GP won't increase

[JEC8]

I am 31 and new here, diagnosed hypothyroid 2011, why won't GP increase my dose of levothyroxine?

Oct 2017 (100mcg)

TSH 9.1 (0.2 - 4.2)

Free T4 12.9 (12 - 22)

Free T3 3.1 (3.1 - 6.8)

Thanks

[SeasideSusie Remembering]

Oooh, don't tempt me, I might say something very naughty and I've done too much of that lately so I'm trying to be good

Let's just say, very likely your GP is a ... (oh no, I said I'd be good!).

JEC8 I think maybe your GP doesn't really understand hypothyroidism.

What dose of Levo are you on?

Have you always been on the same dose?

Have you had thyroid antibodies tested, if so please post results.

Have you had vitamins and minerals tested, if so please post results and say if you are supplementing.

You are very undermedicated with those 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 if that is where you feel well.

Has your GP given any reason for not increasing your Levo?

[JEC8 in reply to SeasideSusie]

100mcg levothyroxine, I had it reduced from 150mcg to 100mcg by GP. Endo has intervened and requested I increase and sent letter to GP asking them to give me new prescription and the GP is refusing to do this. I have TPO antibodies 804.5 (<34) TG antibodies 276 (<115)

No reason given at all as to no increase.

Thanks

[Rapunzel in reply to JEC8]

Endo has intervened and requested I increase and sent letter to GP asking them to give me new prescription and the GP is refusing to do this.

Sadist of the week, too. tsk

[SeasideSusie Remembering in reply to JEC8]

OK, down to business

So, are these what resulted from your GP reducing your Levo to 100mcg?

Oct 2017 (100mcg)

TSH 9.1 (0.2 - 4.2)

Free T4 12.9 (12 - 22)

Free T3 3.1 (3.1 - 6.8)

Presumably some other results made GP reduce the dose, what were they?

**Info for Dr Jerk - changes in dose should be gradual, normally 25mcg at a time, 50mcg is too much.**

Endo has intervened and requested I increase and sent letter to GP asking them to give me new prescription and the GP is refusing to do this

Mmmm, so GP thinks he's above the endo then! Why is your GP refusing to do what the endo has asked? Has the GP actually had the endo's letter? Do you have a copy? Can you contact the endo or his secretary and tell him what your GP has done. Can you see a different GP? Can I come and punch your GP?

**

TPO antibodies 804.5 (<34) TG antibodies 276 (<115)

These are probably playing a part in all this.

Has anyone bothered to tell you that you have autoimmune thyroid disease aka Hashimoto's as confirmed by your high antibodies? This is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results and I'm wondering if a particular set of results are the reason why your GP reduced your dose.

It's probably best that you read and learn about Hashi's so that you can help yourself, clearly your GP doesn't know much about hypothyroidism let alone Hashi's. Most doctors dismiss antibodies as being of no importance and don't understand how it affects the patient.

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_...

[JEC8 in reply to SeasideSusie]

Thanks

Yes those were the results from the reduction to 100mcg. Other results that made GP reduce dose were

TSH 0.08 (0.2 - 4.2)

Free T4 20.6 (12 - 22)

I don't know why GP is refusing to do what endo asked, the GP has had the endos letter. I have a copy and I can contact the secretary.

You are welcome to punch the GP if you wish

[SeasideSusie Remembering in reply to JEC8]

JEC8

TSH 0.08 (0.2 - 4.2)

Free T4 20.6 (12 - 22)

OK, what happened here was Dr Jerk saw a suppressed TSH and flipped! He obviously didn't notice that your FT4 was in range, and if he'd bothered to test FT3 that would have been in range as well. So no problems. TSH is useful for diagnosis but once on thyroid replacement it's irrelevant.

TSH is a pituitary hormone, the pituitary checks to see if there is enough thyroid hormone, if not it sends a message to the thyroid to produce some. That message is TSH (Thyroid Stimulating Hormone). In this case TSH will be high. If there is enough hormone - and this happens if you take any replacement hormone - then there's no need for the pituitary to send the message to the thyroid so TSH remains low.

Doctors do seem to have a hard time understanding this!

So with your current results

TSH 9.1 (0.2 - 4.2)

Free T4 12.9 (12 - 22)

Free T3 3.1 (3.1 - 6.8)

you desperately need that increase. You could show this to your GP - 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. However, I don't know if this is in the current edition as it has been reprinted a few times.

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 [e-mail] print it and highlight question 6 to show your doctor.

However, if your GP is ignoring your endo's request, he probably wont take a lot of notice of the article.

If I were you I would contact the endo's secretary first thing in the morning. Ask if she can get an urgent message to the endo, explain what your GP is doing, and can he urgently contact the GP and insist he increases your dose, or can the endo send you a prescription (not sure if they can, but you can try).

