Thyroid UK
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Medical Exemption certificate confusion and advice for new diagnosis

Hi there,

I need some advice as my Doctor's surgery applied for a medical exemption certificate for me but it's come back requiring more information. The GP didn't complete part one of the form and they didn't stamp it. According to the medical exemption list criteria, what should hypothyroidism be 'ticked' as?

Have been on 50mcg levothyroxine for 2 weeks after 12 weeks of 25mcg levothyroxine and still feeling awful.

Completely new to this and was an energetic, physically and mentally fit 26 year old, and have been chronically exhausted and other symptoms for months now with no improvement. Just want to feel like me again and be capable of returning back to normal activities and not having to sleep for hours on end in the evenings.

Serum free TSH is 10 miu/L (0.25-5.00) and serum free T4 level is 16.3 pmol/L (9.0-23.0) on latest bloods. I literally have no idea what any of this means as the doctor hasn't spent more than 90 seconds explaining it to me. I've learnt more from this forum than from my GP.

Any help and advice is appreciated.

15 Replies
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DisneyLoverJ

The GP didn't complete part one of the form and they didn't stamp it. According to the medical exemption list criteria, what should hypothyroidism be 'ticked' as?

Crikey, you'd think they'd have done a few of these before!

nhsbsa.nhs.uk/exemption-cer...

Under Medical Conditions it's down as

•myxoedema (that is, hypothyroidism which needs thyroid hormone replacement)

**

Have been on 50mcg levothyroxine for 2 weeks after 12 weeks of 25mcg levothyroxine and still feeling awful.

You should have been retested and given an increase 6 weeks after starting Levo, make sure that future tests are done every 6 weeks until you reach the dose you need.

You wont feel the benefit of the increase yet, it takes 6 weeks to feel the benefit of a dose increase. It can take months before you start to feel real improvement. Things work slowly in hypothyroid world!

Serum free TSH is 10 miu/L (0.25-5.00) and serum free T4 level is 16.3 pmol/L (9.0-23.0) on latest bloods

The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo if that is where you feel well.

Take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, for an hour either side as absorption will be affected. Take any other medication and supplements 2 hours away from Levo, some need 4 hours.

When booking thyroid tests, always book the very first appointment of the morning and fast overnight (water allowed) . This gives the highest possible TSH which is needed when looking for a diagnosis, an increase in dose or to avoid a reduction. TSH is highest early morning and lowers throughout the day. It can also lower after eating and coffee also affects TSH. Also, take your Levo after the blood draw because if you take it before then your FT4 will reflect this and show higher than what is normally circulating. We usually advise 24 hours between last dose of Levo and blood draw so if you take your Levo in the morning then delay until after the test, or if you take it at night then delay that dose until after the test. These are patient to patient tips which we don't discuss with doctors or phlebotomists.

You may find looking around ThyroidUK's main website informative

thyroiduk.org/tuk/about_the...

Work down the purple menu on the left hand side.

5 likes
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Thank you so much, I really appreciate the advice.

It's incredulous that nothing has been explained and I come out of the one appointment I have feeling more confused and upset. My thyroid results have been inconclusive for years and it's only because a nurse pushed for them to be looked at further in April that we even got to this point. Finding it hard to adjust in every way.

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Pity you can't be looked after by the nurse! It always seems a long way to regaining the real you but that's how it is but keep posting your results and ranges-ranges important as they differ from lab to lab and we shall help you to understand your readings and advise you on what to say to your GP if he is floundering.

As thyroid patients we also are likely to have other problems as well. Stomach acid tends to be low and we are often low on vitamins etc. The four things you should ask your doctor to test are Vit D, B12, folate and ferritin and it's not unusual to be low in some if not all. They need to be optimal, not justcin range. Many of us supplement to ensure wellness but these help the Thyroid to work better, help with conversion issues should you find that's a problem and good for general health. They can also help with other symptoms we may have.

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You poor sausage

Firstly 25mg is so tiny that nobody would feel better. You doctor has been very cautious. This is not a bad thing but leaving you for 12 weeks was terrible. 50 won't help either so book yourself an appointment in 5 weeks and insist they up your dose every 6 weeks. As the average dose is 125-150 it will take you

5 years to feel better if he gives you an extra 25mg every 12 weeks.

Tell your GP this

Secondly the medical exemption form is a simple form. If your surgery can't do it then you really have to question how competent they are.

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As I'm over 60 I don't have to bother with that any more but when I did I'm sure I had to get the form and fill in and get the GP to sign it< and then I had to send it off and the certificate came to me.

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Hasn’t the threshold increased to 65 now? With the pension age increase?

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Still 60 in England:

nhsbsa.nhs.uk/exemption-cer...

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Good to know something has stayed the same. I think the age for a bus pass has gone up

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Amazing. As they increased my pension age by six years then ask me for five more years national insurance contributions though I have a full contribution record, oh and pay for my own thyroid replacement as well, I can’t believe they’ve done something to make my life a little easier!

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Not quite as "easy" as for those who don't live in England!

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Sorry, I don’t understand?

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There are no prescription charges in Wales, Scotland and Northern Ireland. Hence no need to do anything (such as age sufficiently, get pregnant, or acquire another qualifying disease), not even request an exemption certificate. :-)

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Oh, thank you, I didn’t realise. Nothing United about UK these days :) Miffed that London residents get free transport over 60 too, but as an over 60 visitor to London I can’t. Though London residents may feel differently ...

1 like
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Hi

I can see others have helped with the form but I would add it’s up to you to renew the exemption certificate when it runs out. All you do is ask the surgery for another form....hopefully by that time they will have learnt how to fill it in. The certificate lasts s few years so it’s easy to forget.

As for retesting, if I didn’t ring and ask for bloods they wouldn’t be done -maybe your surgery is the same? Don’t be afraid to ask for testing - the practice get paid to look after you and should be doing routine tests.

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Hi DisneyLoverj,

I completely agree with SeasideSusie!

Your dose is very low and your T4 is on the lower range, so as others have said, your blood needs to be retested every six weeks until on correct dose.

Yes the Dr should have filled the exemption certificate out correctly and ticked the correct box as already mentioned.

Another thing to remember, if for any reason in future you are prescribed other meds, such as iron, (not saying you will) never take it within four hours of your thyroid meds, it disrupts the absorption of the thyroid meds, same with any medication really.

Hope everything is sorted soon.

Never ask the receptionist for the results either as she is only reading from a script and is not medically trained. Always ask to speak to a dr, you have a right to do so.

Take care :)

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