forthcoming telephone consultation with gp concerning blood test results

[MOEONIAN]

hello

i asked gp if i had a private consultation with an endo would he go by the endo's recommendations, and he agreed.

in the event he chose the endo in our local hospital who decided that because my T4 and TSH were normal i didn't have a problem and then went on to ignore my symptoms and recommend muscle biopsies to chase a supposed nerve problem. he also asked for serum testosterone blood test in case it was low, and causing some of my symptoms. (for the same reason last year following a blood test, my gp has given me B12 injections and a course of folate, which were low normal, to try to alleviate hypothyroid symptoms, with little discernible result.)

why does the NHS give so little attention to thyroid issues, yet seem eager to treat all the symptoms emanating from thyroid deficiency as separate, unconnected, issues?

yesterday my gp phoned and asked for a telephone discussion of my NHS blood tests.

taking the advice of healthunlocked members i have had a private blood test which showed the following:

T3 6.3 pmol/L (3.1-6.8) which i estimate to be high normal

T4 17.2 pmol/L (12-22)

TSH 5.12 mU/L (0.27-4.2) which is high.

my gp is going to discuss my (normal) testosterone test results and, i imagine, stick to the endo's advice that my thyroid is normal.

what can members advise regarding my private test results indicating that my thyroid is under active? are my results severe enough to warrant medicating? if they are should i make a fuss, and, if so, what points should i emphasise?

i would be extremely grateful for any advice.

[knitwitty]

Hi MOEONIANWelcome to the forum. I am not as knowledgable as some on here but didn't want to ignore your post.

Your T4 and T3 seem to be quite reasonable, but your TSH is high for someone who does not have a hypothyroidism diagnosis.

You have come to the right place for some good advice and I'm sure there will be some people far more knowledgable than me along to comment very soon.

Are you currently taking any thyroid medication either prescribed or bought yourself ?

Also when was your blood test taken as that can affect some of the readings especially TSH, for example if you had your bloods taken in the afternoon your TSH would be lower than if they were taken first thing in the morning, additionally if you are taking levothyroxine you should leave 24 hours before a blood draw, and if you are taking T3 ( liothyronine) you should leave 8-12 hours after the last dose before the blood was drawn to get an accurate reading.

It is always recommended to do blood draws first thing in the morning and before eating or taking medication, unless you are taking T3 when you should leave 8-12 hours.

I find it hard to comprehend that either your GP or an endo could suggest that you do not have a problem if your TSH is outside the range , and I'm sorry but I don't know why your TSH is rising so far when your free T's are towards the upper end of the ranges unless you are taking levothyroxine and took it close to the blood draw.

Good luck, I'm sure someone will be along to help soon.

[MOEONIAN in reply to knitwitty]

thanks for your reply. i have no idea what my antibody count is, so can't use that when i talk to gp tomorrow.

it seems, from what i have read, that the NHS thinks that TSH scores under 10 are not important in the elderly, as bringing them down with medication does not relieve symptoms very much.

i will ask for copies of previous blood test results that may have measured T4 and TSH, but quite how accurate they would be since they were rarely taken in the morning and not before eating.

i suppose i will have to await the eventualities of the phone consultation before deciding on my next course of action.

thank you again for your reply

[knitwitty in reply to MOEONIAN]

Hi again, I've just had another thought, have you ever had your vitamin levels checked as some key ones, if low or not optimal can give similar symptoms to underactive thyroid, although that won't explain the high TSH and not too bad T3's and 4's The key ones to test are

B12

Ferritin

Folate

Vitamin D

Any of these or all of them being low can give rise to similar symptoms of an underactive thyroid gland.

Many people who come here for advice ( myself included) often have to pay for private blood tests to get a fuller picture of what's going on.

Two popular companies who do blood tests are Blue Horizon and Medichecks.

I more often than not use Medichecks and they have special offers on on Thursdays on Thyroid blood tests. At the moment they have 25% off blood tests.

I always do a finger prick test but you can opt to have. nurse do a blood draw ( whether that option is available during the covid situation, I'm not sure), if like me you do a finger prick test you are in full control regarding the time you do the test.

Maybe your doctor will request a blood test to look at vitamin/mineral levels if you ask.

Also request a print out of all your past blood test results and any in the future , at least you can look for any changes and in the case of vitamins and mineral results which might be just scraping in at the bottom of the range, your doctor will probably say they are fine even if they are right at the bottom of the range but they may not be optimal for you.

My vitamin D was one point above the bottom of the range and I was advised to buy a low dose vit D to improve my dire levels, had it been one point lower I would have been prescribed loading doses. It was through research that I discovered I needed a much larger daily dose all year round to bring my vitamin D levels up to and maintain a good level.

