Hi - I have Low T4 and normal TSH so the GP is not really willing to do anything although I do have symptoms.
What do people do next? Will my GP be able to refer me to an endocrinologist on the NHS or do people go private. They seem to cost about £150 per half hour. Also are private endocrinologist constrained by the same rules as the GP - i.e. they will not be able to prescribe Levothyroxine if you have normal TSH?
A Functional Medicine Practitioner seems to be more open minded and flexible but I presume they cannot prescribe anything like the GP? What is a Functional Medicine Practitioner likely to do to raise T4 levels?
Also some of them seem to be incredibly expensive at around £350 per hour which is more than an endocrinologist.
thanks for your help
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marbo
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Your GP is unlikely to refer you in the NHS. An NHS endocrinologist would likely refuse the referral anyway as there is nothing in your results to merit their attention .Hypothyroidism is considered fixable at GP level .
You are not alone in this many on here have had the same .
You need to be proactive so learn as much as you can and do private tests as was suggested on your other post .
Before considering booking any consultation you need FULL thyroid testing done (remember to stop taking any supplements that contain biotin a week before test)
Essential to test TSH, Ft4, and Ft3 plus both TPO and TG antibodies
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease).
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Gluten intolerance is often a hidden issue.
Hi SlowDragon - thanks for the reply. Yes my Cholesterol is high even though I have a very healthy diet and do not eat very much - which I always thought was strange. Also my Testosterone level just keeps dropping.
Here are some results;
Serum cortisol 129nmol/L
Serum testosterone 9.2nmol/L (8.8 - 26)
Red blood cell (RBC) count 4.4910*12/L (4.5 - 6.5)
You are unlikely to need multivitamins or extra iron with these results. Iron is toxic in excess. If supplementing iron you need full iron panel test 3-4 times per year
You likely need to reduce vitamin B complex generally and certainly need to stop this for week before ALL BLOOD TESTS because will have biotin in it (multivitamins probably have biotin in too)
Vitamin D probably needs reducing to maintenance dose
No idea about any of the following supplements
1 x Ubiquinol 100mg 120 Softgels
1 x Best Naturals Ashwagandha 500 mg 120 Capsules Immune, brain, stress
Yes I checked and the Vit B and Multivitamins do both have Biotin so I have stopped taking these. I am pretty much vegan but do still have eggs and full fat yogurt. I also mostly avoid Gluten as I feel better without it.thanks
What is the range for this and what time of day did you do this test? If you took it early morning this seems low. If you can provide this information then Hidden is good at interpreting serum cortisol results.
1 x Best Naturals Ashwagandha 500 mg 120 Capsules
Did you know that Ashwagandha lowers cortisol? This could be an issue depending on your cortisol result/range/time of day.
I think the Cortisol test was taken about 10:30 - 11:00 am. It says the range is 113-456nmol/l for a test between 8am and 10am. It does not say what the range is at 11:00am? thanks
I think the Cortisol test was taken about 10:30 - 11:00 am. It says the range is 113-456nmol/l for a test between 8am and 10am. It does not say what the range is at 11:00am? thanks
The trouble is the reference range isn't great to go by as cortisol varies through the day, being at it's highest first thing in the morning. This chart shows what normal cortisol levels should be, it was produced by an Endo who does a lot of research into cortisol issues. Prof Stafford Lightman. Even for 10.30-11am your level is low & depending on what other symptoms you are experiencing. Low cortisol can cause weight loss, low BP, pigmentation, feeling dizzy, stomach issues ie diarrhoea & vomiting.
Thanks for the chart. Looking at it it seems normal range for 11am is 320-450nmol/l - so I am quite low. I also had a test at 9am which was 287 nmol/l which also seems low for that time. Beginning to think there might be an issue with my adrenals or maybe the pituitary - as well as the thyroid. All my hormones seem to be low. thanks for your help.
An early morning cortisol should be between 350-550nmol/Ls so yours is on the low side. It could be that your thyroid meds aren't at an optimal level but it would be worth asking your GP to do an early morning cortisol blood test & refer you to an Endocrinologist for further testing. The Endo should do a short Synacthen test (SST) to see if your adrenal glands respond to the artificial ACTH they inject you with. They should do an ACTH blood test at the start of the test, this should go onto ice straight away. ACTH is the hormone secreted by the pituitary gland to stimulate the adrenal glands to produce cortisol. Sadly not all Endo's are conversant with pituitary/adrenal issues, if you tell me where in the country you are I can suggest an Endo department where they are used to treating people with these issues, I hold the list from the Pituitary Foundation. The oestrogen contraceptive pill, HRT & biotin will give an elevated cortisol result so it's best to be off them for a few weeks prior to testing.
I am not on any thyroid meds at the moment as my doctor does not think there is an issue. Will a UK GP refer you to a endocrinologist even if they themselves don't see an issue? Would I need to go private? I am near Macclesfield in Cheshire - if you could send me the list of suitable endo's that would be great! thanks for your help
I think that as your cortisol is on the low side he should refer you on to see an Endo. Have a look at the NICE guidelines for info, although I think the reference range has been lowered with a new assay. cks.nice.org.uk/topics/addi... I'll pm you with suggestions of an Endo.
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