Endo

[mummytosix]

Quick question. Does everyone with hypothyroid get referred to an endocrinologist? I only ask because everyone that I’ve spoken to sees theirs on a regular basis but my doctor hasn’t mentioned anything about referring me. Thanks 🙂

[SeasideSusie Remembering]

mummytosix

Simple answer - No.

I was diagnosed hypothyroid in 1975 after 2 years of being fobbed off by my then GP.

I saw an endo in 2002 simply because I was on a high dose of Levo with suppressed TSH, over range FT4, symptomatic and my GP didn't know what to do.

If your GP is managing your hypothyroidism, and you are stable there would be no need to see an endo. Many endos end up making things worse anyway (mine did) so it's not always a good thing!

[JumpJiving]

I saw an endo initially, but only because my GP at the time knew so little about thyroid problems that I had to suggest my symptoms were caused by my thyroid. The endo did blood tests and confirmed a thyroid problem, but I've not been back to him again in the approx 10 years since for anything thyroid related.

If your local endo is anything like mine, you are not missing anything - the endo is unlikely to do any blood tests that your GP wouldn't do, and is unlikely to prescribe anything that your GP wouldn't. Or put another way, if you want a full suite of thyroid-related blood tests, you're likely to need to pay for them privately, and if you want NDT or T3 instead of just T4, you're also likely to need to pay for them privately. Whether you see a GP or a NHS endo, that's likely to be the case.

[MaisieGray]

No, definitely not. There is no automatic need, and in any case, it is not always advantageous to see one. However, the CKS/NICE guidelines for referral in the case of overt, non-pregnant hypothyroidism are:

Refer or discuss with an endocrinologist (the urgency depending on clinical judgement) people who:

-Are suspected to have subacute thyroiditis (de Quervain's thyroiditis).

-Have a goitre, nodule, or structural change in the thyroid gland – if malignancy is suspected, refer using a suspected cancer pathway (for an appointment within 2 weeks). For more information, see the CKS topic on Neck lump.

-Are suspected of having associated endocrine disease.

-Do not start thyroid hormone replacement before specialist glucocorticoid replacement in suspected adrenal failure — this can precipitate an adrenal crisis.

-Have adverse effects from levothyroxine (LT4) treatment.

-Consider undiagnosed Addison’s disease if the person feels worse after starting treatment. For more information, see the CKS topic on Addison's disease.

-Are female and planning a pregnancy.

-Have pre-existing cardiac disease.

-Have atypical or misleading thyroid function tests.

-Are suspected of having an uncommon cause of hypothyroidism, such as due to medications (for example amiodarone).

-Have a persistently raised thyroid-stimulating hormone (TSH) despite adequate treatment, where reversible causes (such as poor adherence, drug interactions, or malabsorption) have been excluded.

-Have persistent symptoms despite treatment, following consideration of alternative causes of symptoms.

[SlowDragon Administrator]

Looking at your first post, you have only very recently started on Levothyroxine

Getting dose slowly increased and vitamins optimal is first step

Push GP to test vitamins and thyroid antibodies at next test

Come back with new post once you get results and ranges

[mummytosix in reply to SlowDragon]

Thankyou. I won’t be tested again now until July but I just feel totally and utterly awful. Cold and hot, shaky, weak legs, brain fog, sick. Since I started on the Levo I’ve gone from feeling poorly but still being active to feeling worse and struggling with any activities at all. And my mind is totally low, each day just feels like a chore to get through 😫

[SlowDragon Administrator in reply to mummytosix]

So see GP this week to get vitamins and antibodies tested

Or order private testing

Which brand of Levothyroxine are you currently taking?

[mummytosix in reply to SlowDragon]

I’m on 50mg of North Star levothyroxine.

[SlowDragon Administrator in reply to mummytosix]

Activis, Alumus and Northstar are all exactly same Levothyroxine

thyroiduk.org.uk/tuk/treatm...

When dose gets increased to 75mcg. You will have to cut a 50mcg in half as they don't make 25mcg tablets

Teva brand is only one to make 75mcg - Teva upsets many people, (unless lactose intolerant) so is best avoided.