What to say to the doctor (AKA be prepared!) - Thyroid UK

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What to say to the doctor (AKA be prepared!)

Bobbymcbobblepants profile image

Hi everyone,

I've posted my results before but must have written a boring post as there were no replies!

I'm preparing to ask for an increase in my levothyroxine to 175mcg (from 150). Is there owt else that I should ask about? Perhaps just seeking some reassurance! Like so many here sick to death of symptoms and quite frankly the weight and fatigue are chuffing me off! Especially when they look at me and say I need to watch my diet and eat less (despite being seen by the eating disorder service who said I need to eat more and shouldn't cut out any more food groups in order to loose weight) - makes me feel worthless.

Anyway, screenshot of my results from my last post attached...

Thanks in advance

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Bobbymcbobblepants profile image
Bobbymcbobblepants
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SeasideSusie profile image
SeasideSusieRemembering

Bobbymcbobblepants

I'm sorry you didn't get a reply to your previous post.

2 months ago it was suggested you get the full tests listed and if it wasn't possible to get them all done with our GP then to do a private test with Medichecks (Thyroid UltraVit) or Blue Horizon (Thyroid Plus Eleven).

You really do need all the tests as the ones you have had done don't give the full picture.

With your current dose of Levo being 150mcg, your TSH is a lot higher than one would expect to see. Are you taking any other medication that may be affecting the Levo's absorption? Are you taking your Levo correctly - on an empty stomach, one hour before or two hours after food, with a glass of water only and no tea, coffee, milk, etc, and water only for an hour each side of the Levo? If taking any supplements or other medication, are you leaving at least 2 hours between them and the Levo?

If you are taking your Levo correctly then you are undermedicated.

As for the missing tests, the TG antibodies will tell us whether you possibly have autoimmune thyroid disease or not, TPO on it's own, when the result is negative like yours, doesn't mean that you can rule out Hashi's. The TG antibodies could be positive. Ferritin is important, it needs to be 70 for thyroid hormone to work, and you other nutrient levels need to be optimal.

Vit D: 45 - this needs to be 100-150nmol/L according to the Vit D Council, the Vit D Society and Grassroots Health. So you need to supplement and I would suggest 5000iu D3 daily for 2-3 months then retest. You also need to take Vit D's important cofactors magnesium and Vit K2-MK7 naturalnews.com/046401_magn...

Once you've reached the recommended level then you'll need to find your maintenance dose by trial and error.

B12 is low at 242. Do you have any signs of B12 deficiency - check here b12deficiency.info/signs-an... If so then you need to ask your GP for further testing for B12 deficiency/Pernicious Anaemia.

Folate is low and should be at least half way through it's range. A good B Complex such as Thorne Basic B or Igennus Super B will help raise it, but don't supplement for that until further testing of B12 is carried out if it's necessary.

All this really needs to be done

Bobbymcbobblepants profile image
Bobbymcbobblepants in reply toSeasideSusie

Thanks for getting back to me so quickly!

I tend to take the levo in the morning with most of my other meds tbh (200mg Pregablin, 50mg Sertraline, a heyfever tablet - Certirizine, and 4mg Detrusitol). It'd be around 3/4 hour after my morning coffee, but since I learnt about the caffeine interaction, I now delay my second coffee til at least an hour after I've taken the meds...maybe it should be 2 hours! Don't eat owt in the morning so no issue there.

When I asked about the blood tests I spoke to a advanced pharmacist practitioner person (can't remember the job title) as I couldn't get a docs appt. I will ask again about the TG, ferritin etc and if not do the private tests.

Some of the B12 symptoms I have, but so many cross over with other things don't they? Difficult to tease out the cause. The one that really jumped out at me tho was poor wound healing. I have lots of piercings and tattoos but I'm sure in the past year my ability to heal has gone downhill. Even cat scratches (from where they launch off my lap) take ages to heal and leave scars - never had it like that before. I had a B12 spray (Better You, 1200ug) I'd started taking; do you think I should stop?

Thanks again for your help!

SeasideSusie profile image
SeasideSusieRemembering in reply toBobbymcbobblepants

Bobby

First of all, you must take your Levo well away from those other meds, as far away as possible so there can be no possible interactions or absorption problems.

It's doubtful you'll get TG antibodies done at GP level, it's rarely done on the NHS and if at all it would be in secondary care (endocrinologist).

As you have some B12 symptoms, don't assume they're to do with something else. Make a list of the symptoms, show them to your GP, say you understand they may be signs of B12 deficiency so would s/he arrange for further testing. Stop using the B12 spray, supplementing will skew the results so you really need to be off it for as long as possible before further investigation into your B12 level. And definitely don't start a B Complex until after testing and starting any B12 supplementation. Many people with B12 level in the 300s originally are on B12 injections.

shaws profile image
shawsAdministrator

I am really sorry your previous post was missed somehow but am glad you've reposted. It is very unusual for posts not to be responded to. SeasideSusie has given wise advice as usual. Especially to take levo alone. I would either take levo first thing with one full glass of water and wait an hour before eating.

