Hi
I am struggling to figure out why my GP won't increase my Levo from 100mcg to 125mcg?
Diagnosed 2014, list of symptoms below
Tiredness
Feeling cold
Numbness and tingling in fingers and feet
Breathlessness
Dizziness and blood rushes when standing from sitting
Heavy and long periods
Dry skin
Constipation
Bladder infections
Thank you
TSH 7.1 mIU/L (0.2 - 4.2)
Free T4 13.8 pmol/L (12 - 22)
Free T3 3.6 pmol/L (3.1 - 6.8)
Hi Karalo,
You'll have to ask your GP why. You certainly need a dose increase because TSH is considerably over range.
The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.3 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options 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.
If your GP still won't increase dose see other GPs at the practice or change practice.
You should also ask for ferritin, vitamin D, B12 and folate to be checked. They are commonly low/deficient in hypothyroid patients and low iron can cause heavy periods, fatigue and breathlessness, and low B12 and folate can cause numbness and tingling in hands and feet.
Hi thanks, I think these were all tested 2 weeks ago. I had a message on my phone from the GP asking me to see him because something came back abnormal (I wasn't told in the message what it is. and I have trouble getting through to the surgery as well) Once I know I will post results if ok?
Karalo,
Your TSH is abnormal. GP probably wants to increase dose. You need to make it clear that it is the GP who meddled with the 175mcg your endo prescribed who is responsible for you being undermedicated. GPs have no business interfering with endo's treatment plans. If they think something is wrong they should discuss with the endo and get agreement before altering dose.
I'm struggling to figure out why your GP won't increase your levothyroxine too!!! In fact, I don't think a 25mcg rise is going to be enough. You need to increase by 25mcg and retest in 6 weeks and then increase by 25mcg again until your TSH is around 1.
What reason did your GP give for not increasing your dose of levothyroxine? Did you give him/her a list of your symptoms? If so, what did GP say?
Hi thanks, thinking back she did say there was a discrepancy in my dosage. My endo wrote to me and the GP saying my dosage was 175mcg but the GP then decided to reduce it based on bloods below
TSH 1.20 (0.2 - 4.2)
Free T4 19.3 (12 - 22)
Free T3 4.0 (3.1 - 6.8)
The endo wasn't aware of this reduction and had written that I was taking 175mcg. The GP then called me several times over the course of a whole week leaving messages asking me what I was taking when they were the ones who had reduced my dose in the first place. They also stopped my medication scripts.
I haven't yet been to my GP because I was so fed up of being messed around so many times that I moved to my new one 2 weeks ago. I am due a medication review and I plan to take a list of my symptoms with me.
Have you been tested for thyroid antibodies?
I suspect you have autoimmune thyroiditis otherwise known as Hashimotos thyroiditis and your previous GP knew diddly squat about thyroid conditions and panicked at a low TSH.
Your Endo prescribed the correct dose by the sounds of things but you very likely had an attack of antibodies which caused a rise in thyroid hormone. This has the knock on effect of reducing TSH temporarily. You will only know if this is the case or not if you have TPO and TgAb antibodies tested or get copies of previous results.
You can read about Hashimotos on Thyroid UK website thyroiduk.org/tuk/about_the...
Ask your new GP to check:
TSH
FT4
FT3 (GP might not be able to do this, it depends on labs)
TPO antibodies
TgAb
Vitamin B12
Folate
Ferritin
Vitamin D
Thyroid patients can be low in all these vitamins and we really don't feel the full benefits of levothyroxine if our vitamins are sub optimal.
Yes thyroid antibodies were
Thyroid Peroxidase antibodies 905.4 IU/mL (<34)
Thyroglobulin antibodies >1000 IU/mL (<115)
My ferritin, folate, vit D and B12 were tested 2 weeks ago and the GP called me 3 days after to say my vitamins and minerals came back abnormal but I'm not sure what
Well, as you can see you have elevated thyroid antibodies and therefore you have Hashimotos thyroiditis. So the fluctuation in thyroid levels is not unexpected.
You now need to get back on the correct dose of thyroid medication and you need to chase up those vitamin results and make sure you get the right treatment from your new GP.
Check out SeasideSusie replies to other people about what should be prescribed for vitamin deficiencies and take the info to your appointment to make sure you get the correct treatment.
Results I posted in my original thread for thyroid are 2 weeks old
TSH 7.1 mIU/L (0.2 - 4.2), Free T4 13.8 pmol/L (12 - 22)
Free T3 3.6 pmol/L (3.1 - 6.8) I presume you mean these ones are 2 weeks old? So they are current. TSH is unlikely to have changed much from this in 2 weeks unless you've started feeling overactive.
These results show you are now undermedicated and need to increase your dose but you might want to increase slowly to avoid feeling unwell.
When your results were TSH 1.20 (0.2 - 4.2), Free T4 19.3 (12 - 22), Free T3 4.0 (3.1 - 6.8) There was nothing wrong with these. Your FT3 and FT4 are in range and TSH was just about where you want it to be as SeasideSusie has already said.
As everyone else on here has said, don't let the GP mess about with your dose. You're under the Endo and the GP should follow their instructions.
Karalo
There was nothing wrong with those results they certainly didn't suggest a dose reduction was needed, in fact adding some T3 would have been a good idea. What reason didn't he GP give for reducing dose? The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it is needed for FT4 and FT3 to be in the upper part of their respective reference ranges if that is where you feel well.
However, in the grand order of things, endo trumps GP. Endo is a specialist, GP is a generalist. If endo says your dose is 175mcg then that's your dose, GP has no right to alter it. You should tell your GP that your endo wants you to take XXXmcg and if GP wants to change it then s/he should discuss with endo first. If it was me I would be contacting endo's secretary to ask him to sort this and instruct your GP accordingly (as in leave dosing to endo).
Thanks I told my GP that I was under the care of an endo and the GP still reduced it and then left messages for me saying there was a discrepancy in my dosage.
Sounds like he has realised his mistake and had t looked at you notes it it also shows he does t know what he is doing as he reduced your dose!
Thanks was taking T3 before but it was taken away
Karola
Why was it taken away? Was it a different endo? What reason did they give?
Taken away by a different endo because he didn't approve of T3
Is the original endo still at the hospital? Presumably you were doing well with the addition of T3, very unfair when a different endo goes against what the first endo prescribed when it's helping.
No she is now the other end of the country
We've had lots of people on here saying the same thing. I suppose you know about the NHS consulation on T3 and did you fill in the consultation paper that was going around? I think the consultation is closed now but if you look over to the right of this page you will see a link to NHS England Consultation.
Your Endocrinologist should not have taken your T3 away if you were feeling well with it. If your vitamin levels have dropped it's likely due to having your T3 removed.
Hi there. I think GP wont increase Levo. because you have both hypo and hyper symptoms - dizzyness and blood rush arent hypo symptoms, i had them from levo intolerance, whick is common. Often our body cannot assymilate levo. its synthetic and not exactly the same as human thyroid hormone. Also dizzyness on standing can be adrenal fatigue. Again, common with hypo. Check how you cope with eyes closed and try to balance on one leg. Then swap legs. Do you tip and lose balance?- adrenal burn out! Saliva testing for this is better than bloods. Dr Durrant-Peatfield has written some great guidance on this intolerance problem. Good luck.
Thanks I do tip and lose balance and I have adrenal fatigue
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