Bad appointment with gp

[birkie]

Hi lovely people

Well just had an awful appointment with my gp I told him I was concerned about my last blood work on my thiyroid I was hyper diagnosed with graves Jan this year had thiyroid removed in May this year ...below are my results

TSH.. 3.53..range..0.30-4.50

T3..2.3..range..3.10-6.80

T4..10.9..range..11.00-22.00

He said my T3,, T4..are really not that bad and my TSH was in range.. As I told him I'm not well I'm sure he put me down to 25mg levo but he is has denied this🤔 I told him I upped the dose to 50mg as I felt awful.. He insists I've been on 50mg and that's why my tests are like this. I challenged him on the TSH result being to high for me and the T3 T4 were to low he then became angry and went on to say for you to be hypo your TSH would be low and your T3 would be high.. Humm I said no that's hyper.. That's what I had my TSH was suppressed and my T3 was 24.2 after shaming him he realised he'd make that mistake and became more angry saying this takes time you can't yoyo your meds like you are!!! Erumm I'm not yoyoing my meds😠 I asked why they concentrate on TSH alone when the T3 is the active hormone he rambled on about it being the best way of seeing how your body is coping anyway he never really listened to me and became irritated he is trying me on another levo as I told him I'm having very loose bowls bad bowel pain and acid reflux bad headaches and server muscle pain I also have colitis so that's my appointment with my awful gp no further ahead he said I'll see you some time in Jan for you next bloods Thanks For nothing.. 😔😔😔😔

[fuchsia-pink]

I'm not competent to analyse your results, but if you are part of a group GP practice, can you see a different GP another time? I am (belatedly) waking up to the idea that you don't have to keep on seeing someone who doesn't suit you, just because they are the doctor and you are a mere patient.

[birkie in reply to fuchsia-pink]

Hi thanks for your reply fuchsia-pink

To be honest I have seen another gp but she was no better... 😭😭😭😭

[Wetsuiter in reply to birkie]

keep trying

[SeasideSusie Remembering]

It's very obvious that you are very undermedicated.

It's also very obvious that your GP hasn't got a clue if he doesn't know that below range FT4/FT3 and high TSH indicate hypothyroidism.

See a different doctor.

[birkie in reply to SeasideSusie]

Thanks for the reply

I'm going to try to see the doctor who diagnosed me in September 2018 but she is only a locum at our practice and not their alot... But will be trying my best because she recognised my symptoms immediately without a blood test where my gp I saw today didn't and their was only 3wks between me seeing him then seeing her how did my gp who I saw today miss my symptoms... Ho yeah... Because he has no idea about thiyroid illness and symptoms 😠

[SlowDragon Administrator]

GP you saw today should not be practicing

Three options...see a different GP

Or get referral back to endocrinologist (though they also sounded hopeless....TSH often remains suppressed after Graves' disease....most important results are FT3 and FT4

Or if can't get any sense out of anyone......get some extra Levothyroxine and increase dose yourself

Your results show you are extremely under medicated

You need 25mcg dose increase in Levothyroxine and vitamin D tested

Bloods should be retested 6-8 weeks later

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...

Aiming for full replacement dose .....as detailed here.....

New NICE guidelines

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

[birkie in reply to SlowDragon]

Hi slowdragon

You said that many people find their TSH to be 2 or under to feel well.. I mentioned this seeing as mine is 3.53 and told him would I not feel better with a level of 2 or under? Well here's his answer.. "we do not want your TSH at that level because that would make you hyper and we don't want that because it's dangerous to the heart" I said OK but isn't hypo as dangerous, as you gain weight and that's also bad for the heart and the body... By now he is really peed off with me.. He said in a very stern voice.. " this takes time sometimes years to get the right amount of medication to feel well.. Ho dear well I then said" do you not think that's because you only concentrate on the TSH keeping us unwell T3 is the active hormone it deals with every cell in the body.. I'm having bad side affects with the higher dose of levo I have colitis and find taking the higher dose it flairs the colitis up.. He knows this as I've informed him he is now trying me on another brand of levo.. He does not want me to take a higher dose that 50mg..so I'm on this till Jan next year eventho I was on the loo 5 times last night with bad bowle pain bad headaches bad body pain... Lovely looking forward to my Xmas hols.. Not!!!!! 😭😭😭😭

[jimh111 in reply to birkie]

Maybe get a gastroenterologist referral for the colitis, they can prescribe locally acting steriods but they are expensive so you need to let them know the impact on you.

[birkie in reply to jimh111]

Hi

I take buscopan and omeprazole for it my gp ia putting me on another brand of levo to see how I cope on that... 🙄🙄

[jimh111]

Your GP is wrong. There are at least two reasons your TSH is not reflecting your hypothyroid state (low fT3, low fT4 is definitely hypothyroid).

1. After hyperthyroidism the hypothalamic pituitary thyroid axis can become down-regulated, the TSH fails to respond adequately to low thyroid hormones. Sometimes it recovers, sometimes it doesn't.

