH of 0.6 when the reference range is 0.5 - 4.5. But doctors like the one you saw today totally dismiss this and pretend that people at each end of the range feel perfectly well.

The same issues occur, as I'm sure you know, with nutrients being within range. And for many doctors even being under the range is fine because "it's close enough". (I've heard that phrase being used in reference to my own results.)

Being told that your issues are psychological has always been the go-to excuse for doctors who don't want to treat their patients. The use of this excuse is being expanded enormously in order to save money. There have been reports on the news and in the newspapers about the government spending more money to expand mental health provision. The extra money isn't being spent on "traditional" mental health problems like schizophrenia, bipolar disorder, psychosis or whatever, but is being spent on treating people who they don't want to treat or can't treat. So, if you have (for example) fibromyalgia, the doctors are going to stop attempting to help the patients, their symptoms will be declared to be "medically unexplained" and the "cure" will be CBT or counselling. Once someone has been fobbed off in this way the NHS will no longer investigate those particular symptoms. In some cases people are having their prescribed medications taken off them.

I think your only choice is to see another doctor, move to a different surgery (where you have no guarantee the doctors will be any better), or treat yourself, because the one you saw today won't help you feel well.

Mirtazapine is prescribed to treat major depressive disorder according to this link :

drugs.com/mirtazapine.html

And according to this link :

sleepio.com/articles/sleep-...

Mirtazapine is an antidepressant drug prescribed to treat Major Depressive Disorder, Obsessive Compulsive Disorder and a range of anxiety disorders. Alongside these, it may be prescribed ‘off-label’ to people experiencing prolonged periods of poor sleep.

I've never taken this drug, so can't comment on it from a personal point of view.

[Inana in reply to humanbean]

Thank you @humanbean. I don't want to take the antidepressant. I've been off antidepressants for a while now and going back would be s waste of my time and effort for all these months.

I will just increase my dose of Levo, wait two weeks, take the blood tests and treat myself. It is a cop out to just put me on an antidepressant when the issue is my thyroid.

He does seem to not know a lot. It could be early days but when he told me that T4 was the active thyroid hormone, I knew that he is not the right fit. He even refused to do some blood tests I asked for so what is the point?

😕