Seen the doctor today and the verdict is 'anxiety'!

[TrishaL]

Thanks to all of you who offered support before my appointment today. I went to my doctor armed with printouts supporting the reduction of TSH to under 2.00, a list of symptoms and my temperature readings from the last week. He eventually agreed to retest my thyroid levels and to include ferritin, thyroid antibodies and anti-thyroglobin. But, after quizzing whether I had any medical training, he told me that my symptoms are caused by anxiety and that I shouldn't believe what I read on the website. He won't countenance the use of NDT (UK medicine is more advanced than American)! Looks like it's time to find a new doctor!

[SeasideSusie Remembering]

Trisha

What printouts did you give to support TSH being below 2.0?

Did you tell him that you had been on a forum?

We have to be very careful how we phrase these things. Rather than say "the internet" or "a forum", if you have been given suggestions on this forum then you can say that you "have taken advice from NHS Choices recommended source of information for thyroid disorders" (which is ThyroidUK), they are less likely to dismiss that.

Also, I can't see on your previous post that anyone referred you to Dr Toft's article in Pulse magazine which says

"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)."

Dr Toft is past president of the British Thyroid Association and leading endocrinologist.

You can obtain a copy of the article by emailing Dionne at [e-mail] print it and highlight question 6 to show your doctor.

Also, if you look at this article, it says that TSH >2.00 can indicate under replacement and that a level of 0.2 - 2.0 indicates sufficient replacement

pathology.leedsth.nhs.uk/pa...

The "anxiety" label is a classic response when doctors don't really know very much about treating the thyroid and think that anywhere in range is perfect.

See what other tests get done, and if not all of these

TSH

FT4

FT3

TPO antibodies

TG antibodies

Vit D

B12

Folate

Ferritin

then I strongly suggest you do the Medichecks Thyroid Check UltraVit which does the full thyroid panel and all the important vitamins and minerals. If we've got the complete picture then we can take it from there.

[TrishaL in reply to SeasideSusie]

Hi Susie,

I went on to the Thyroid UK website and printed off some of the articles there, e.g. the interpretation of Thryoid blood results page and even highlighted the relevant sentences for him. He read it then dismissed it, saying that he had been trained by the UK medical authorities etc., etc...

I will certainly email Dionne and request the article you mentioned to take to my follow up appointment after the next set of results come through. Many thanks for that suggestion.

I was doing some digging around earlier and came across this website which mentions that there is to be a trial later this year comparing the experiences of patients on T4 only and mixed T4/T3 meds to see how to proceed in the future when treating hypothyroidism. I thought you may interested in taking a look

verywellhealth.com/the-t4t3...

Many thanks,

Trisha

[SeasideSusie Remembering in reply to TrishaL]

Trisha

Dr Toft is now also advocating that many patients would do better with a combination of Levo and T3 and is sort of backtracking on his earlier article a bit

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

Even that article is saying the current guidelines aren't fit for purpose, the biggest problem is, of course, getting GPs to accept this and be more open minded.

[SlowDragon Administrator]

For full Thyroid evaluation you need TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies.

Plus vitamin D, folate, ferritin and B12.

Essential to test thyroid antibodies, FT3 and FT4, plus vitamins

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies

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 ideally be done as early as possible in morning and fasting.

If on Levothyroxine, don't take in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's. Low vitamins are especially common with Hashimoto's. Food intolerances are common too, especially gluten. So it's important to get antibodies tested.

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 at

[e-mail]

Suggest you request list of recommended thyroid specialists.

Professor Toft recent article saying, T3 may be necessary for many otherwise we need high FT4 and suppressed TSH in order to have high enough FT3

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

[Clarrisa]

I recently got the exact same diagnosis “anxiety.” I didn’t bring printouts, I only made & presented a thorough list of my (anxiety provoking) symptoms. I don’t think one is spared the anxiety diagnosis by not doing doctor education (with printouts) during the appointment. Could the doctors be projecting their own anxiety?

[TrishaL in reply to Clarrisa]

What amazed me was that he admitted he knew very little about the Thyroid but refused to consider anything other than the standard parameters for the tests. However, I have managed to persuade him to do a further blood test (the last one was taken at the beginning of February) and I can always take those elsewhere if need be!

[G2G2]

A major source of anxiety is ignorant doctors.

[TrishaL]

Thank you!