Private medical tests

[Sanban1]

Hi qq:

Would my endo accept any blood results done by Medichecks?

Ive ordered a kit as my GP only checked TSH at last blood test and Endo has kept me on the same dose even tho last time I felt I was going Hypo..

[SeasideSusie Remembering]

Sanban1

Some doctors will accept them, some wont.

If they're not accepted and any of your results come back abnormal you can use this as a lever to suggest the endo does his own tests.

We always advise:

* Do thyroid tests early morning, no later than 9am, because TSH is highest early morning and lowers throughout the day, highest possible TSH is needed for diagnosis of hypothyroidism or to avoid a reduction in dose of Levo or when looking for an increase in dose.

* Do test before eating or drinking anything but water.

* If you take thyroid meds, last dose of Levo should be 24 hours before the test, last dose of T3 or NDT should be 8-12 hours before the test. Any closer you will get false high FT4/FT3 results, any longer and you will get false low results.

* If you take Biotin or a B Complex leave this off for 7 days before the test.

[Sanban1 in reply to SeasideSusie]

Great! I'm currently being treated for overactive thyroid, bloods done on 2nd match only checked for TSH when should have been all. These bloods were done by GP not endo.

Ordered medichecks today to see the full result as endo was hoping to reduce my meds to just 5mg.

[PurpleNails Administrator in reply to Sanban1]

Do you have the results? By GP

What dose are you taking? How long have you been taking it. Are you tested regularly eg 6 weekly? It’s usual to start quite high & be reduced.

I think you are right to worry about going hypo when not being fully tested.

Also a TSH can lag behind considerably after a period of being hyper. Your dose should be adjusted by FT4 & FT3 never TSH alone.

[Sanban1 in reply to PurpleNails]

Hiii so bloods done 2nd March showed TSH at 0.85

Previous bloods done 19.01 were as follows:

TSH 2.71

T4 11.8

T3 4.58

Endo has had me on 5mg 5 days amd 10mg 2 days since Nov ive been taking Carb since 1st diagnosed May 2020 but with last results amd symptoms I started just taking 5mg everyday as felt I was going Hypo.

Recent bloods he wants to keep me on the original dose but as Ive been only taking 5mg for the past 4 weeks amd feelimg great I dont want to or feel I should go back to the original dose.

Frustrated at my docs not getting my full bloods checked.

[SlowDragon Administrator in reply to Sanban1]

Ft4 looks low

Please add ranges on these Ft4 and Ft3 results

Essential to regularly retest vitamin D, folate, ferritin and B12 too

What vitamin supplements are you currently taking

Are you currently on strictly gluten free diet

[Sanban1 in reply to SlowDragon]

Im taking vit d and b12

On a gluten and dairy free diet

[SlowDragon Administrator in reply to Sanban1]

So you’re correct and Carbimazole needs tweaking as now over treated and Ft4 is too low

When were vitamin D, folate, ferritin and B12 last tested?

[PurpleNails Administrator in reply to Sanban1]

TSH 2.71

T4 11.8

T3 4.58

Please add ranges (they vary between labs)

The January results, I would guess are bordering low levels. Your carbimazole should have been adjusted down. Was this done?

Ideally a consistent daily dose is best. But getting the right amount sometimes needs tweaking dose, I myself alternate 5mg, 10mg daily. Varying the total dose too often is not a good approach. Carbimazole reduces production of new hormone. Doesn’t reduce what’s already in your system.

Was your original starting dose higher?

Did your doctors confirm the cause of your hyperthyroidism by antibody testing? Often they don’t and just treat all low TSH as Graves and give anti thyroid to lower levels.

Often they test Thyroid Peroxidase (TPO) and Thyroglobulin (Tg) if autoimmune thyroiditis (hypothyroid) Also referred to as Hashimoto, this condition can begin with transient hyper, ultimately hypo. If Graves suspected (continuous hyper) Thyroid Stimulating Immunoglobulin (TSI) and or TSH receptor antibodies (TRAb) should be tested.

[Sanban1 in reply to PurpleNails]

These are the lab ranges

The carb wasnt adjusted down the original dose was 5mg 5 days and 10mg 2 days which i just tweaked to 5mg 7 days as i was getting very fatigued puffy face and all the feeling of when i went hypo last year

Lab range results

[PurpleNails Administrator in reply to Sanban1]

Your FT4 is below range. You should not have been left on same dose.

