Thyroid UK
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GP won't medicate with TPO antibodies

Morning, I've had blood test results back-

TSH 6.2 (range 0.5-5)

TPO 900 (range 0-59)

GP won't prescribe until TSH reaches 10, regardless of antibodies and other symptoms. (Have had low Vit d, exhaustion, trying to conceive for 2 years).

I've read up a bit and found this may not be the best plan of action. Has anyone been in this position and what did you do?

Is it likely to be a GP's personal approach so I could try a different gp in the same surgery? Or would you change GP even? Or also consider private second opinion?

Thank you

9 Replies
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Definitely try a different GP and if no joy there, ask for a referral to an Endocrinologist. If no joy again and you can afford some private testing and seeing a specialist privately, then it sounds like you should go ahead. It could well be why you haven't managed to conceive and you would need a much lower TSH level for pregnancy.

You would need your FT4 and FT3 tested as well. I really hope you get this sorted soon.

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See a different GP

Your TSH is over range and treatment should be started. Guidelines somewhere say if TTC then TSH should be around 2

For full evaluation you ideally need TSH, FT4, FT3, TT4, TPO and TG antibodies, plus vitamin D, folate, ferritin and B12 tested

See if you can get full thyroid and vitamin testing from GP.

Private tests are available

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should be done as early as possible in morning and fasting. This gives highest TSH and most consistent results

Link about antibodies

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

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Print this list of symptoms off, tick all that apply and take to GP

thyroiduk.org/tuk/about_the...

What was your Vitamin D test result and what did GP prescribe?

With Hashimoto's, our gut can be badly affected. Low stomach acid can lead to poor absorption of vitamins. Low vitamin levels stop thyroid hormones working.

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

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

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...

Email Thyroid UK for list of recommended thyroid specialists

dionne.fulcher@thyroidUK.org

Reply

Qwerty11,

I would see every GP in the practice and, if necessary, change practice until you find a GP who will treat you. Most GPs will treat when TSH is over range in the presence of positive antibodies. Read Dr. Toft's comments in Guidelines for the Use of thyroid Function Tests in thyroiduk.org.uk/tuk/about_... Email dionne.fulcher@thyroiduk.org if you would like a copy of the Pulse article to show your GP.

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Qwerty11,

The TSH of women planning conception should be in the low-normal range 0.4 - 2.5. When pregnancy is confirmed dose is usually increased by 25-50mcg to ensure good foetal develop-ment. NICE also recommends that hypothyroid women planning pregnancy should be referred to endocrinology. cks.nice.org.uk/hypothyroid...

Management of primary hypothyroidism: statement by the British Thyroid Association Execu-tive Committee

13. 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 refer-ence 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 tri-mester (1/++0). L-T4/L-T3 combination therapy is not recommended in pregnancy (1/+00).

onlinelibrary.wiley.com/doi...

According the ATA First Trimester TSH levels between 2.5 and 5.0 are associated with increased pregnancy loss

thyroid.org/patient-thyroid...

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Thank you for all this info. I'll book another appointment and check it's not with the same GP, be a bit more assertive (demanding!) and see if I get a different response. Just to check I've got the correct understanding on this- many GPS will treat with TSH over range and TPO antibodies? Thanks

Reply

GPs are a law unto themselves so it isn't what other GPs do it is whether you can convince the one you see to follow NICE guidelines, local guidelines or a specialist's advice. Some times the presence of an additional person in the consulting room including a medical student is enough to get them to do this.

As you are trying to conceive you must stress this and point to evidence - if the GP doesn't know ask for referral to a fertility specialist, which you may have to do privately, as you need to be medicated until your TSH is under 2.5 but preferably under 1.

Reply

Hi - I was in the situation as you with a TSH level of 6.32. The doctor wasn't going to do anything about it until I told her I was planning on getting IVF. According to the NICE guidelines that should treat you if you are trying to conceive or have clinical symptoms so as an extra measure you could print out the list of symptoms available on this website and tick off the ones applicable to you plus take your temperature every morning. Chances are it is low. Show that to the doctor (a different one) as well.

I would also go gluten free and check your vitamins and minerals.

Sorry just repeating what SlowDragon has already told you but just wanted to add my personal experience.

In the end I was too ill and too old to do the IVF but at least I got started on my journey to wellness thanks in a large part to this website.

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Thank you for the advice... coincidentally my husband just phoned me to talk about specific diets he had read can help with hashimotos- he read an article about vegan diets but most of what I've seen on here recommends gluten free if anything. Have you ever heard of someone actually coming off treatment as diet played such a part in improving things? or is that unrealistic really?

I'm glad you are on the road to feeling well, I agree this website has been a godsend for me in working out what's going on.

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Hi again - I've been reading a lot of stuff from Isabella Wentz and she claims that some people could go into remission but I have yet to meet anyone who did. She recommends the Autoimmune Paleo Diet or GAPS diet.

One of the key things seems to be selenium supplements as well as making sure that your vitamins B12, folate & D as well as ferritin are optimal. For example I sometimes have a sore wrist but if I take a Vitamin B12 tablet (chewable) it goes away within an hour - likewise I get a cramp in my shoulder muscles (right hand side) which goes away after I take a Vitamin D soft gel. I try to take them every day but sometimes forget.

A lot if not all hypothyroid patients have problems with their stomachs and absorbing vitamins. We have 'leaky guts'. I have had a lot of success with going gluten free. I also had SIBO (small intestinal bacterial overgrowth) which gave me food intolerances which resulted in terrible headaches. I have not got rid of this and am feeling a lot better.

You could try to find out what the root cause of your condition and address that. For some people it could be some kind of parasite, or exposure to toxins, or SIBO, or epstein barr virus or ....? The theory is that if you can correct the root cause you will go into remission.

I think its worth a try because the worst thing that can happen is you feel better! I know it's a steep learning curve but it's worth it.

Good luck!!!!

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