Update on GP appointment

[Katrina999666]

I had my appointment with the GP this morning she looked at the results of the bloods taken by Medichecks and said she would need to run her own, because in April my bloods were normal :0( almost dismissed me however I quickly pointed out that we are now in August not April I was so angry. I then catalogued my signs and symptoms referred her back to a hospital admission some 5 years ago when I had similar hepatic and duct issues. she is now going to run her own set of bloods to be taken tomorrow as well as antibodies for Primary Biliary Cholongitis. She then said oh I see you also have Thyroid antibodies and that's when I went into my rant about how I had checked out the NICE guidelines and that the minimum starting dose was 50mcgs and not the 25 I was on. I told her that I felt under medicated and that I would like to be placed as directed by those guidelines on 50 an increase of 25mcgs, to my amazement she agreed immediately not sure if she just wanted rid of me lol ... I will start the increased dose tomorrow and have my Thyroid levels checked again in 6 weeks time. Will be interesting to see what my bloods show up this week with regards to my Liver function.

[SlowDragon Administrator]

Good to hear you got dose increase

Get FULL Thyroid testing in 6-8 weeks

[Katrina999666 in reply to SlowDragon]

I should purchase shares in medichecks lol

[fuchsia-pink in reply to Katrina999666]

Well done

Post your next blood results and we'll see how you are doing after 6 - 8 weeks on the higher dose. So you know that "in range" and "normal" aren't good enough - and you now have the measure of your GP! I suspect going forwards you may get improved treatment by referring (often) to things like: "as recommended by Thyroid UK" and saying how much better you feel since the last dose increase but your'e not quite there yet [assuming that's the case]; and how helpful it is to have a GP who is with you on your thyroid journey. A combination of knowledge (and determination) on your part and flattery to the GP can be surprisingly successful x

[Katrina999666 in reply to fuchsia-pink]

Thanks for replying I wasn't feeling great today so I think I went in with the determination that she wasn't going to patronise me and they are not infallible. I will have bloods taken again by medichecks as the GP doesn't do T3 I'm hoping that I will see an improvement.

[SlowDragon Administrator]

guidelines on dose levothyroxine by weight

Even if we don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose

NICE guidelines on full replacement dose

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.

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.

RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

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Way to go!