Thyroid UK
84,222 members99,222 posts

Advice please - to undergo psychological assessment

Hi I am new I have Hashimotos and I had my T3 stopped on NHS even though I felt better on it. Endo has asked GP for me to undergo psychological assessment. Diagnosed 2013 and symptoms are early morning constipation, aching in joints, dry skin, heavy periods, feeling cold, tiredness, weight gain, twitching in muscles. Taking 100mcg levo from 200mcg levo and 12.5mcg T3

Thankyou

TSH 5.60 (0.2 - 4.2)

Free T4 17.3 (12 - 22)

Free T3 3.8 (3.1 - 6.8)

TPO antibody 375 (<34)

TG antibody 286.3 (<115)

Above result taking 100mcg levo

Ferritin 49 (30 - 400)

Folate 2.2 (2.5 - 19.5)

Vitamin B12 185 (180 - 900)

Vitamin D 35.5 (25 - 50 deficient)

Iron 9.6 (6 - 26)

Transferrin 15 (12 - 45)

33 Replies
oldestnewest

Knowledgeable people like SeasideSusie may well pop along shortly with suggestions - and it will help them to comment on your circumstances if you have any other blood test results to share with them such as vitamin, mineral, iron panel levels etc. (complete with their reference ranges as you've done above).

Clutter tends to sum up the role of Levothyroxine is to "restore the patient to euthyroid status. For most patients that will be when TSH is 0.2 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted".

Your results show a TSH that is above the top of the range; your FT4 is high in range and FT3 is in the lower third of its range. So, you're looking under-medicated from those results but really need someone who knows more than I do to comment further.

2 likes
Reply

Done thankyou

Reply

yes..TSH way too high..T4 should be in mid range and your T3's should be up in the high end of the range shown.

Reply

Taking 800iu D3 and 1 iron tablet

Reply

Ah, with the antibody information, it's looking like someone will comment on that and ask if you've implemented various dietary recommendations to reduce the impact of Hashimoto's?

That's a big drop in your medication levels - what was the reason given for it for both stopping the T3 and dropping the levo.? How long have you been on your current dosage of levo.?

Your vitamin and mineral levels are low in range except for folate which is below the range. It's not looking like those vitamin D or iron supplements are doing much - but how long have you been taking them?

SeasideSusie's responses on this are excellent and give lots of suggestions for useful products and appropriate dosages to bring up your levels to the optimal range that hypothyroid people need in order for the hormones to be most effective (as it's often said that neither our own nor supplemented hormones work well out of the optimal range which differs to the 'normal' range).

ETA: If you browse through here, you'll see some of Seaside Susie's previous answers to people with vitamin and mineral deficiencies: healthunlocked.com/user/sea...

Reply

Thankyou reason given for drop in medication was TSH 0.03 (0.2 - 4.2) Free T4 20.6 (12 - 22) Free T3 4.5 (3.1 - 6.8) been on current dose since end of August.

Been taking vitamin D since Feb 2014 and iron since Jan 2017

Reply

This result showed you were UNDER medicated, T3 was still too low

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, or T3 in 12 hours before test, delay and take both straight after.

This gives highest TSH

Was this how this test was done?

Reply

Yes

Reply

Then the T4 dose was about correct but you probably needed T3 increased

But it's essential to get vitamins good and be gluten free if this is an issue (and it is for most of us with Hashimoto's)

Pity endo had no idea (many don't)

We are seeing many people turn up in same situation

A few enlightened endos realise we need T3

Then on NHS consultation further down the line you end up with different one and they take T3 away with completely disastrous consequences

T3 is only supposed to be banned from GP's initially prescribing, but if a specialist says you have clinical need it should be prescribed via GP

CCG's are deliberately mis-reading proposals

Reply

Never mind you having psychological testing, so should doctor and endocrinologist due to the fact that your vitamins/minerals are dire and can cause clinical symptoms as well and deficiencies can have serious consequences. You are also on an insufficient dose of levo and the fact they have stopped your T3, is appalling and you are now suffering more.

Your TSH is far too high and should be 1 or below. You have an Autoimmune Thyroid Disease called Hashimoto's - the commonest form of hypothyroidism. Your FT3 is bottom of range and should be towards the top. T3 is the only Active Thyroid Hormone which is required in all of our T3 receptor cells.