I would take your other meds at lunchtime or at bedtime.

B12 has to be optimum. Too low could cause dementia or other serious problems.

Treepie profile image
Treepie

Another option would be to take your levo before bed or in the night if ,like me you have to get up a few times,and your other meds in the morning.

Thanks everyone. I have other meds I have to take at bedtime, so I'll take levo only and shuffle the rest til the afternoon, although I'll still need to take the hayfever tablet in the morning I won't take them at the same time.

I'll ask about B12 too. And I'll look again at the private tests.

Really helpful advice, I appreciate it!

TYellowcello profile image
TYellowcello

Are you not eating any breakfast? As far as I understand it, your Thyroid is working hard to keep your blood sugar stable. Rather than our bodies reacting to how much Thyroxine we need, our bodies get a constant ammount in pill form. If your blood sugar drops too low you’ll be using more thyroxine and your body will be struggling to keep up, you’ll have symtoms. We are supposed to eat every 3 hours (and limit the highs and lows in our blood sugar) to give us the best chance to reduce symptoms. Before I was diagnosed I couln’t get out of bed without eating a biscuit first, otherwise I’d collapse in the shower! My body couldn’t function if my blood sugar was low as my thyroid couldn’t bring it up, I wasn’t making enough , incidently the Dr said this was normal and to just eat a biscuit every morning....

Bobbymcbobblepants profile image
Bobbymcbobblepants in reply toTYellowcello

The breakfast thing links into my ED. My goal is to have a banana and a snack in the morning, which I normally manage about 11am, on work days at least (at the weekend I get into bad habits and don't eat til 4 sometimes). I've had my sugar tested before and it's been OK so I guess I'm lucky with that.

TYellowcello profile image
TYellowcello in reply toBobbymcbobblepants

I’m sorry I don’t know what ED is? I’m not sure you understand how not eating will make you symptomatic no matter what your blood sugar level is. It is the fluctuations not the level it is at when you got it tested. It is no wonder you need such a high dose and don’t feel well on 150. Increasing the dose isn’t likely to help you because you are still taking a constant ammount each day but your Thyroid has to swing from working really hard to not at all. If that is going on in your body you will always be symptomatic either hyper or hypo symptoms. If I were you I’d try to balance your blood sugar before doing any tests as they don’t really tell the full story otherwise. If you have coffee (a stimulant) in the morning and don’t eat until 11am, you will be fatigued, (probably anyone would be!). Your body is trying to tell you something. An increased dose of levo is very unlikely to help unfortunatly. We just have to live with the fact that our bodies don’t react to fluctuations like other peoples do.

silverfox7 profile image
silverfox7

I'm sure you will see an improvement if you keep other meds 2 hours away and things like iron, Vit D, calcium, the Pill of HRT 4 hours away. It feels a nightmare at first but you will soon get into a rhythm! I bought myself a pill holder that does a week and 4x a day but apart from my thyroid meds which are separate I divide the day into lunch, evening, lunch, evening so when it's all filled it's 2 weeks of meds sorted. It's a bit too chunky to carry around as some tablets are large but the day's worth can be taken out and slipped in your bag so you only need to carry that day with you. Picked it up at my local chemist.

I agree with SeasideSusie , your B12 should be much higher as should your folate and Vit D.

It may mean a private blood test as NHS will say your B12 is in range, but it might be worth testing to make sure you don't have Pernicious Anaemia. You'd need a test for Intrinsic factor.

Personally, I'd supplement with B12, Vit D and folic acid for 2 months to see if there's an improvement in how you feel.

I agree. I've been trying to reduce the antidepressants as I was put on a load a few years back after a breakdown. I've seen my mum get more and more ill, with diabetes, then Fibromyalgia then taking a pill for the side effects of other pills and so on til she's a shadow of her former self and in and out of hospital. I don't want to get like that.

I've already shuffled my usual morning meds to when I get back from work so I just take the levo in the morning. I'll print all this out and talk to the doc on Thursday and see how far I get.

Thanks again!

Urgh. Had my phone appt with the doc. She was rushing and seemed like she didn't want to talk to me about this. Phone call was 3 minutes *sigh*

Anyway, in maybe positive news she said she'd write to a consultant and ask their advice as I still had symptoms. She didn't want to up my meds as my results are normal, even when I said about people feeling better if the TSH is towards the bottom of the range and T4 the top. She did agree to test my T3 tho so we'll see what that comes out as.

Feel a bit dismissed tbh; when I tried to mention B12 she cut across me and changed the subject. When I asked anything she repeatedly said 'I'll write to the consultant, OK?'

Oh well. These things always seem to be a battle.

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