Advice please

[Pisces2]

Hi I am new I have symptoms of an underactive thyroid GP won't test me for it and sent me away with antidepressants how can I go about getting thyroid tested? Thanks

[SeasideSusie Remembering]

Pisces2

Hopefully you haven't started the antidepressants.

If GP refuses to test thyroid, you can do a private home fingerprick test with one of our recommended labs.

You can do a full thyroid panel including both types of antibodies, or you can add vitamins and minerals which are useful too.

Full thyroid panel:

medichecks.com/thyroid-func...

bluehorizonmedicals.co.uk/t...

Including vitamins and minerals as well:

medichecks.com/thyroid-func...

bluehorizonmedicals.co.uk/t...

Medichecks have special prices until midnight tomorrow (Monday) for Black Friday weekend.

Post any results on the forum for comment, include all reference ranges too.

[Pisces2 in reply to SeasideSusie]

Thanks I had TSH done before and it was 7.2 (0.2 - 4.2) free T4 13.7 (12 - 22) then a retest showed TSH 5.3 (0.2 - 4.2) free T4 12.1 (12 - 22) the GP said she wasn't arranging any more tests and sent me away with antidepressants and I have only taken 3 of them

[SeasideSusie Remembering in reply to Pisces2]

Pisces2

So your GP has tested.

You are obviously hypothyroid but unfortunately your GP is sticking to the guidelines which say TSH should reach 10 or FT4 below range.

Were both your tests done at the same time and did you fast overnight? We always advise the earliest appointment of the day for blood draw and to fast overnight (water allowed) as this gives the highest possible TSH.

It would be an idea to have thyroid antibodies tested. Unlikely to be done by your GP by the sound of her, but NHS only do Thyroid Peroxidase and almost never do Thyroglobulin. You can be negative for TPO but positive for TG so it's important to test both. You could do the fingerprick test, both types of antibodies are included.

[Pisces2 in reply to SeasideSusie]

TPO antibodies are 704.5 (<34) and TSH when tested for very first time was over 20

All tests done early morning and fasting

[SeasideSusie Remembering in reply to Pisces2]

TSH over 20 at one point.

Thyroid antibodies of 704.5

See a different GP, get diagnosed and prescribed Levo, then make a formal complaint about this one for not diagnosing you hypothyroid when you had a TSH of 20.

[Pisces2]

Thanks I had TSH done before and it was 7.2 (0.2 - 4.2) free T4 13.7 (12 - 22) then a retest showed TSH 5.3 (0.2 - 4.2) free T4 12.1 (12 - 22) the GP said she wasn't arranging any more tests and sent me away with antidepressants

[Clutter in reply to Pisces2]

Pisces2,

Change your GP. Most GPs will diagnose hypothyroidism when TSH has been abnormal twice and FT4 is bottom of range. You need Levothyroxine, not antidepressants.

[Pisces2]

Thanks both done early morning and fasting

[Pisces2]

Mum has hypothyroid and diabetes and cushings and multiple sclerosis, grandmother has diabetes, distant cousin has thyroid problems and lupus and uncle has diabetes and ulcerative colitis. TPO antibodies are 704.5 (<34) and TSH when tested for very first time was over 20

[SeasideSusie Remembering in reply to Pisces2]

So your high antibodies confirm autoimmune thyroid disease aka Hashimoto's. She should diagnose and prescribe levo.

Email [e-mail] for the Pulse article written by Dr Toft. In it he states that where antibodies are present then Levo should be started to 'nip things in the bud'. Print the article, show question 2 to your GP. If she won't prescribe ask for a referral to an endocrinologist.

[Pisces2]

Ferritin 22 (30 - 400)

Folate 4.1 (4.6 - 18.7)

Vitamin B12 79 (180 - 900)

Vitamin D 26.6 (25 - 50 deficiency)

[SeasideSusie Remembering in reply to Pisces2]

Pisces

Ferritin is below range, can indicate iron deficiency anaemia so you need a full blood count and iron panel.

Folate is deficient, B12 is so low that you need intrinsic factor antibodies testing, you very likely have Pernicious Anaemia and may need B12 injections. Ask for further advice on the Pernicious Anaemia Society forum healthunlocked.com/pasoc, quote Folate/B12/Ferritin results and any signs of B12 Deficiency from this list b12deficiency.info/signs-an... then see GP about it.

