Right to see nhs endo?: Do I have a right to see... - Thyroid UK

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Right to see nhs endo?

Kla88
Kla88

Do I have a right to see nhs endocrinologist if I'm trying to conceive with hashimotos. My tsh came back 4.1 ( 0.27. 4.2) I'm on 100mcg at the min but was looking into NDT. My tsh levels jump quite a lot each blood test. In April tsh was 1.88 and previous to that January 5.6 (dose was up by 25mcg).

Last year tsh jumped to 26... Does this ever stabilze.

11 Replies
oldestnewest

Not if your doctor is dosing by the TSH, no. He should at least test the FT4, even if he can't test the FT3. The TSH should come down to one or under, if you are correctly dosed with thyroid hormone replacement. And, after that, it is irrelevant. Your dose should not be reduced when it goes low, because it doesn't mean anything.

As to your right to see an endo... I don't think you have any rights in the NHS. But, on the other hand, endos often know less than GPs, so you're sometimes better off not seeing them!

Kla88
Kla88 in reply to greygoose

The thing is he will leave me with a high tsh because it is in the so called reference range. I don't want to be taking medication and not be optimally treated. None of the gps I've seen no anything. I tried to go private to see Dr Margaret griffin but she wouldn't accept my gps referral letter. Back to the drawing board.

Thanks for replying

greygoose
greygoose in reply to Kla88

I'm afraid you have to keep nagging at them. No, they don't know much about thyroid, it's true. And, they do think that once you are somewhere in range, their job is done. So, we have to keep at them, until they give us what we want, just to get rid of us! Be polite but forceful.

I've never heard of Dr Margaret Griffin. Is she on Louise's list of good endo's?

Kla88
Kla88 in reply to greygoose

I've heard lot of good things about Dr Griffin, I found her from researching some posts on here. I'm in Northern Ireland and she's in Dublin & gps letter wasn't good apparently. It's unfortunate you would think that it would be more straight forward trying to go private. I don't have Louise list of good docs. Do you know where I could get a hold of it ? Many thanks

greygoose
greygoose in reply to Kla88

Yes, it should be easier, but it's as if they put every possible obstruction in the way. Here, in France, you don't have to have your doctor's say-so to get to see a specialist, you just ring up and make an appointment. I think doctors on the NHS are control freaks! The want to be in charge all the time.

To get Louise's list, you have to email her, and I can't remember the email address. Clutter, shaws, can one of you step in with the address, please? Thank you. :)

Kla88
Kla88 in reply to greygoose

Thank you for your help.

greygoose
greygoose in reply to Kla88

You're welcome. :)

shaws
shawsAdministrator in reply to Kla88

email louise.roberts@thyroiduk.org.uk who has a list of specialists.

Kla88,

It can be difficult to conceive when TSH is >3.0 and high TSH increases the risk of miscarriage. The TSH of women planning conception should be in the low-normal range 0.4 - 2.5. Dose is usually increased by 25-50mcg when pregnancy is confirmed to ensure good foetal development and avoid post-partum psychosis.

Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee says:

The serum TSH reference range in pregnancy is 0·4–2·5 mU/l in the first trimester and 0·4–3·0 mU/l in the second and third trimesters or should be based on the trimester-specific reference range for the population if available. These reference ranges should be achieved where possible with appropriate doses of L-T4 preconception and most importantly in the first trimester (1/++0). L-T4/L-T3 combination therapy is not recommended in pregnancy (1/+00).

onlinelibrary.wiley.com/doi...

NICE recommend hypothyroid women planning pregnancy are referred to endocrinology:

Management

Refer to an endocrinology specialist all women with overt or subclinical hypothyroidism who are:

Planning a pregnancy

Check thyroid function tests (TFTs) before conception if possible.

If TFTs are not within the euthyroid range, advise delaying conception, until stabilised on levothyroxine (LT4) treatment — discuss with an endocrinologist if there is any uncertainty about initiation of treatment or what dose to prescribe while waiting for review.

Check that the woman understands that her dose of LT4 must be adjusted as early as possible in pregnancy to reduce the chance of obstetric and neonatal complications.

Advise the woman to seek medical advice immediately if pregnancy is suspected or a menstrual period is missed.

Pregnant

Check TFTs immediately once pregnancy is confirmed.

Discuss urgently with an endocrinologist regarding initiation of, or changes to, dosage of LT4 and TFT monitoring while waiting for review — trimester-specific TFT reference ranges may vary locally.

cks.nice.org.uk/hypothyroid...

Kla88
Kla88 in reply to Clutter

Thank you.

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