GP said my results were borderline

[FinneUK]

Hi

I went to my GP who said my results, which he did not share, were borderline. And that i should ask to be retested 3 months, then 6 months....then not bother any more. I'm not waiting 6 months as I now have another option, for a while at least.

My own recent medichecks tests which I already posted here were TSH 9.05 (0.27-4.2) and T3 and T4 normal but lowish - T4 lower in range than T3. So I am guessing my "status" hasn't changed much over 10 years or so when I had similar results of TSH about 7 and T4 low normal. Then, I started my own meds under advice from Dr P.

I'm going to restart these and if I can no longer pay I will have to go back - not to that GP - to try again. Has anyone any advice about guessing how long before a "borderline" thyroid issue like mine would resurface after stopping meds. This time it was about 3 months when I stopped because of costs. I had mostly symptoms of feeling cold - some low body temps - but fluctuating. I would go by these again probably but wonder how much the time of year is significant - e.g., would TSH rise over the winter and reduce in the summer (assuming reasonable temps!). i remember Dr P saying I might not need support in sunnier climes.

Kind regards

Finne

[shaws]

Go to the surgery and ask for a print-out of your most recent results. Make sure the ranges are stated (these figures are in brackets after the results). Put them on a new post.

Did you get your blood test at the earliest possible, fasting (you can drink water)? If you were taking thyriod hormones you'd allow a gap of 24 hours between dose and test.

Put your results, with the ranges, on a new post for comments.

Or you can make an appointment with your GP or drop a note into the surgery with a copy of medichecks' results. See what GP states. Tick off your symptoms (doctors seem to be unaware at all of any symptoms which, at one time, were the priority for diagnosing). They prefer sticking to their guidelines as they don't want to lose their livelihoods.

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

thyroiduk.org.uk/tuk/testin...

(I am not medically qualified ) but was fortunate to see two doctors who were brilliant and who had that bit of "humanity" and desire to make patients well again and and who disregarded the 'modern' method but symptoms, symptoms, symptoms was the priority. Unfortunately in these 'modern' times, all symptoms are disregarded, unknown to the professionals and which were replaced by blood tests alone and disregard to the symptoms patients were experiencing).

Professionals obviously don't want to lose their livelihoods so have to follow the guidelines they've been given. We've already had a few doctors who lost their licences for doing as they were trained when students. Most have retired long ago.

[FinneUK in reply to shaws]

Thanks.

Yes, I did have the tests as early as possible, fasting. I'm aware there are guidelines they have to follow. If there is a "next time" when I want to return, and it won't be 3 months, I will ask for results but at the moment one doctor is unlikely to go against another in the practice I would imagine - as you say - they have guidelines. I'm now going to go back to NT for a while and retest myself if i can afford it, but I wondered about a seasonal variation in demand for hormones - is that a thing as well as daily variations and other individual innate or environmental differences?

[MaisieGray in reply to FinneUK]

Guidelines are exactly that, and are not rules nor are they mandatory. In principle, a GP is free to prescribe any treatment if he believes the patient needs it and will benefit from it, even off label and even unlicensed. Nor can you necessarily assume that one GP in a practice will take the same professional stance as another. On the big, or costly, or NHS Contract issues, yes they might adopt a more corporate stance, but are less likely to be prescriptive about the routine things. So with regard to hypothyroidism, and the NICE Clinical Knowledge Summary guidelines for it, it states:

- Many people with Sub-Clinical Hypothyroidism do not need treatment, but if a decision is made to treat, prescribe levothyroxine (LT4) .............

- If TSH is between 4 and 10 mU/L and FT4 is within the normal range:

In people aged less than 65 years with symptoms suggestive of hypothyroidism, consider a trial of LT4 and assess response to treatment 3–4 months after TSH stabilises within the reference range.

So even if guidelines were rules, which they aren't, you might reasonably be able to argue that your case exactly matches this permissive approach to prescribing, and on that basis Levo may be initiated. He is of course, perfectly free to argue that in his professional opinion your symptoms aren't suggestive of hypothyroidism; but he cannot argue in any sense, that the guidelines prevent him initiating treatment.

reference: cks.nice.org.uk/hypothyroid...

[FinneUK in reply to MaisieGray]

Ok. Good to know if I go back at some point. Thanks. Kind regards

[FinneUK in reply to MaisieGray]

Do you know why age is mentioned?

[MaisieGray in reply to FinneUK]

As we age, there can be a number of age-related implications for treatment, not least re. cardiac issues. So in very very loose lay terms, it wouldn't be sensible to load a frail 90 yr old with a dicky heart, with a large dose of thyroid hormone from the get go, if at all. (There is a school of thought amongst some medics, that older people need lower ongoing doses, and treatment should start at higher levels, than for younger adults). Likewise, for children who are smaller, weigh less, and metabolise differently from adults, dose adjustments have to be made. Of course, we aren't suddenly different on our 65 th birthday, than we were the day before, but there has to be a rough parameter - although you'd hope a Dr would take account of all factors and not just age, when initiating treatment.

[Greekchick]

Dear FinneUK,

I can only share my experience with borderline results with you and hope it is helpful.

I was borderline hyperthyroid with a multinodular goiter for 22 years and received no treatment. I did not have major symptoms and so in agreement with my endo, did not take any medication. I developed Graves’ disease two years ago, was treated successfully with Tapazole until last October, when I became resistant to it and had a TT 4 weeks ago because my thyroid doubled in size over the period of a month. Believe it or not, my blood tests were normal up to the day of my surgery, despite very obvious and serious symptoms.

It is very hard to say how long one can stay borderline. I agree with shaws that you need copies of your results. I would also want copies of the results that your GP would not share with you so you can compare the progression in your blood work. I would try to see an endo if you can.

The real key is how you feel - do you have symptoms that keep you from functioning? Does being cold bother you? Blood tests are only one indicator of how you are doing. You and whichever doctor you choose must look at the entire clinical picture - and not just the tests in isolation of all other considerations. I can not address the question of moving to a warmer climate that you raise.

I wish you well and send positive thoughts your way for good health.

[FinneUK in reply to Greekchick]

Thanks very much.

[Crazy-horse]

Get the patient access medical app you can see all your blood results documents etc right back to when you were born

Ask GP for a ID number

[FinneUK]

I have access to online appointments etc. Is that what you mean? Though there are no test results or records that i can find.

[SeasideSusie Remembering in reply to FinneUK]

Not every surgery offers this, although I believe those in England should. If in Wales, no chance (I'm in Wales). Just ask at the reception desk for a print out, you are legally entitled to your results, and they can't charge you.

[bantam12 in reply to FinneUK]

Our surgery doesn't have online results or records either, just prescriptions and appointments.

[SlowDragon Administrator]

Essential to regularly retest vitamin D, folate, b12 and ferritin if you are heading towards hypothyroidism

Plus BOTH TPO and TG thyroid antibodies too

Low thyroid hormones tends to affect gut function and vitamin levels drop

Ask GP to test these, or test privately

[janveron1]

Ask for full results!! janveron1