Advice on new readings

[Fifteen]

I have an appointment with my GP on Tuesday and would like some advice on how to handle it.

e.g Should I increase my Thyroxin to 150 mcgs?

My latest results on 22/10:

Serum Free T3 3.8 pmol/L [2.5 - 5.7]

Serum Free T4 15.7 pmol/L [9.0 - 23.0]

TSH <0.01mU/L [0.3 - 4.2]

In July, he increased my Thyroxin from 100mcg to 125mcg at my request

I take 1/2 to 1 Thybon 20 Henning (previously 1 a day)

On 4/07 my results were:

Serum Free T3 3.2 pmol/L [2.5 - 5.7]

Serum Free T4 11.8 pmol/L [9.0 - 23.0]

TSH 0.01 mU/L [0.3 - 4.2] NOTE: He panicked at this result. Now it is lower....

Ferratin 125ug/L [20.0 - 300.0]

Serum 25-hydroxy Vit D 133.7 nmol/L [70.0 - 150.0]

Folate 9.8 ug/L [>2.7]

B12 519 ng/L [160.0 - 800.0]

Advice on how to handle his reaction to the lower TSH and any suggested adjustments in medication will be welcome.

Thanks

[SeasideSusie Remembering]

Fifteen

Advice on how to handle his reaction to the lower TSH

TSH <0.01mU/L [0.3 - 4.2]

Serum Free T4 15.7 pmol/L [9.0 - 23.0]

Serum Free T3 3.8 pmol/L [2.5 - 5.7]

As you are prescribed T3 then your doctor needs to understand how to interpret test results when someone takes T3.

T3 tends to lower, even suppress TSH, it often lowers FT4 and when taking T3 most people feel best when FT3 is in the upper part of it's range.

So your TSH is what is to be expected.

Where we need FT4 when on combination hormone replacement is very individual. Yours is 48% through range, that may be fine for you, only you can say. I need mine much higher (I'm on combination replacement too).

Your FT3 is 41% through range which seems to be rather low for someone taking T3.

I take 1/2 to 1 Thybon 20 Henning (previously 1 a day)

Why have you changed your dose? You should be taking the same amount each day, it has a half life of 24 hours so we need a steady supply, the same amount every day.

The most important question is "How do you feel"?

[Fifteen in reply to SeasideSusie]

Thanks for your reply.

I still feel tired and need a sleep most afternoons.

[SeasideSusie Remembering in reply to Fifteen]

I'm not surprised with that level of FT3. It's low T3 hormone level that causes symptoms.

Why did you change your dose of T3?

[Fifteen in reply to SeasideSusie]

To give you the background:

My GP has written the prescription for Bennewitz because I asked for it. (My private Endocrinologist told me about this option when he was still saying that some people need T3).

My GP sees himself as 'liberal'.

I recently saw another GP (new, young, Oxford educated) in the practice as I needed a new prescription. He was refusing to write one as he believes that no one needs T3. He only follows TSH. (AndctThis GP says he listens to his patients).

I explained that my mood was low. His reaction? 'Oh! I can fix that' and he reached over to write a script for an anti-depressant. I told him I did not want that...... you can imagine the rest. A real concern as he has his career ahead of him.

It seems that he spoke to my GP (the senior partner). Do not know what was said but my GP was nervous last time I saw him. So negotiated - I would take 1/2 Thybon 20 if he increased my Thyroxin to 125mcgs.

Now I wonder if I need to increase the Thyroxin more plus go back on 1 tab of Thybon 20 Henning.

All he will be thinking about is the TSH. He has no idea about Hypothyroidism - last time I saw him he recited something he had memorised (or so it sounded) but without understanding.

He is panicking about the TSH. And scared. The fact that my bone density is fine and my Cardiologist has recommended that I be given T3 for quality of life cannot reassure him.

(If there was a decent GP in the area, I would change. I had hoped the new GP would be good, but no. I am told all the good GPs locally now practise as Private GPs - this is an area with a large o/s population).

So I need to be well prepared for my appointment.

[SeasideSusie Remembering in reply to Fifteen]

I think you should increase your T3 at this point. You need to get your FT3 up to a better level. If I were you I would get back to 1 tablet a day, wait 6 weeks, retest to check your levels and see how you feel. Reassess at that point.

[Fifteen in reply to SeasideSusie]

Thank you, SeasideSusie. Your advice is much appreciated

[Fifteen in reply to SeasideSusie]

Comments and advice from my GP this afternoon:

He said: Many people may say they fee better with thyroid medication but the TSH is the main matter!

In other words - do not trust how people feel.

I said I know my body and, after years of suffering with undiagnosed hypothyroidism, I was not willing to go back to that state.

I told him that the GP in the next office had been quick to offer anti-depressants when I told him about my low mood with undertreated hypothyroidism. This seemed not to be a great concern as he said that does does work! I assume he means it makes people feel better........but that does not fit with his earlier remarks.

He brought up the usual possible side-effects of T3 - I pointed out that my bone density is fine and my cardiologist had recommended I stay on T3 stressing that he did not see any potential problems. My GP accepted the first - but not the recommendation of one of the top Cardiologists.

He said my T3 and T4 readings were good - and insisted that mid-range is fine even though I still need a rest in the afternoon. He then recommended that I lower my thyroxine - I refused.

He was not strong enough to say to stop my T3 medication - instead I got a whole story about how its impact only lasted half an hour and, because of this, it caused damage to the TSH (he used the analogy of a fire, but I won't go into that). And much more..... I doubt he will write me another script for our German supplier.

Somewhere in this he mentioned thyroid cancer - I think he was saying that the TSH was linked to it, but I decided not to pursue that.

He printed out my readings over time and said he would not be happy until all were stable (they have not been since 2010, so why now?) He wanted a retest in 4 weeks but has now accepted 8 weeks.

What a disaster.

[Fifteen in reply to SeasideSusie]

P.S. I should emphasise that my discussions with my GP (see following post) are always in a conversational tone. I do not believe in confrontation - it is unnecessary, non-productive and unprofessional.

[Wetsuiter in reply to Fifteen]

whats a large os population?

[Fifteen in reply to Wetsuiter]

Hi, a large population of people from overseas (o/s), in this case who live here only part of the year.

In this area, these people use private medical services only and pay well for them. Good GPs can earn much higher incomes as Private doctors than they could ever even dream of as NHS doctors.

Hope that explains.