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Gp not referring

marianna1978 profile image
21 Replies

Hello everybody,

I discovered I have a thyroid nodule having a scan done by chance abroad, i have hypothyroidism since 2015, but when I asked my GP to refer me to an endocrinologist, he said it’s not necessary. I showed my surprise, since nobody told me the nature of that nodule, but he insisted it wasn’t necessary. Should I trust him?

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marianna1978 profile image
marianna1978
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21 Replies
greygoose profile image
greygoose

No. Did he even feel your neck? Perhaps he should order his own scan if he doesn't trust these foreign ones. Without it he can hardly know if it's necessary or not.

Most people have some nodules, but it's when there's just one of them that it should be taken more seriously.

marianna1978 profile image
marianna1978 in reply togreygoose

Thanks a lot, I am going for a second chat with another GP at the same practice, and see what he thinks, but I will do my best to get the referral. It’s really frustrating to not be heard especially with something scary like nodules..

greygoose profile image
greygoose in reply tomarianna1978

Nodules are that scary. By far the majority of them are completely harmless. It's just best to check when there's only one. Where you told what size it was?

I thought GPs could order ultrasounds themselves. I didn't think you needed a referral to an endo. Try asking for that.

marianna1978 profile image
marianna1978 in reply togreygoose

I showed him the scan from abroad and based on what he saw said it was fine..

greygoose profile image
greygoose in reply tomarianna1978

Yes, but you don't know how good he is at interpreting scans, do you. Doctors are supposed to know how to interpret blood test results, but look at the mess they make of that! Didn't you get any sort of letter from wherever the scan was done, giving details?

marianna1978 profile image
marianna1978 in reply togreygoose

Yes, it was in Italian, which I obviously translated for him, where the doctor who took the scan for me, suggested further investigation and to see a specialist.

marianna1978 profile image
marianna1978 in reply togreygoose

And then he also seemed to be annoyed by this scan done abroad, saying that when people do test abroad they usually come back with paranoia

greygoose profile image
greygoose in reply tomarianna1978

Typical GP remark! With no substance in fact. In any case, paranoia is a hypo symptom! lol Well, I don't know what to suggest. Except what you're already doing, which is seeing a different GP. Sorry I can't be of more help. :)

marianna1978 profile image
marianna1978 in reply togreygoose

Thanks for the advises!

greygoose profile image
greygoose in reply tomarianna1978

You're welcome. :)

SlowDragon profile image
SlowDragonAdministrator

If you have Hashimoto's (autoimmune thyroid disease) you will have lots of nodules

How much Levothyroxine are you currently taking?

Do you have recent Thyroid and vitamin results

marianna1978 profile image
marianna1978 in reply toSlowDragon

I don’t know if I have Hashimoto because I have only been checked tsh and FT3/4 , I’m on 25mg of levothyroxine...

SlowDragon profile image
SlowDragonAdministrator in reply tomarianna1978

How do you feel?

How long on 25mcg Levothyroxine?

Standard starter dose of Levothyroxine is (unless over 60, frail or heart condition)

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH significantly under one) and most important is that FT4 in top third of range and FT3 at least half way in range

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

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

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised (Hashimoto's)

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

Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).

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 primary 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_...

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

Bloods should be retested 6-8 weeks after each dose change (or brand change) of Levothyroxine

marianna1978 profile image
marianna1978 in reply toSlowDragon

Thanks for the infos. Should I ask the GP to get these checked?

SlowDragon profile image
SlowDragonAdministrator in reply tomarianna1978

When did you start taking 25mcg Levothyroxine?

Bloods should be retested 6-8 weeks after starting Levothyroxine

marianna1978 profile image
marianna1978 in reply toSlowDragon

Long time ago, 5 years ago

SlowDragon profile image
SlowDragonAdministrator in reply tomarianna1978

How do you feel?

List of hypothyroid symptoms

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

When were thyroid levels last tested?

do you have any actual blood test results? if not will need to get hold of copies.

You are legally entitled to printed copies of your blood test results and ranges.

UK GP practices are supposed to offer online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also 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 before eating or drinking anything other than water . This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).

marianna1978 profile image
marianna1978 in reply toSlowDragon

I feel ok, but I usually have muscle pain, I loose hair and i am sleepy..

SlowDragon profile image
SlowDragonAdministrator in reply tomarianna1978

So you need full Thyroid and vitamin testing

Being hypothyroid can cause vitamin deficiencies and high cholesterol and affect heart

Important to be correctly treated

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

marianna1978 profile image
marianna1978 in reply toSlowDragon

Thanks I will discuss all of this with the GP hopping that this one will be more emphatic..

SlowDragon profile image
SlowDragonAdministrator in reply tomarianna1978

Suggest you get copies of your last thyroid test results

You are legally entitled to printed copies of your blood test results and ranges.

UK GP practices are supposed to offer online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

Come back with new post once you get results and ranges

If these were done some months ago, and depending on what results were like, then you would be able request getting new thyroid tests done and vitamin testing too, if not been done

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