I posted on here yesterday and received amazing support and information. As requested I have my blood work! i have severe hypo symptoms that are becoming very hard to manage (extremely low blood pressure, weight gain, fatigue, tiredness, depression). I cannot be diagnosed or given any symptom relief by my doctor currently.
TPO is 124 (normal range 0.00-5.60)
TSH is 7.14 (normal range 0.35-5.00)
T4 is 10.1 (normal range 9.00-22.00)
Thank for all the help! can this explain my hypo symptoms? or maybe it's not related to thyroid?
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ilovedoggos
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Your TSH is over-range, In fact it's more than 20 times higher than the lower end of the range. At the same time, your free T4 is only 10% along the range.
Most of us feel well when our TSH is less than 2, and often less than 1, and need our free T4 to be in the top third or top quartile of the range.
And you have high thyroid antibodies. This may be a blessing ...
In most countries they will treat you when your TSH gets to 3. In the UK, for some unexplained slightly sadistic reason they often wait until it's 10. But if I were you I'd go back to my doctor and say that the TSH is over-range [and if that doesn't matter to him/her it rather destroys the point of even having a range] and you have high antibodies, and as such can s/he please put you on a trial dose of levo to see how that improves things?
If s/he will do face-to-face appointments, you may find you do better if you can bring an adult MAN with you to the appointment, to emphasise how he has seen you deteriorate as your TSH has risen well above the top of the reference range. I don't know why, but doctors often find the presence of some Y chromosome reassuring and pay more attention to us poor hysterical hypo women
I can't tell you how thankful I am, I'm starting to feel more validated about this issue now.
Yeah I'm definitely bringing someone with me next time, maybe it is a UK thing, they just basically say get in with it! my blood pressure is in average 74/45
Thank you so much for your kindness and support 💖💖💖
Perhaps it’s coincidence.......but since GP’s became in charge of their own budgets they seem increasingly reluctant to prescribe (unless it’s things they get bonus payments for ...like Statins or antidepressants)
Taking along a supportive (preferably male) friend or family member as witness (They don’t need to say anything) can have much more positive outcome from consultation
yeah great shout! this all got rolling because of my sister! I'll be taking her next time with me! again this is all so so helpful! I've sent an email to request some other doctors! Thank you for caring!
PS that blood pressure looks VERY low - your doctor ought to address that too (the UK tends not to treat low -ish blood pressure compared with say Germany - but that is too low in my view)
It's not that your doctor can't help you, it's that your doctor doesn't want to help you. Hypos cost the surgery money, due to free prescriptions and not getting any kick-backs on levo. Which is why they like the TSH to get to ten before they will help.
Tell your doctor to have a look at the guidelines - and remember that guidelines are just that, they are not cast-iron, inflexible rules - where it says that they can diagnose if the TSH is over-ranger AND the antibodies are high. So, if your doctor is telling you he's not allowed to help you til your TSH reaches 10, he's either lying or he's ignorant of how to apply his trade.
thank you so much! this is really educating me! I'm going to push to get this sorted because the more support and help I'm getting here, I'm starting to a light at the end if the tunnel! Thank you so much! I'll be looking at all of those resources!
‘Hypos cost the surgery money, due to free prescriptions and not getting any kick-backs on levo’
I am not sure if you are talking about another country here? In England the local CCG pays the bill for prescriptions (funded by the nhs), so it wouldn’t cost an individual surgery income in that way. Also they don’t get any kick-backs from drug companies....
OK, scrub the word 'kick-backs' and insert 'financial incentives', which they do get for prescribing things like anti-depressants and statins - which a hypo patient correctly treated, wouldn't need anymore. They get nothing for levo. And, yes, I am talking about the UK, based on everything I've read on here.
Ok, i only mentioned as I didn’t want people to get into some sort of debate with their dr about financial incentive without knowing how it all works:...
Not wanting to be pedantic, but looking at QOF indicators, there is no incentive for prescribing an antidepressant. There is increased funding for a hypothyroid patient on levothyroxine and for blood monitoring. There is no incentive for prescribing a statin in people unless they have had a heart attack or stroke as far as I can see - though this would presumably be started in hospital and continued by GP.
