Endocrinologist sending another test to a different blood lab

[FluffyHoody]

Hello everyone,

I am new here but going to dive straight in.

Have been suffering years of not having high (or even medium) energy levels.

In August (after many previous thyroid tests), I had an abnormal thyroid result:

TSH 2.31mu/L range 0.27-4.20

Free T4 9.8 pmol/L 12.00-22.00

Free T3 3.8 pmol/L 3.10-6.80

Redone in November (same ranges):

TSH 1.75 m/ul

Free T4 8.4 pmol/L

Free T3 3.6 pmol/L

So GP referred me to endocrinology (which as these were signifying central hypothyroidism, should have (under NICE guidelines) been done as an urgent referral, but was not...

So I have been trying to get seen earlier and in the course of doing so, the head consultant orders my bloods to be done again, which come back as:

TSH 5.9 mu/L

Free T4-13.8

(don't have the free t3)

There is a lot of background to this and I presented the consultant with all the information that I had gathered in the intervening period, to demonstrate that previous diagnoses I have been given, could all be explained by an under-active thyroid. But he doesn't want to know. I have to do further blood tests in three-four weeks time and then those samples will be sent to Addenbrookes Lab, as well as the hospital one.

Has anyone else had this happen to them? I would really like to know what the outcome of the tests being looked at by a different lab (with better equipment, apparently) has been and also does anyone know the ranges of the lab at Addenbrookes?

And just also, is he justified in doing this? I get the different results point in different directions but just taking another blood test at this point in time seems like a hoop I need to jump through to get treatment for fatigue which at this point in time is seriously impacting on my life.

I probably won't be back tonight as my energy levels are diving as I type but thank you to anyone for getting back to me.

[RockyPath]

I cannot comment on the legality of their trying to dodge treating you, though it's certainly immoral and unethical. Probably there's some financial incentive in shuffling off new patients who would be regarded as a drain on the system because they need lifelong treatment. Sorry for the cynical rant, but this is terrible, the maneuvers they go through.

Are you taking the blood tests at 5 AM (or as soon as the lab opens)? Due to circadian rhythms of TSH and other thyroid hormone production, the values will be different at different times of the day. They will be the most compelling first thing in the morning. Ideally, in order to see a doctor for treatment, you would want to visit the lab between midnight and 2 am, but that's not possible, so you just need to get there as soon as they open.

Presumably you've noticed your fatigue follows a circadian rhythm as well. It's a well studied phenomenon.

This would be the most common explanation for the disparity in your results.

[MaisieGray in reply to RockyPath]

RockyPath There is no financial incentive such as you suggest. In England, the general rule is that when a patient that is registered with an NHS GP, is referred for secondary care out patients treatment, even when the provider is a private facility, responsibility for payment of that treatment remains with the CCG in which the referring GP practise operates. The rules on payment for emergency care are similar, in that for A&E attendances and emergency admissions, the CCG that would ordinarily be the responsible commissioner for a patient under the above rule, is responsible for paying the provider for the costs of that patient’s care.

[FluffyHoody in reply to MaisieGray]

Yes but once you have a thyroid diagnosis, that is free prescriptions for life, so that could be an incentive against diagnosing people (dons tin foil hat)...

[helvella in reply to FluffyHoody]

I don't think we have ever seen any evidence that diagnosis is deferred/delayed in England compared against diagnosis in Wales, Scotland and Northern Ireland. Which is what you would expect if the "free" prescriptions issue were an important issue.

Of course, it is possible that there are many factors involved and that the "free" issue is counterbalanced by other factors. But it would take proper analysis to arrive at that conclusion.

Also remember that a lot of people who might be in line for diagnosis are already exempt in England.

[helvella in reply to RockyPath]

I am not entirely convinced that rhythms are the most common explanation for such disparity. Yes, I certainly agree they can have sufficient impact to sway a result up or down and affect treatment.

There are many possible causes of interference with test results and, in the case of standard thyroid tests, these include antibodies to TSH, to T4, to T3 and a range of other antibodies.

Some labs use procedures which are sensitive to some or all these antibodies where other labs are relatively immune. (And it might vary so that each test is differently sensitive.) That is one good reason for samples to be tested at another lab. Ideally, the same blood draw produces samples that are analysed at two or more labs.

[FluffyHoody in reply to RockyPath]

Thanks yes I am aware that time of day and even season can influence the results. And from now on will be doing my tests (as I did on the last occasion), first thing in the morning and fasting. On the NHS, at least under my CCG, if a GP orders the test, you have to get the blood taken at the surgery and most of the time the appointments with the nurse for blood draws are between mid-morning and mid-afternoon. If a consultant orders the tests, then you can have them done at the hospital, where the clinic is drop in and open from 8am. So maybe that goes some way to explaining the discrepancy. Anyway you look at it, my thyroid is definitely having issues and if they treated the symptoms, rather than the tests, I would be in a much better position right now.

[SlowDragon Administrator]

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Is this how you do your tests?

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

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 special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

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 very common too, especially gluten. So it's important to get TPO and TG thyroid antibodies tested at least once .

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Link about antibodies and Hashimoto's

thyroiduk.org.uk/tuk/about_...

thyroiduk.org.uk/tuk/about_...

List of hypothyroid symptoms

thyroiduk.org.uk/tuk/about_...

Extremely common for inadequate testing via GP or Endocrinologist

Email Dionne at Thyroid Uk for list of recommended thyroid specialists

please email Dionne at

[e-mail]

[posthinking01]

Don't worry about tests being sent to Addenbrookes etc. - that is good - he will probably ask for more in depth issues going on - I had tests sent to them at the beginning of my illness and some went off to Austrialia and it came back that I had low growth hormone - IGF1 - but that is another story...............

[FluffyHoody]

Had another set of bloods done and they came back as:

TSH; 3.53 (Range: 0.27-4.20)

Free T3: 5.5 (Range: 3.10-6.80)

Free T4: 13.3 (Range: 12.00-22.00)

So now the endocrinologist is likely going to turn around and say that as I am back in range, everything is all fine and there is nothing to be done.

But I in no way at all, feel fine. I feel dreadful, really exhausted and way older than my actual age...