I have just had my appointment with my doctor to talk about my thyroid blood test results
He said there was no need to alter my thyroxine but he has given me Carbimazole 20mg to take for 28 days, i have to take one at night and my thyroxine in the morning never at the same time
Then a month after i finish them i have to have another blood test
Is there a difference in result between keeping my thyroxine at 125mcg but taking the Carbimazole and just reducing my thyroxine dose instead?
Thank you for any advice or help
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cloudwalker
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Can you post your TSH, FT4 and FT3 results and ranges and say how much Levothyroxine you are taking.
Your GP seems to be treating you with 'block & replace' which is a therapy for hyperthyroid patients, not for overmedicated hypothyroid patients. If you are overmedicated on thyroxine the dose should be reduced.
I suspect your GP thinks you are overmedicated because TSH is suppressed. Suppressed TSH doesn't mean you are overmedicated as long as FT4 and FT3 are within range, and yours are not even high in range, so you aren't overmedicated. Unless you feel overmedicated I wouldn't reduce dose from 125mcg because FT4 and FT3 will drop. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email louise.roberts@thyroiduk.org if you would like a copy of the Pulse article to show your GP.
If you had been overmedicated the right thing would have been to reduce dose. It's insane to prescribe Carbimazole which can cause considerable adverse effects including lowering white blood cells which fight infection instead of reducing Levothyroxine dose. I would make a complaint to the practice manager because your GP obviously needs some training on how to manage hypothyroid patients.
Oh please............. what a donkey! Please don't take the carbimazole.
It was said in your previous thread, you can't be overactive as you don't have a thyroid.
The aim of a treated 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 and the article by Dr Toft which Clutter has mentioned states
"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)."
Email for a copy like Clutter suggests, print it then highlight question 6 to show your GP.
It is truly frightening that hopeless doctors like this one are left to use their vague knowledge of thyroid matters (half a day at medical school, I believe) on trusting patients and have no idea what health havoc they are creating. Does anyone feel, like me, that there should be an independent body to whom a patient can easily present these cases of medical negligence (without fear of repercussions from the practice concerned), so that extra training can be given to these doctors?
We should be able to report such things to the senior partner at the practice or the practice manager. There should be no repercussions on any patient reporting poor treatment. That GP is a dangerous menace to thyroid patients.
Hennerton Clutter I was having this conversation with someone about 2 hours ago, in real life.
It increasingly feels as if there should be an independent, quick turnaround, '2nd look' NHS service where people can send along their results and questionable prescribing decisions, and, without attributing blame - request a 2nd look. People want the appropriate treatment and to move on - not to be mired in closed ranks.
We should be able to ask another GP at the practice for a second opinion on results and/or prescription. Of course, you'd need to know the first GP's opinion was wrong or off to know you need a second opinion.
I agree that we should be able to ask for an automatic reconsideration by another GP at the same practice without any apprehension about consequences. However, given how long it can take some members to obtain an appointment, and then to book another one to query the decision of the first one - it would be good to streamline the process.
I've seen some very odd decisions over on the PAS forum - and with the blood test results that some people are reporting, they are at risk of developing some non-reversible consequences if the appropriate treatment isn't started as rapidly as feasible.
You, cloudwalker are NOT suffering hyperthyroidism. Nor are you preparing for thyroidectomy in hyperthyroidism (obviously - as you are NOT suffering hyperthroidism). Further, you are not preparing for radio-iodine treatment.
And most certainly hyperthyroidism has NOT been confirmed by laboratory tests. I'd go so far as to say it has been categorically ruled out by those tests. If your FT4 and FT3 had been high, even somewhat out of range, it would be effectively impossible to diagnose hyperthyroidism whilst taking 125 micrograms of levothyroxine.
Therefore your doctor is intending to use a medicine not licensed for the purpose intended, and flagrantly dismissing and ignoring a highly specific printed warning.
Your doctor utterly fails to understand how carbimazole works. It affects the rate at which a thyroid makes thyroid hormone. It has no impact on the thyroid hormone that comes from a tablet. As I understand, you have no thyroid! So there would be absolutely zero point in taking an anti-thyroid medicine even if you were massively over-medicated.
In my opinion, you are possibly slightly under-dosed. The low TSH is of no importance and certainly cannot be regarded as a more important or significant result than FT4 and FT3.
Your doctor deserves to be up in a court of law for this degree of misunderstanding. Looks to me like he is being paid under false pretences.
It seems especially dreadful in the internet era when all the resources such as the Electronic Medicines Compendium, GP-specific websites, even many NHS sites, are available almost instantly, that these issues appear to be worsening. Of course, that might just be my perception, but we do see some frighteningly bad practice reported.
I've been appalled by some of the recent posts where members have had high doses of Levothyroxine stopped because TSH is mildly suppressed and severely deficient vitamin and mineral levels marked no action necessary. This attempt to add Carbimazole instead of reducing Levothyroxine dose (if the patient had been overmedicated, which is debatable) is possibly the worst I've seen.
Yes - and cases like this that have looked decidedly odd for some time (also involving Carbimazole): healthunlocked.com/thyroidu...
Given how few people must find their way here to this forum - I have to wonder how many similar decisions are passing unnoticed every day - and what percentage it represents because it feels ludicrously high.
That member is being treated with Carbimazole for hyperthyroidism. Carbimazole is being titrated down & I think she may be passing out of a transient Hashitoxicosis phase.
Thank you everyone for all your information and advice, i am definately not taking the Carbimazole and getting a appointment to see another gp as soon as possible
The side effects of this medication can be really serious from what i have read, it is shocking and unbelievable that it can be used in inappropriate cases
It would be good for Cloudwalker to show this entire thread to the practice manager, as it shows very clearly that internet support forums are vital for correcting mistakes made by GPs and should not be derided by the medical profession and considered to be full of incorrect advice.
Carbimazole prevents iodine from combining with inactive hormones IN THE THYROID to create active hormones....but you have no thyroid ?? It doesn’t work on stored thyroid or tablets, which is why some hyper patients take a high dose of carbi every day to block their own production completely, in parallel with a dose of levo which gives them a predictable dose of thyroid every day.
Is it possible you have some thyroid gland remaining ?
Whether your (apparently in-range) thyroid levels need to be reduced at all is another matter entirely.
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