Usually a much higher dose is taken eg 40mg then often reduced to 20mg. If you were never on a higher dose, and a tiny dose has resulted in you becoming hypo I’m wondering if you need carbimazole at all.

What antibodies were tested?

Why were you hypo last year?

[Sanban1 in reply to PurpleNails]

So when 1st diagnosed I was on 30mg then reducaed to 20mg then became Hypo so told to stop. After leaving it for 2 weeks i was then told to take 10mg 2 days amd 5mg 5 days which I have been on until January and with the blood results above I reduced ro just 5mg each day as I was feeling so horrible.

Now 0.85 tsh im going to go back to docs on Monday and get them to test the full panel so I know where I am x

[PurpleNails Administrator in reply to Sanban1]

That’s makes better sense now. I thought you had always been on low dose...

You do need current FT4 & 3 levels not just TSH if doctor or lab protocol refuses to test private companies are an option.

Did you previously have antibodies testing?

[Sanban1 in reply to PurpleNails]

Ive just ordered a medichecks kit to test

Ive complained about the nurse and drs not checking

I did have the antibody test when 1st diagnosed and not again

Was I right to decrease and just take 5mg a day?

[PurpleNails Administrator in reply to Sanban1]

When I feel like my dose is not right, part of me thinks I should work together with my doctor and agree the best approach. On the other hand most endos are TSH focused, don’t have a clue, & will happily leave me until I’m very hypo (especially as I have a under range TSH).

I have self tweaked my dose very slightly, but only when I have the blood test results to know for sure.

Antibodies don’t need repeating after diagnosis as it’s not knows how to control or reduce them. Did you have positive TRAb or TSI?

[Sanban1 in reply to PurpleNails]

Im not sure what I had.

Think im going to be honest and spwak to the Endo and let him know what I did by reducing my dose.

And see what he says

[kittyelen]

I was told they test TSH and if this is fine they don't test more, however if not in range they then test T3 and T4.

I think there may be some difference between teams. I had my dose lowered and GP sent form just THS on it for a test in 4 weeks, however my endo sent me a separate form for the next blood test before their appointment in April and this form has the extra bits on it not just TSH

The endo should be sending the blood form if they need to see the full results but if left to GP they GP only send for TSH (As the GP believes if this is in range then fine, lab only tests further if out of range) so I would speak to your endo and provide them the medi checks as this changes a lot

[holyshedballs]

According to the NHS, The British Medical Association and the General Medical Council, any doctor should accept your private test results. This is more so if the the results come from a laboratory accredited by ACAS.

However, as Seaside Susie said, some do and some don't despite what the below say.

"Guidance on NHS patients who wish to pay for additional private care" Dept of Health 2009 says:

"Where the same diagnostic, monitoring or other procedure is needed for both the NHS element of care and the private element, the NHS should provide this free of charge as part of the patient’s NHS entitlement and share the results with the private provider if necessary.

Patients should not be unnecessarily subjected to two sets of tests or interventions".

I cant highlight on this computer but the last sentence is the important one. its about not doubling up on blood tests. The DoH advice is about the NHS sharing results with private providers. In this context, the advice should be a two way street and the NHS should accept results from a private provider.

The BMA document "The interface between NHS and private treatment: a practical guide for doctors in England, Wales and Northern Ireland" 2009 says:

"Can patients receive part of their treatment within the NHS and part privately?

Dilemmas can arise if patients choose to seek part of their treatment privately and part on the NHS. A common scenario is where a patient pays for private investigations in order to obtain an earlier diagnosis and then switches back to the NHS for any subsequent treatment. Patients who seek private investigations:

• may opt into or out of NHS care at any stage, provided they are entitled to NHS treatment

• may subsequently be placed directly onto the NHS waiting list at the same position as if those investigations had been undertaken within the NHS (where the treatment in question is not provided by the NHS but is clinically necessary, )

• do not need to have a further assessment within the NHS before receiving their treatment, nor do they need to be referred back to their general practitioner (GP).

THE GMC say in Good Medical Practice 2013:

16 In providing clinical care you must:

...b provide effective treatments based on the best available evidence.

Clearly, a contemporary blood test from an accredited laboratory is the best available evidence and therefore the doctor should accept those results.

My own view is that any doctor who doesn't accept private blood test results is not complying with his/her duties and may be negligent if harm occurs.

[thyr01d]

Mine did, however, two of us on here have found Medichecks results did not seem reliable, the other person had her bloods tested at another lab at the same time and the results were different. With both of us it was the ferritin that we were sure was not right.