Do you have a good enough supply of Levo that you can increase the dose by 25mcg yourself for now and that will give some time for your endo to fight it out with your GP. If so, I would tell the endo's secretary that this is what you intend to do and will she pass that information on to the endo.

[SlowDragon Administrator in reply to JEC8]

Can you see a different GP

This one is either ignorant or negligent

Once you get sorted you should put in complaint to practice manager.

TSH 0.08

FT4 20.6.

This result is likely perfect (ideally you need FT3 tested too)

But no doubt ignorant GP just freaked at low TSH

It's irrelevant on Thyroid replacement, as long as FT4 and FT3 are within range

Have you got recent tests for vitamin D, folate, ferritin and B12

Highly likely too low

When Hashimoto's is not adequately treated then gut is very badly affected, vitamins crash out

Very likely to benefit from strictly gluten free diet

Changing to a strictly gluten free diet may help reduce symptoms, lower antibodies and help gut heal

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

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

chriskresser.com/the-gluten...

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

drknews.com/changing-your-d...

Low stomach acid can be an issue

Lots of posts on here about how to improve with Apple cider vinegar or Betaine HCL

thyroidpharmacist.com/artic...

drmyhill.co.uk/wiki/hypochl...

scdlifestyle.com/2012/03/3-...

Other things to help heal gut lining

Bone broth

thyroidpharmacist.com/artic...

Probiotics

carolinasthyroidinstitute.c...

[Clutter in reply to JEC8]

JEC8,

Perhaps you could see another GP at the practice? If not, write to the practice manager and ask why the GP is ignoring the endocrinologist's instruction.

[Rapunzel]

Because (s)he's about to win the Dr Stupid of the day award.

Call for SeasideSusie Clutter can fill you in on what a medicated TSH is supposed to look like if Susie's not around.

You must be feeling awful you poor thing xx

[JEC8 in reply to Rapunzel]

Thanks yes I have been getting more infections lately, also I contracted conjunctivitis from somewhere which is making me feel miserable. I haven't had conjunctivitis in 18 years

[Rapunzel in reply to JEC8]

I get that sometimes. If you have a gold ring rub it along the tear line...it really works ( so long as your ring is clean of course...) but I think I may get my conjunctivitis from hugging my minging cat

[JEC8 in reply to Rapunzel]

Thanks for this sorry to hear you might be getting it from your cat

[Rapunzel in reply to JEC8]

He's a handsome boy and although he has no dangles, the lady kitties around here seem to like him. Obi wan katobi is my wallpaper if you click on my avatar...

[JEC8 in reply to Rapunzel]

He is handsome I like cats but the ones around where I live are quite shy and don't like being petted

[Rapunzel in reply to JEC8]

Sorry I've hijacked you post JEC8. I'm going to wash my hair now

[JEC8 in reply to Rapunzel]

That's ok.

[SeasideSusie Remembering in reply to Rapunzel]

"although he has no dangles, the lady kitties around here seem to like him"

You're really putting me off my stride!

[SeasideSusie Remembering in reply to Rapunzel]

"but I think I may get my conjunctivitis from hugging my minging cat "

God, you crack me up Rapunzel

[Rapunzel in reply to SeasideSusie]

I love him, Susie. He loves his daddy and I'm just the food bitch...even when I say, ' I am your mother' he still looks at me like I'm some random bint

[DeeD123]

Please please please don’t wait but change your doctor now. Wish I knew where you are as she sounds like the one that almost killed me. Same thing happened to me. Eye hospital emailed her with my blood results and told her i need ed upping but she never acknowledged it. In the end they arranged endo appointment and he wasn’t listened to either. Lovely man he was, Dr Gibby, now sadly retired phoned me and told me to change my doctor ASAP. So I’m telling you. Change next week and ask hospital to write a prescription for you with right dose. Good luck.

[KathFrances]

This seems to be relevant to several posts today: doctors all have limited and different degrees of intelligence, knowledge and ability - like electricians or plumbers. If an electrician or plumber doesn't give you a satisfactory service, then you'll look for a better one - right? Ok, same with GPs! Although your T4 and T3 are just on the borderline of the NHS normal range, your high TSH clearly indicates that these levels are not ok for you. You need to find someone who will listen, understand and treat you correctly. Wishing you all the best.

[birkie]

Hi JEC8

It's un real how some doctors think they are above endos and patients he/she has no right to egnore a endos request to adjust your meds.. Talk about a god complex ⛪ I'm dealing with one to, he thinks he knows everything and if I question him he becomes very arrogant and quite frightening he never listens to my concerns this doctor is to blame for me being un diagnosed in the first place and me being very ill for 3 years... He should be thankful i never reported him.. But I'm just waiting on my next bloods in 8 days if theirs no help I will be reporting him then leaving his surgery,, ho and his the major doc as its his surgery 😠😠😠😠