Also I should add the incentives are to increase the general funding for the practice to provide care for their patients (not into someone’s pocket) it is an increased funding for someone that is likely to need more healthcare above those who have no health problems. I’m not saying this is the best way of doing things, but it is what it is. By decreasing funding the quality of healthcare will only decline (as I am sure many have experienced in our underfunded nhs)
"The qualitative study also found patients were reluctant to stay on their courses of statins because they worried it signified the end of their healthy life even when they were showing no symptoms of disease.
Under current guidelines set out by the National Institute for Health and Care Excellence, statins should be recommended to patients judged to have 10 per cent risk of developing cardiovascular disease within a decade.
The threshold was halved from 20 per cent in 2014, and the policy was backed up with financial incentives under the Quality Outcomes Framework, leading some experts to complain it gave GPs no latitude to recommend lifestyle changes before prescribing statins. "
I must admit, i find it quite hard to get my head round 'who pays who for what' nowadays in the NHS.
Out of interest , do you know if/how the QOF has changed in relation to diagnosis/treatment of Hypothyroidism /Subclinical Hypothyroidism in recent years.
I have heard that there has been some change , but don't really know where yo look for the details of any changes.
I was going to say the link I put on Greygooses post, but it seems that is actually out of date. I think this is the most recent one. It looks like the hypothyroidism section is no longer there, so I was wrong about this before. It changes every year I think. I expect it is seen as ‘core professional responsibility’ to have a register of hypothyroid patients and monitor their blood at least annually - not sure if this is what happens 🤔
So in laymans terms, do you think my understanding that where previously a surgery would get extra financial help for a diagnosis of Hypothyroidism, they now do not ,is correct.
A GP practice is a business with an nhs contract. There is a standard income per patient that forms part of the income of the practice to pay staff etc to provide the care of patients. They can get more funding from QOF for the listed indicators. This also forms part of their general income to pay for the care of patients overall. Yes previously it looks like there were points for keeping a register and for monitoring blood tests. (This was at least to 2015 looking at that link above). I do get an annual recall so presume at least in some practices this still happens
I suppose it’s up to the individual if they want a prescription or not. If they choose to attend for an nhs health check maybe they are interested in the results. If guidelines recommend a statin, as you say they’d probably be offered one. But whether they are prescribed it or not does not affect income. (Though I suppose actually it will cost the surgery in some sense as they will have to pay staff to deal with prescriptions and the odd blood test, whereas if medication declined then presumably less input is needed from the surgery?)
I hadn’t really looked at the diagnosis of depression as incentivised - more that like all other listed conditions if someone has this condition they may need more care (by staff and this costs money).
I don’t know what the best way of funding GP surgeries is - I am sure we would all agree that if we want healthcare that is free at the point of access that funding is needed. When saying incentive it sounds like a bonus almost on top of finding - but it is not. It is what is used to provide care for people.
* QOL points are awarded for "the percentage of hypertension patients who are currently treated with statins "
*QOL points are awarded for diagnosis of depression
but,
QOL points have been removed for diagnosing or monitoring Hypothyroidism.
I'm not saying GP's are pocketing juicy bonuses, I'm just pointing out the stupidity of QOL which awards money to the practice for a depression diagnosis and a statin prescription, but now makes surgeries fund the whole cost of monitoring thyroid patient's .
It's no wonder our care is often rubbish.
And it's no wonder i've been offered an unwarranted diagnosis of depression several times, but have difficulty getting a very necessary FT3 test from GP.
Not directly. They have an nhs contract to provide care for patients. This would include paying staff to do checks/blood tests etc. Someone would need regular blood tests or annual at least if stable on medication (Ie cost of a phlebotomist appointment). If someone has an untreated illness presumably it would place more demand on the service and in terms of more consultations, so this would cost them more I would think. The prescribing budget is separate to the surgery so whilst they may be conscious of the cost of medication to the nhs, decisions wouldn’t be made for personal gain etc....
Sorry I realise my comments had nothing to do with your thread - sorry if it’s annoying!
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