As already stated SeasideSusie will respond re your vits/minerals and how best to resolve deficiencies.

These Endocrinologists/doctors are withdrawing T3, it would seem to me, that they don't care if patient has worse disabling symptoms than before. They have also lowered your dose of levothyroxine and it just doesn't make sense at all when they cannot even assess the thyroid hormone deficiencies you have.

british-thyroid-association...

2 likes
Reply

Thankyou the endo even asked me if I was still taking iron and vitamin D and I feel that it didn't occur to him my symptoms may have been caused by low vitamin and mineral levels and that I take supplements for a reason

1 like
Reply

You have had a quick lesson in how not to treat hypothyroid patients as you will now know more than both doctors put together.

However, back to withdrawal of T3. On the right-hand side there is a Pinned Post and the top is about the T3 Campaign, please sign as many of us have a clinical need for T3.

Also make an appointment with your local MP and complain to him taking along a copy of the above link, that it shouldn't be withdrawn if we have a clinical need. Also sign the Petition as many of us rely on T3 to have a healthy life.

Rather than having adjustments of 25mcg up or down, at one swing they have reduced your thyroid hormones from 250 mcg T4/T3 by a massive 150mcg which should always be done slowly, slowly. The high TSH shows you are underdosed never mind the clinical symptoms. They love the psychological tag as it allows them to do what they like as they have no knowledge, it seems to me of how to deal with patients clinical symptoms. They know none so haven't a clue that thyroid hormone replacements are given in order to resolve them and the patient feels well.

Also tick off all your symptoms on the above link.

3 likes
Reply

Was this same endo that started you on T3 or different one ?

This one that stopped T3 obviously knows nothing about thyroid, or the importance of vitamins

Reply

Different one

Reply

This is happening time and time again, we the patients are just piggy in the b.....dy middle

Reply

Tara_L

Ferritin 49 (30 - 400) - 1 iron tablet

For thyroid hormone to work ferritin needs to be at least 70, preferably half way through range. 1 x iron tablet is probably the usual amount prescribed for low ferritin, but as yours is very low it might be worth asking for your dose to be increased to 2.

However, is the iron being absorbed? Are you taking your iron tablets with Vit C? Each iron tablet should be taken with 1000mg Vitamin C to aid absorption and help prevent constipaton. Always take iron 4 hours away from thyroid meds and two hours away from other medication and supplements as it will affect absorption.

Absorption and gut problems tend to go hand in hand with Hashi's and it could be that you have a problem there. SlowDragon has information and links about this.

Iron 9.6 (6 - 26)

Transferrin 15 (12 - 45)

These are in range but low. I don't know enough about it but it would be worth discussing with your doctor and maybe investigate anaemia.

**

Folate 2.2 (2.5 - 19.5) Vitamin B12 185 (180 - 900)

You are folate deficient with very low B12. Check for any signs of B12 deficiency here b12deficiency.info/signs-an... then go and post these results (alosng with your ferritin/iron results plus any signs of B12 deficiency you may be experiencing) on the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc then discuss what they say with your GP. He has been negligent in ignoring your folate deficiency, and I think you will need testing for Pernicious Anaemia and may need B12 injections.

**

Vitamin D 35.5 (25 - 50 deficient)

800iu D3 since February 2014

Ask your doctor the following question;

"Considering I've been supplementing with Vit D for almost 4 years, why is my level still very low in the deficient category?"

And the answer is (and he wont admit this) that you should have been given loading doses originally if your level was below 30 according to the guidelines. 800iu D3 isn't going to ever raise your level. It is hardly a maintenance dose for someone with a reasonable level.

Unfortunately, your GP is following the guidelines and probably can't prescribe more. Best thing to do is take this into your own hands and buy some D3 softgels like these bodykind.com/product/2463-b... and my suggestion would be to take 10,000iu daily for 4 weeks then reduce to 5000iu daily for a further 8 weeks then retest. If you don't feel comfortable taking that much, then just start with 5000iu daily but I think you need an initial boost. If your level was below 30 then you would qualify for loading doses which would total 300,000 over 6 weeks.

Once you've reached the level recommended by the Vit D Council - which is 100-150nmol/L - and then you'll need a maintenance dose which may be 2000iu daily (or 5000iu alternate days, maybe less), it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/

There are important cofactors needed when taking D3

vitamindcouncil.org/about-v...

D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.

Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds

naturalnews.com/046401_magn...

Check out the other cofactors too.

**

TPO antibody 375 (<34)

TG antibody 286.3 (<115)

As mentioned, our high antibodies mean that you are positive for autoimmune thyroid disease aka Hashimoto's which is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results.

You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.

Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.

Gluten/thyroid connection: chriskresser.com/the-gluten...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

thyroiduk.org.uk/tuk/about_...

**

Reason given for drop in medication was TSH 0.03 (0.2 - 4.2) Free T4 20.6 (12 - 22) Free T3 4.5 (3.1 - 6.8)

There was no need to reduce your medication based on these results. The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo only. Add T3 into the mix and you normally see a very low or suppressed TSH, FT4 can be low in range and FT3 should be near the top of it's range. As long as FT3 is in range you aren't overmedicated. In fact, if you didn't feel completely well with those results and you were taking T3 then your T3 dose should have been increased.

TSH 5.60 (0.2 - 4.2)

Free T4 17.3 (12 - 22)

Free T3 3.8 (3.1 - 6.8)

So you're now in the position of being grossly undermedicated. You need an increase in your dose and in support of this take the following information to your GP or endo:

From thyroiduk.org.uk/tuk/about_... > Treatment Options

According to the BMA's booklet, "Understanding Thyroid Disorders", many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above.

The booklet is written by Dr Anthony Toft, past president of the British Thyroid Association and leading endocrinologist. It's published by the British Medical Association for patients. Avalable on Amazon and from pharmacies for £4.95 and might be worth buying to highlight the appropriate part and show your doctor.

Also -

Dr Toft states in Pulse Magazine, "The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the article by emailing louise.roberts@thyroiduk.org print it and highlight question 6 to show your doctor.

**

There is no way you need a psychological assessment. The only thing wrong is that neither your GP nor Endo have a clue how to treat Hypothyroidism/Hashi's/

6 likes
Reply

I have iron anaemia nothing done about it thanks

Reply

Tara

I have iron anaemia nothing done about it thanks

Well in that case your GP is a total donkey and doesn't deserve to be practising. "Practising" well that obviously means they've not got it right yet and still learning!!!

So, go back to your GP, remind them that you have a diagnosis of iron anaemia, and ask for the appropriate treatment according to the guidelines - see NICE Clinical Knowledge Summary for iron deficiency anaemia treatment (which will be very similar to your local area guidelines) cks.nice.org.uk/anaemia-iro...

How should I treat iron deficiency anaemia?

•Address underlying causes as necessary (for example treat menorrhagia or stop nonsteroidal anti-inflammatory drugs, if possible).

Treat with oral ferrous sulphate 200 mg tablets two or three times a day.

◦If ferrous sulphate is not tolerated, consider oral ferrous fumarate tablets or ferrous gluconate tablets.

◦Do not wait for investigations to be carried out before prescribing iron supplements.

•If dietary deficiency of iron is thought to be a contributory cause of iron deficiency anaemia, advise the person to maintain an adequate balanced intake of iron-rich foods (for example dark green vegetables, iron-fortified bread, meat, apricots, prunes, and raisins) and consider referral to a dietitian.

• Monitor the person to ensure that there is an adequate response to iron treatment.

3 likes
Reply

I agree @SeasideSusie. You think we read awful posts and yet another pops up even worse than the others. To tell a patient who is under his care that clinical symptoms are psychological when it is all down to his treatment.

4 likes
Reply

So your going to need to slowly step your T4 back up, improve vitamins as SeasideSusie has given you but also really need to look at the root cause of Hashimoto's - leaky gut that then causes food intolerances- usually gluten

Changing to a strictly gluten free diet may help reduce symptoms. Very, very many of us here find it really helps and can slowly lower antibodies.

Hashimoto's is as much a disease of the gut as it is they thyroid. Your latest endo obviously hasn't a clue nor has your GP.

Find a T3 friendly endo via Thyroid UK or self medicate

Email Louise at Thyroid Uk for list of recommended thyroid specialists

Louise.roberts@thyroiduk.org.uk

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

amymyersmd.com/2017/02/3-im...

chriskresser.com/why-changi...

scdlifestyle.com/2014/08/th...

Reply

Tara_L was this request put in writing by the Endo to your GP? I would ask for sight of it. Then tell whoever it is, in writing, to jog on and you'll be contacting the Care Quality Commission.