When / if you get any results( with ranges) come back and post again and I'm sure someone will be along to help you.

I'll add in the names of some of the people who have helped me in the past and they might come along and see your original post, SeasideSusie, GreyGoose , SlowDragon, helvella and add any comments.

Good luck with your GP, and I hope you're feeling better very soon.

[MOEONIAN in reply to knitwitty]

thank you so much. valuable information there.

[tattybogle]

The NHS are allowed to "consider giving a trial of Levothyroxine" for what they call 'sub clinical hypothyroidism' but whether they will or not is at the opinion of the GP, and may be influenced by the level of symptoms, and also the presence of raised TPOab (Thyroid peroxidase antibodies)may encourage them to offer Levo .(I was given Levo with TSH at 6.8, but did also have very high TPOab)

'sub clinical hypothyroidism' is defined by them as 'having two over range TSH results ,( with ft4 still within range) that are taken at least 3months apart'.... this rules out a temporary fluctuation in TSH.

You recent private test does show over range TSH, (but not by much, as far as they are concerned)

You must have had previous NHS thyroid tests in order to have been referred to endo. So it would be useful to find out the actual results as 'normal' means nothing until you've seen the numbers.

the TSH will be highest if taken early as possible 8/9am in the morning, it falls to it's lowest around 2pm. Actually it's highest in the middle of the night , but you can't get a blood test then.

GP will probably not accept private results for diagnostic purposes, but you can always request a repeat thyroid function Test . (they do have rules about the time interval before they will fund another test if the previous one was normal, but do check the results yourself before you accept an opinion on 'normal')

If you get another NHS test , make certain it's at 8/9am even if you have to wait weeks to get an appointment at that time . and just have water before , have breakfast afterwards. as eating can lower it a little too.

You could ask them to check your TPOab if they haven't already. Raised TPOab shows an increased likelyhood that the person may eventually become hypothyroid.

You fT4 and fT3 do actually look pretty good, but stupidly the GP's won't know that , or even look at T3 anyway cos they think TSH(Thyroid Stimulating Hormone ) tells them all they need to know .

You might find this graph interesting ... it shows the % of the healthy population who have TSH at various levels , and you'll notice hardly anyone has anywhere near 4 let alone 5

healthunlocked.com/thyroidu...

[MOEONIAN in reply to tattybogle]

thanks for your informative reply.

i shall use the graph details to try to make my point. it appears from the info you supplied that high TSH plus old age does not seem worth treatment, since the treatment does not seem to alleviate symptoms by much in the elderly.

at my time of life any treatment that could give me a tad more energy, more mental clarity and more interest in living, and allow me to clamber out of this slough of despond that i find myself in would be a boon.

if the gp is not convinced that i need treatment, is thee any other avenue i could explore that would allow me to obtain treatment from another source?

thanks again for your interest, i am most grateful.

[Partner20 in reply to MOEONIAN]

Unfortunately the latest thinking is that those of us who are "elderly" do not gain sufficient benefit from levo if medicated when TSH is only slightly above range, and so prescribing for those over 65 years old is now not considered appropriate until TSH is over 10. In a sense this is understandable because TSH tends to rise with age, but to be considered "elderly" at the age of 65 seems rather shocking, as this is far too young to be facing years of symptoms without help. When I read about the recent proposals I was glad that my diagnosis had already been made, but I am always fearful that my GP will cotton on to this and not be too concerned about my TSH levels in the future. Age is just a number, and it is frightening to think it can cause our treatment to be affected. Hopefully your GP will be a listener, they do exist! Make sure you list your symptoms, and how they affect your life, and ask what your GP thinks could be the cause, and put the ball in their court. Hope you have a fruitful appointment.

[MOEONIAN in reply to Partner20]

thanks for your input.i wouldn't care if it was possible to bypass the NHS and purchase the medication under medical supervision.

i don't know what the treatment costs, but i would imagine a private gp would not be cheap since my private endo charged me £200 for a short consultation.

if you, or anybody, has an idea as to cost, i would be grateful. at least i can then see if the private route is affordable

many thanks

moeonian

[Lora7again in reply to MOEONIAN]

I do all my own private blood tests and ask for help and advice from sites like this one and others in the US. My GP only tests the TSH and rarely tests the T4 and T3 even though they know I have a multinodular goiter and I have Graves' disease written on my notes. This is what some of us have had to do because we were not being monitored properly. My GP has actually admitted he knows nothing about thyroid disease.