Finally I persuaded GP to check T3 and T4 before my major op on Tuesday. Lab results have come back with repeat TSH and T4- no T3!!!
TSH 0.66 (0.5-4.4)
T4 20.0 (10.0-20.0)
I managed to persuade doc to increase to 50mcg thyroxine 3 weeks ago. Not sure what to do now, worried about op.
Thanks in advance
Labs often refuse to test even when a GP asks, which is why private tests are popular. The surgery team will decide whether your TSH is too low to operate without the full picture. Sorry ,but others may have advice on what to do.
My understanding is that your GP is legally responsible for your care so the lab should not refuse a specific request for tests. I have heard of endos being refused full testing too. So complain directly and to PALS and your doctor should do so too. There is little point in having a doctor patient session that ends with ‘let’s run the tests and then discuss further’ for your time to be wasted. Labs may well have protocols but the full range of thyroid problems can not be diagnosed or monitored with minimal testing.
The labs follow strict guidelines won’t have tested T3 because the TSH is at the lower end of the range and T4 at the very top. Bloods will be redone at pre op assessment and if the anaesthetist has any concerns will retest
Thanks. Had pre op, but don’t think they did thyroid tests. They wouldn’t know what to do anyway.
Thanks. I really dont know what to do, as having major op and bleeding etc is a possible complication. Tried to get things sorted before I go in. It’s so ridiculous. I have already written to pals about endo and general rant about nhs re thyroid.
Ive had the same trouble with our local hospital labs so much to the point they only do a tsh test-useless!!😠 if your tsh is in range they dont do frees- my endo is not much use really but even he was fed up with not having the full results- so i now have to travel 50 miles to endos hospital where he requests them to be done -at least i get the full set.😊
The ability of path lab personnel to decide on which tests to do or not to do is an ethical scandal of the first degree. They have no contact with the patient except through a blood sample, they have no first hand knowledge of the interaction between doctor and patient and the detailed patient presentation. They are in effect acting in a God-like capacity to provide the tests, and only such tests that they in their (Wisdom?) deem necessary. This is all down to cost disguised as efficiency, which it clearly is the opposite. It is time the medical profession stood up to this behaviour.
Is there any way of raising such ethical issues for public scrutiny?
I keep thinking that ethical failures abound in thyroid medicine and it might be more effective to take the establishment on using that basis. It is, for example, much harder to say "There is no evidence..." as a retort in the case of labs refusing tests if the refusal istelf were deemed unethical.
To be fair to the labs, in many cases they have been given guidelines by the local health authority and have to work within these. (I’m not saying the guidelines are right). So GPs may not be able to order FT4 unless TSH is outside range, and n which case the guideline may stipulate it be done automatically by the lab. FT3 and antibody tests are often ‘specialist order only’.
You should in any case make sure the consultant for your operation is aware of the risks.
As regards the power of the labs, by whatever rules they are guided, they have not the power or the knowledge to suggest diagnoses to the GP solely on biochemical grounds. This however they exceed frequently, by interpreting results to "guide" the GP. They have no role except to post up "out of range" results without further comment.
What needs to be done is to forcibly drag out into the open by FOI the logical basis by which path labs decide thyroid hormone testing strategies and on whose authority and knowledge base.
I'm more than happy to submit an FOI about this. But who could I send it to?!
Perhaps best to ask BTF first where the guidelines on path lab testing exist and who devised them.
Did you have any luck with BTF or FOI?
I'd forgotten about this! I asked:
"Sometimes local path labs do not always carry out T4 and T3 blood tests, despite them being ordered by doctors.
Labs sometimes make their own decisions that patients only require a TSH test, or possibly a TSH test and a T4 test.
Please can you provide me with information regarding NHS thyroid testing?
1. Where can I find the national NHS guidelines for path lab thyroid testing?
2. When were they devised?
3. How were the guidelines drawn up - using what research or evidence?
4. Who was responsible for these thyroid tests guidelines?
5.Can a path lab over-ride the requests from a GP or endocrinologist, as to which thyroid blood tests they carry out, regardless of which tests were ordered?"
The BTF adviser's response was:
"There are many guidelines across the world on the management of thyroxine replacement therapy in patients with primary hypothyroidism. In all cases these guidelines recommend a combination of improving clinical symptoms and 'normalising' serum TSH levels. To the best of my knowledge none of these guidelines recommend any role for measuring serum T4 or serum T3. The most recent BTA Guidelines for the management of primary hypothyroidism state 'There is insufficient evidence to recommend monitoring serum T3 as a therapeutic target in hypothyroidism' See table 3 of the Guidelines (see link below) for further details.
btf-thyroid.org/images/docu...
I can combine questions 1-4 of the request by reference to the attached document. This is the relevant section of the NICE Clinical Knowledge Summary for Hypothyroidism. As with all NICE documents it will have been written by a panel of UK experts - in this case the panel will include thyroid physicians, GPs and laboratory scientists.
That leaves question 5 in the request and the short answer is 'yes'. Labs have clinical practice guidelines that they follow. These guidelines are shared with users of the lab. There is pressure on labs to avoid unnecessary testing and so they will stick to their practice guidelines unless an individual case can be justified by the requesting doctor. There are a few patients who are difficult to stabilise on thyroxine and so other tests may be performed by arrangement with the lab during non-standard therapy. However, I doubt if any UK NHS lab will measure T4 and/or T3 when monitoring a routine case of thyroxine replacement therapy."
So, what do you think?!
Many, many thanks.
Just as I thought!!! We have no chance of getting the right tests, diagnosis or treatment within the NHS!!!! I find the whole thing ridiculous, especially as I know of older sufferers who were tested, diagnosed and treated 30+ years ago at their GP surgery, and still remain in good health because of this, no need for endo referrals!! How times have changed!! I have been fighting for almost 15 years!!
Thing is my previous T3 results were not that bad. So could now be over 5. My GP has now said I have to reduce back to 25mcg. It’s a worry with a major op on Tuesday.
4.7 Oct ‘17
4.8 Feb ‘18
Good luck for your op and all the best for your recovery. I'm so sorry you have these additional worries on top of it all. x
I was wondering if you ever did inquire about the guidelines for lab testing? Thank you!
TaraJR any luck? 
Timing of taking T4/T3 prior to TSH Lab Work
T4 low, TSH low side of normal. GP won’t test T3 or refer to endocrinologist.
GP refuses to test my free T3 and T4
Test Results T3/T4 - TSH low consultant want me to decrease!
Rundown of TSH, T3, T4