4 likes
Reply

Yes put in writing by endo to GP and I have a copy of it

Reply

Tara_L that is disgraceful and you should definitely report this "Endo" to the Hospital Trust and to the CQC. We don't pay our taxes for this cr*p treatment.

2 likes
Reply

Head of med management at my CCG said I should be referred to psych because I was fighting to save my t3! Don't stand for it

3 likes
Reply

Good grief.

Reply

Tara_L I can't help commenting although you've recieved all the advice you need because I'm so fed up of Endo's coming up with this psychological malarky. Indeed, his treatment has kept you ill and not improved your symptoms and I agree with Hidden that we don't pay our taxes for such awful incompetent treatment. I hope you do write and complain. Also, make sure you write to your GP to refute the opinion of the Endocrinologist who is not qualified to make an assessment of anyone's mental health pointing out the Endo has not bothered to address your vitamin deficiencies.

2 likes
Reply

I'd write a complaint about Endo to GMC, you are not properly treated, that should be sorted out before anything psychological surely?

1 like
Reply

PaulB in my experience the GMC don't give a stuff about patient complaints concerning poor treatment from NHS doctors. In fact it must be the only profession that has no accountability for anything which of course is why some choose to behave in an unprofessional manner.

2 likes
Reply

Hello, it looks like you're not converting t4 to t3 sufficiently, your folate and iron is way too low, your Vitamin B12 is on the floor and you probably need B12 injections, your vitamin D3 is still way too low, you need a higher dose more like 5,000iu. I had the same experience, took a dose of vit D3 that was too low for 3 years and my numbers hardly moved, took 5,000iu of vitamin D3 and within 6 months or less my Vitamin D3 had risen to 80.

Your thyroid antibodies show you have hashimotos, you need to take selenium and cut gluten out of your diet to see if it gets your antibodies down.

Why are you having a psychological evaluation? Your low Vits and low T3 are enough to make you feel rotten and depressed.

Reply

Thanks I am having a psychological assesment because I keep going to the GP with symptoms they say are not caused by anything physical

Reply

Go on the main Thyroid UK site, look up the list of symptoms of under active thyroid, and print them off and take them to your appointment. I did this myself to get diagnosed, plus waking temperatures for 5 days. The doctors simply don't know the symptoms. When my GP looked at the list her face was a picture. This is all about the doctor's ignorance about the thyroid.

1 like
Reply

I believe, though am not sure, that T3 is sometimes used by psychiatrists to treat depression, so, it might be worth taking up the suggestion if it is to a psychiatrist rather than a psychologist as the psychiatrist will assess you from a medical as well as psychological perspective and can prescribe.

If it's a psychological assessment that might be valuable too, the psychologist might write to your GP in support of whatever it is you need and if they find you psychologically well-balanced that goes in your favour. If they find depression that is a common sympton of being hypothyroid, so I can see a lot of reasons for accepting.

This view is unpopular on here and there may be a lot of reaction against my post but I used to work as part of a multi-disciplinary team in a psychiatric hospital and we often picked up problems missed by GPs, especially hypothyroidism and sadly from one particular GP cancer in patients referred for depression.

Also, I believe in accepting what is offered so that the GP sees we are listening to them and grateful for their advice and input rather than not!

2 likes
Reply

Hi

I have had thyroid problems for a long time, but never taken prescription drugs as I was never convinced doctors really knew what was going on. Now 30 years later I am as well as I have ever been despite still having a goitre. More energy.

I learned a long time ago that a high dose bioavailable broad spectrum supplement helped me , even if I added on other specific ones. The body doesn't really work best taking single nutrients as all kinds of trace elements are needed to be able to use things.

Thyroid issues can cause depression and anxiety in themselves. Having had a lot of trauma when young it seems like chicken and egg.. which caused which? It has lead to me having had periods of therapy, but it was never regarded as a psychiatric problem, and I don't think I would have gone for that kind of testing, as psychiatrists seem to favour drugs, which would complicate things more.

I am now taking something which seems to be the missing link for me. A state of the art, advanced supplement. NAD is one of the things it provides. I take it with some other supplements and would really recommend it. I feel more energetic and positive than for years. Contact me privately for details.It lifted me very quickly, seeming to clear my brain fog and depression and giving me steady energy all day from waking until midnight.

Reply

You may also like...