Vit D is deficient and needs loading doses according to NICE Clinical Knowledge Summary cks.nice.org.uk/vitamin-d-d...

"For the treatment of vitamin D deficiency, the recommended treatment is based on fixed loading doses of vitamin D (up to a total of about 300,000 international units [IU]) given either as weekly or daily split doses, followed by lifelong maintenance treatment of about 800 IU a day. Higher doses of up to 2000 IU a day, occasionally up to 4000 IU a day, may be used for certain groups of people, for example those with malabsorption disorders.

Several treatment regimens are available, including 50,000 IU once a week for 6 weeks (300,000 IU in total), 20,000 IU twice a week for 7 weeks (280,000 IU in total), or 4000 IU daily for 10 weeks (280,000 IU in total)."

By the way, if this same GP has ignored these results, she is a sadistic b**ch and you absolute have to make a formal complaint.

[Pisces2 in reply to SeasideSusie]

Yes same GP who did the tests. I have looked up my complete blood count and iron results online and they show iron anaemia so will take these to appointment thanks

[SeasideSusie Remembering in reply to Pisces2]

Pisces2

Make an urgent appointment in the morning, see a different GP.

Point out what your other GP has failed to treat and show him the appropriate guidelines so that he knows you mean business:

Ferritin 22 (30 - 400) my complete blood count and iron results online and they show iron anaemia

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.

Your Ferritin is so low that you need an iron infusion so ask for one, it will raise your level within 24-48 hours, tablets will take many months.

For thyroid hormone to work (that's our own as well as replacement hormone) ferritin needs to be at least 70, preferably half way through range. You can also help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, and including lots of iron rich foods in your diet apjcn.nhri.org.tw/server/in...

If given iron tablets, then take each one 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.

**

Folate 4.1 (4.6 - 18.7)

Vitamin B12 79 (180 - 900)

You need to list any signs of B12 deficiency as per the link I gave above. You need to ask for intrinsic factor antibodies to be tested. You need treatment for the folate deficiency, but don't start taking folic acid until further tests have been carried out, and B12 has to be started before the B12. As I said, go to the PA forum for further advice so you know what to insist upon when you see your GP.

**

Vitamin D 26.6 (25 - 50 deficiency)

I have stated above that you are deficient and need loading doses. Don't leave the surgery with a prescription for 800iu D3 which most GPs will give. the NICE CKS summary states loading doses for your level. Once these have been completed you will need a reduced amount (more than 800iu so post your new result as the time for members to suggest a dose) to bring your level up to what's recommended by the Vit D Council - which is 100-150nmol/L - and then you'll need a maintenance dose which may be 2000iu daily, 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 helps D3 to work and 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.

As you have Hashi's your absorption is affected (as can be seen from your dire nutrient levels) so when you come to buy your own D3 it's best to get an oral spray which is better absorbed than softgels or tablets, eg BetterYou who do D3 and a combination D3/K2-MK7

**

As for the Hashi's, this 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_...

You will also need to address the gut/absorption problems that Hashi's brings so check out SlowDragon 's reply to this post for information and links to help healthunlocked.com/thyroidu...

Doctors know little or nothing about how Hashi's affects the patient and generally dismiss antibodies as being of no importance, so you wont get any help from your GP there so you're on your own with addressing that.

**

As I said, make a formal complaint against the GP who has ignored all these results.

Come back and let us know how you get on and tell us what investigations are going to take place and what you have been prescribed.

[SlowDragon Administrator]

I agree absolutely with everything SeasideSusie has said

GP should start you on Levothyroxine. As your vitamins are all so low they may start you on 25mcgs.

Essential vitamins are improved, as detailed by SeasideSusie

Low vitamins stop thyroid hormones working

Highly likely to find strictly gluten free diet helps as well

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...

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-...

healthunlocked.com/thyroidu...

Other things to help heal gut lining

Bone broth

thyroidpharmacist.com/artic...

Probiotics

carolinasthyroidinstitute.c...

Your GP has been extremely negligent. See a different GP and put in formal complaint to practice manager

(Apparently there's a financial "bonus" diagnosing depression of £1600. No wonder so many incorrectly get that label)

[liz1952]

Aaaaaaaaaaaaaaaaaah and Grrrrrrrrrrrrrrrrrr and excuse me but FFS..what is the matter with these people?? Can you go and see another 'doctor' in the group or are they all as bad? Or change docs or get a private test done - I can recommend Medichecks. Let us know how you get on.

Liz