Sent away with antidepressants

[Bubble2]

Hi I am new, my GP has sent me away with antidepressants since he believes my symptoms are not hypothyroid.

Heavy periods

Goitre

Tiredness

Feeling cold

Dry skin

Hard stool

Weight gain

Diagnosed hypothyroid 2014. I take 125mcg Levothyroxine. Your comments please.

Dec 2017 (125mcg Levothyroxine)

TSH 5.2 (0.2 - 4.2)

FT4 14.7 (12 - 22)

FT3 3.2 (3.1 - 6.8)

Ferritin 21 (30 - 400)

MCV 80.2 (83 - 98)

MCHC 370 (310 - 350)

[Hidden]

Were antibodies tested Bubble2 ?

Stupid GP didn't notice that your TSH was out of range, your FT3 was .1 above bottom of range and your FT4 was barely above. Did he not notice ferritin?

What is he actually being paid for??

Edit: of course you need to tell him to shove his AD's where the sun don't shine. See another doctor.

[Bubble2 in reply to Hidden]

Thyroid autoantibodies 104.5 (<34)

[Hidden in reply to Bubble2]

Unfortunately the NHS only usually test one type but you have Hashimoto's. Any vitamins tested?

You need T3 as you're clearly not converting T4 to T3, would another GP refer you to an Endo?

[Bubble2 in reply to Hidden]

I am under an endo but he has given me an anxiety diagnosis, GP given me diagnosis of neurosis and sent me away with anti depressants.

Vit D 28.8 (25 - 50 deficiency)

Folate 1.9 (2.5 - 19.5)

Vitamin B12 204 (190 - 900)

Taking 800iu D3, B12 injections and folic acid once a day

Thanks

[helvella Administrator in reply to Bubble2]

Bubble2,

The main patient NHS area is called Choices. It contains numerous descriptions of diseases and disorders. "Neurosis" simply does not appear.

Anti-depressants are not anti-neurotics or anti-anxiety medicines (though there can be some overlap).

[Clutter]

Bubble2,

You are undermedicated and should request a Levothyroxine dose increase. The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.2 - 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 [e-mail] if you would like a copy of the Pulse article to show your GP.

Thyroid peroxidase antibodies 104.5 are positive for autoimmune thyroid disease (Hashimoto's). There is no cure for Hashimoto's which causes 90% of hypothyroidism. Levothyroxine treatment is for the low thyroid levels it causes. Many people have found that 100% gluten-free diet is helpful in reducing Hashi flares, symptoms and eventually antibodies.

chriskresser.com/the-gluten...

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

Deficient ferritin and MCH probably indicate iron deficiency anaemia. What is haemoglobin result and range? Has iron and transferrin saturation been checked?

[Bubble2 in reply to Clutter]

Iron 4.5 (6 - 26)

Transferrin 12 (12 - 45)

[Clutter in reply to Bubble2]

Bubble2,

Indicates iron deficiency anaemia which will be causing your heavy periods and some fatigue. What has your GP prescribed?

[Bubble2 in reply to Clutter]

Hi nothing prescribed

[Clutter in reply to Bubble2]

Bubble2,

I'd change GP and complain to the practice manager. This one is chucking antidepressants at you but ignoring Levothyroxine undermedication and iron deficiency anaemia which are causing your symptoms.

The treatment for iron deficiency anaemia is 3 x 210mg Ferrous Fumarate. Each tablet should be taken 1,000mg vitamin C to aid absorption and minimise constipation. Your GP should prescribe but you can buy FF over the counter without prescription. Take iron 4 hours away from Levothyroxine.

[Anthea55]

Surely a goitre is a thyroid problem. I googled for it and this is the dictionary definition

"a swelling of the neck resulting from enlargement of the thyroid gland"

so how can he say it's not a thyroid symptom?

[Bubble2 in reply to Anthea55]

My goitre is obvious to an observer. GP sent me for an ultrasound which showed an enlarged thyroid. I spoke to GP about the report and she said the thyroid was normal size and shape

[Hillwoman]

Just wondering, is your goitre obvious to an observer? If so, what was your GP's explanation for its presence?

[Bubble2 in reply to Hillwoman]

Yes it is obvious to an observer. GP sent me for an ultrasound which showed an enlarged thyroid. I spoke to GP about the report and she said the thyroid was normal size and shape

[Hillwoman in reply to Bubble2]

I don't think your GP is qualified to dismiss an obvious goitre, or the ultrasound report, which presumably only confirmed what eyes can see.

Find another GP practice, if you can, because your goitre (an obvious sign), your symptoms and test results have no other explanation than hypothyroidism and iron deficiency anaemia. You need prompt treatment for both,

[Anthea55 in reply to Hillwoman]

I totally agree with Hillwoman. I hope you were given a copy of that report.

[SlowDragon Administrator]

You are seriously under medicated to have TSH so high. You need 25mcg dose increase and retesting after 6-8 weeks. Dose increased in 25mcg steps until TSH is around one and FT4 towards top of range and FT3 at least half way in range

Your vitamins are so low BECAUSE you are so under medicated

You do not need antidepressants, you need correct treatment

See a different GP urgently and if possible take a supportive friend or family member with you

Your vitamin D is grossly under prescribed, you need loading dose to raise level quickly. If they won't agree then self supplement. Better You vitamin D mouth spray avoids poor gut function of Hashimoto's. Suggest you try either 3000iu or 5000iu for 2-3 months and retest. Via vitamindtest.org.uk £28

Ferritin must be treated, you are clearly Anaemic

See Box 1. Towards end of article

Some possible causes of persistent symptoms in euthyroid patients on L-T4

You will see low vitamin D, folate, ferritin and B12 listed

onlinelibrary.wiley.com/doi...

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone 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

Ask GP for coeliac blood test first

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...

thyroidpharmacist.com/artic...

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, 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 articles from Thyroid UK email print it and highlight question 6 to show your doctor

please email Dionne:
[e-mail]

Prof Toft - article just published now saying T3 is likely essential for many

rcpe.ac.uk/sites/default/fi...

But with Hashimoto's we must get vitamins optimal first and dose of Levo increased enough to lower TSH to around one and FT4 near top of range

Highly likely to need to be strictly gluten free too

If after all these steps, your FT3 remains low then, like many of us with Hashimoto's, you may need addition of small dose of T3 too

You need a new endo.

Email Thyroid UK for list of recommended thyroid specialists

please email Dionne:
[e-mail]

Detailed supplements advice from SeasideSusie on Low vitamins due to under medication

healthunlocked.com/thyroidu...

Look up your local CCG guidelines on vitamin D deficiency

Eg Oxfordshire

oxfordshireccg.nhs.uk/profe...