2. The pituitary has TSH receptors, it's thought they help the pituitary regulate TSH secretion. To clarify, the pituitary is able to respond to the TSH it is secreting. Graves' occurs when antibodies stimulate TSH receptors, they stimulate the receptors in the thyroid causing excess hormone secretion. The muscles in the eyes have TSH receptors that lie dormant. In Graves' ophthalmopathy the antibodies stimulate the TSH receptors in the eyes causing them to bulge. These antibodies can also stimulate the TSH receptors in the pituitary, fooling it into thinking there is plenty of hormone in the blood and hence supressing TSH secretion. 'We conclude that TSH receptor autoantibodies can directly suppress TSH levels independently of circulating thyroid hormone levels'. This is described in this study academic.oup.com/jcem/artic... .

In your case you cannot use TSH as a marker for thyroid status. Would it be possible for you to contact the endocrinologist who managed your Graves' and tell them you are doing very badly and would appreciate their help? You could then ask them to give your GP some 'guidance' on your care. Whatever you do make sure you can get to a doctor who is capable of giving you the correct care.

[birkie in reply to jimh111]

Hi thanks for your reply❤️

He kept saying my thiyroid for the TSH result I said but I have no thiyroid so rely on medication alone.. His face told it all... He was peed off with me prob because I was asking to many questions I'm at this moment trying to get in touch with my endos secretary as I was told a few months ago my surgeon referred me to him but no one is answering the phone.. Great!!! I'm sure if I was referred I would have received a letter by now.. I'll keep trying... 👍👍

[jimh111 in reply to birkie]

Keep trying. If you absolutely can't get through within a few days contact your surgeon again to see if they forgot or can help you make prompt contact with the endo.

[birkie in reply to jimh111]

Hi

I definitely will❤️❤️ it's so hard trying to talk to my gp he has a very short fuse and definitely does not like it when you question him.. But are we not allowed to ask questions about our health it's so frustrating 😭😭😭😭

[jimh111 in reply to birkie]

This behaviour is a sign of poor expertise. Take someone with you next time, preferably someone big with an air of authority.

[birkie in reply to jimh111]

Wish I could I live alone and my son lives away maby I should hire a bouncer... 🤣🤣🤣🤣

[SlowDragon Administrator in reply to birkie]

Which brand of Levothyroxine are you currently taking?

Have you had vitamin D, folate, B12 and ferritin tested?

Suggest you email your results and short summary of your symptoms to your endocrinologist underlining how unwell you are

I wonder if your gut symptoms are due to being very under medicated ....usually being hypothyroid causes constipation....but as we all know you can get very different symptoms

Most people gain weight, when hypo.....but some really struggle to maintain weight

Or it could be the brand of Levothyroxine.....Teva brand upsets many people

[birkie in reply to SlowDragon]

Hi thank you for the reply❤️

I have colitis when I started on levo this may my surgeon started me on 125gm and both he and my gp have decreased it by 25mg until now.. I'm on 50mg but swear my gp put me down to 25mg then said he was going to stop it for six weeks and I'm sure I posted that on her because I got comments saying don't let him do that.. He is denying he did that!!, I find if I go up I start having flare ups in the bowel and bad stomach pain acid reflux headache bad muscle pain.. As I'm typing this I'm in really bad pain in my knees.. I could not stomach the anti thiyroid meds did same thing I'm also starting to feel sick it's like morning sickness😔 I e- mailed his secretary yesterday relating my concerns I'm waiting for an appointment so also asked what's going on with that... Its the flip in Xmas hols so I'm not holding out much hope to see him this year.. 😠😠😠😠

[birkie in reply to jimh111]

Hi jimh111

My surgeon and gp both agree I don't have graves opthalmology.. I did have very high antibodies and was diagnosed with graves... But after being on levo 125mg starter dose then put down in 25gm incrimins to 50mg but I'm sure it was 25mg gp denied this.. the reduction dose was because my TSH was suppressed but in the last 3 months or more when I wake up I have very bad puffy eyes I've never had this before it looks like I have a bad reaction they go down a little bit but in the morning I look like a bee has stung me in my eyes.. And sometimes I have double vision my eye sight has definitely diminished since my diagnosis 😭😭😭

[jimh111 in reply to birkie]

Your TSH is not suppressed by thyroid hormones. It could be suppressed by antibodies or simply not responding. Your low TSH does not reflect low hormone status. They must ignore TSH it is not a marker for hormone status in your case.

[willsie01]

Oh dear!

[Wetsuiter]

ive sent you a pm

[Angel_of_the_North]

Both thyroid hormones are under range so you need an increase. You doctor is obviously an ignorant idiot - is there another you can see? Don't bother trying to fix stupid, it's not worth the stress.

[birkie in reply to Angel_of_the_North]

Hi thanks for your reply.. ❤️❤️ To be honest it's a small practice I saw another gp and she was just as bad.. So my new years resolution..... Move to another surgery... 👍👍👍👍