Is my GP being unreasonable?

[ctw0410]

I was diagnosed with hypothyroidism after the birth of little girl about a year ago when my TSH levels were over 40 MU/L. I’ve been taking 100mg of levothyroxine ever since. I’ve been more or less ok apart from dips around my period time.

However about 2 weeks ago the crushing tiredness returned along with terrible brain fog, weakness, shakiness along with a new symptom for me of wrinkled, dry fingertips. I simply didn’t have the strength to get to work one day and every other day has been a struggle to concerntrate and be productive. It’s also very hard to care for my little girl.

I went to see a dr at my medical practice to explain how i was feeling and asked for a full thyroid panel to be done including T4, T3 etc. She explained said she’d request these but the lab won’t always do them. It now appears that my actual GP has vetoed me having these tests. I can only assume because I had bloods taken relatively recently. The dates and results were as follows:

15/06/18 - serum iron level 23.9 micro/L (11-30)

serum ferritin - 27 micron/L (10-200)

Plasma TSH level 0.38 Mu/L (0.30-4.20)

20/03/18

Serum folate - 6.9 micron/L (3.0-20)

Serum vitamin B12 - 310 ng/L (180-900)

09.11.17 - at the time of diagnosis

TSH receptor antibody level - 0.9 U/L (< 0.4)

Thyroid Peroxidase antibody level 190iv/ml (<60)

I would really appreciate help in interpreting these results and any ideas of why I’m suddenly feeling so symptomatic again. Could my TSH levels have increased dramatically in 2 months? Should I push for the blood tests?

Thank you in advance

[shaws]

First of all I am really very sorry for you - to have developed hypothyroidism after the birth of your little girl. You wouldn't have been able to enjoy her as you'd been too unwell but members will come to your aid as well as many have been in the same predicament as you. I suspect you need an increase in dose and I'll give you some hints.

You have an Autoimmune Thyroid Disease, also called Hashimoto's or hashi's, due to having thyroid antibodies. These antibodies attack your thyroid gland and wax and wane until you are hypo but treatment is the same. i.e. levothyroxine.

If you can afford a Full thyroid panel we have several labs that do home pin-prick blood tests. If you decide to do so make sure you are well-hydrated a couple of days before. A Full Thyroid Function Test is:-

TSH, T4, T3, Free T4, Free T3 and thyroid antibodies.

All tests for thyroid hormones have to be at the earliest possible, fasting (you can drink water) and allow a gap of 24 hours between last dose of levo and the test and take afterwards. Levo should always be taken first thing with one full glass of water and wait about an hour before eating - food interferes with the uptake of thyroid hormones as does coffee.

Your TSH level isn't high at present but symptoms could be due to your vits/minerals and I will add in SeasideSusie who can advise on your vitamins/minerals. Everything has to be optimal.

[RedApple]

ctw0410,

If I'm reading correctly, your TSH was 0.38 Mu/L (0.30-4.20) on 15th June, which is almost at the bottom of the range. Without knowing the accompanying FT4 and FT3 levels, it's impossible to be sure, but there is a possibility that you are actually on too high a dose of levothyroxine. This could account for your symptoms, particularly the shakiness and wrinkly fingetips.

I'm guessing that you only have 100mcg tablets prescribed. In which case, perhaps buy a pill cutter (available in pharmacies and online), cut the pills in half and then try cutting one half again so that you can take one half and one quarter to make an approximate dose of 75mcg. If cutting into quarters proves to be too difficult, you could alternate with half a pill one day and a full pill the next day.

Either way, try this approximate 75mcg dose for a few days and see how you feel. If you start to see some improvement, go back to your GP and explain, asking for your prescription to be changed to the new dose. You should then be given a follow up blood test after 6 weeks on the new dose.

[helvella in reply to RedApple]

I endorse RedApple's response.

It is not unusual for post-natal hypothyroidism to spontaneously improve after some time. So the thought that you could now be taking too much is entirely sensible.

In my view, you simply must have tests including FT4 and FT3 - however that is achieved.

[Supul]

I'm sorry you are struggling. Just wanted to add, I had palpitations, wrinkly fingertips and felt shaky when I was over prescribed levothyroxine.

My tsh at that time was <0.01 (0.27-4.20). In fact, my levothyroxine then got reduced twice, with my subsequent re-testing.

If my fingertips go wrinkly nowadays, I drink more water. This does appear to help and suggests I was getting a little dehydrated too.

Wishing you well.

[Hidden]

I am way past the menopause, but a friend had the same as you (postpartum hypothyroidism I think is the term). she recovered and now has normal thyroid levels, though she was warned that when she is older the problem may recur.

So it does seem very likely you are over medicated and need to reduce the thyroxine.

Do it gradually though, because your thyroid will probably take a while to readjust. I'm not medically trained but think that's correct).

Hope very much you feel better soon x

[ctw0410]

Thank you so much for all your replies. It seems you're correct in suggesting i'm over medicated. I slightly over jumped the gun by suggesting the drs had vetoed my tests (bad experiences in the past) as results have appeared on line this morning. They are:

TSH level - 0.04 mU/L (0.30-4.20)

Plasma free T4 level - 16.7 pmol/L (9.0-19.0)

Plasma free T3 level - 4.1 pmol/L (2.6-5.7)

Serum ferritin - 21.6 microg/L

I haven't heard anything from Drs yet but assume they'll be suggesting a reduction in my dose. Just hope i'll start feeling better soon x

[jgelliss]

ctw0410 ,

Congratulations For your Bundle of Joy Little Girl. You are moving to the right direction by lowering your T4 dose . Go Slow and Low and keep testing every 6 weeks . You will need to make sure your nutrients are up where they need to be . Vitamin "D"/K2 , B-Complex . B-12/ Folate , Magnesium , Iron if you test low (ferritin) . Electrolytes are Very Valuable I would suggest a pinch of Celtic Sea Salt in water with a 1/2 lemon AM . It has over 80 minerals which are so Very Needed for us . Just keep your thyroid meds 2 hours apart from your Sea Salt .

Enjoy your little Girl ..