Help on how to approach gp on anxiety - Thyroid UK

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Help on how to approach gp on anxiety

Macey2009 profile image

Hi all i would be grateful for some help. After going back and forward to my gp over the years with different symptoms i always get told it's anxiety. Which i kept saying wasn't the case.

So now i do actually feel anxious. Have low mood and irritibility. But it's making me anxious thinking about talking to the gp about it as i feel like anything else i mention in future with be labelled as anxiety even more.

I hope this makes sense.

47 Replies

Macey The anxiety is another hypo symptom to add to your growing list. You are in an awful situation where your symptoms interfere with your well being and life but the GP does not think your blood results are bad enough to merit treatment. A big part of the problem is that GPs and Endocrinologists (even though they are meant to be the experts) have little understanding or knowledge of what constitutes symptoms of thyroidism. They tend to look only at the hormones in the blood - and if you are lucky they will look at the thyroid hormones ft4 and ft3; if you are unlucky they will look a the hormone put out by the pituitary gland TSH.I spent years on citalopram for anxiety and panic attacks when all I really needed was to be properly medicated.

Macey2009 profile image
Macey2009 in reply to Lalatoot

Thanks for your reply. I just don't know how to speak to the gp about it. I know i have hashimoto's thanks to this forum but the gp doesn't acknowledge this 😣

greygoose profile image
greygoose in reply to Macey2009

I know. As I said to you in one of your previous posts, he doesn't want to acknowledge it because he doesn't want to diagnose. But, him not acknowledging it won't make it go away. It's there for good and causing symptoms. But, he's not likely to do anything until your TSH goes higher - at least over-range, as you have high antibodies - but he might insist on waiting until it gets to over 10. Some GPs do. And, I don't think there's anything you can possibly say to change his mind on that.

And, as I said above, in your place, I just wouldn't mention anxiety at all. Ever. It's a symptom, not a disease. But, he is going to treat it as a disease because he has his own agenda - and it's not an agenda that takes your best interests and welfare into consideration.

Macey2009 profile image
Macey2009 in reply to greygoose

I feel like i'm stuck in a horrible situation 😣 I want to mention it for help but at the same time I agree with you that it's a bad idea.

greygoose profile image
greygoose in reply to Macey2009

Yes, but the only help he's going to give you is anti-depressants. There's nothing else he can do, because he's not going to give you thyroid hormone at this point.

Macey2009 profile image
Macey2009 in reply to greygoose

I know i will just have to wait it out i guess and and see what the next bloods show. My thinking is that while my thyoid is being destroyed it could cause hypo symptoms.

I could be wrong but i dont think my gp would think like that.

greygoose profile image
greygoose in reply to Macey2009

You will get hypo symptoms as your T3 level drops, because T3 is the active hormone - either made by the thyroid itself, or produced by conversion of T4. I don't think the act of destruction it self would be felt. But, the more of your thyroid that is destroyed, the less hormone it can make. I would have thought that that was obvious even to a dim GP.

The problem is that GPs don't have much idea about what hypo symptoms are - they might or they might not recognise axiety as being one of them. Or some GPs might insist that anxiety is a hyper symptom, and not be aware that it can be caused by hypothyroidism, as well. But, GPs need no encouragement to prescribe anti-depressants, because they get financial incentives to so do. So, we have to be very careful.

Macey2009 profile image
Macey2009 in reply to greygoose

OK thanks. I was just meaning as i've had the antibodies for at least 3 years or possibly longer then maybe it could cause symptoms. Sorry you might get i'm not very clued up on this lol

greygoose profile image
greygoose in reply to Macey2009

It's debatable whether or not antibodies cause symptoms. I really don't know. Depends who you talk to. :)

When did you have your last thyroid blood test? What were the results? Bet they didn't test the FT3! But, I'm willing to bet it's low T3 that is causing your anxiety. And, if it were me, I would never, ever mention that to a doctor of any sort! They will latch on to it like a terrier with a bone, and use it against you are every possible opportunity. It will be difficult to ever be taken seriously again. Not to mention that the last thing you want is to be put onto anti-depressants or the like, which might not even help and would be difficult to come off. Try and stick it out until you get a hypo diagnosis.

Just my opinion, of course. Others might disagree. :)

Macey2009 profile image
Macey2009 in reply to greygoose

Hi thanks for the reply. Yes i was thinking that way too. My last test was in Feb TSH 2.8 (0.20 - 4.50)

T4 14 (9-21)

Due my next test 2nd of August.

My gp has never tested t3. Not sure if they do i've never asked.

Lalatoot profile image
Lalatoot in reply to Macey2009

FT3 is not routinely tested even if requested. This is because medics mistakenly think that TSH and Ft4 tell them all they need to know.The only things you can say to the GP are that you have hashimotos as your antibodies are over range - no ifs or maybes. and

Your ft4 is under half way through its range. I liken it to shoe sizes - if you are a normal size 7, a normal size 3 shoe will not fit. Maybe your optimal ft4 is a normal 18 and you are now 14.

Macey2009 profile image
Macey2009 in reply to Lalatoot

Hi thank you. I don't think that would work. As i've already been told that the high antibodies only indicate a risk of developing autoimmune thyroid disease on future. That's why they are now doing 6 monthly tests. My next test is 2nd of August.

Lalatoot profile image
Lalatoot in reply to Macey2009

It is so frustrating.

underact15 profile image
underact15 in reply to greygoose

This is a really interesting post - thank you all!

greygoose my endocrinologist is reluctant to let me try T3 because I really, really struggled with feelings of vertigo/dizziness/walking on a boat, extra adrenaline, anxious, a general feeling of being “wired” etc when my levothyroxine was increased and my T4 went slightly over range. After 6 horrendous weeks, she reduced my dose a little bit and I’ve been feeling slightly better but not much. She says the same symptoms are likely to come about again if I take T3 😭 I’m talking to her again on Tuesday (blood test results) so I’m not sure if I should push for T3 or not. The last thing I want is to feel any worse in the vertigo/anxiety department!!! It really has been unbearable and pretty debilitating.

greygoose profile image
greygoose in reply to underact15

Has she ever actually tested your FT3? Do you know how well you convert? Have you had your B12 and other nutrients tested?

I would suggest you write a new post, giving all the details, blood test results and ranges, and then people will be able to advise whether T3 is likely to help you or not. Not much one can say, otherwise. :)

underact15 profile image
underact15 in reply to greygoose

She has, twice! Once in December 2020 (4.4, range 3.1-6.8…I had been on 100 levo every day for years) and once in April 2021 after 6/7wks on 125 levo every day (4.5, range 3.1-6.8…so an increase in levo didn’t seem to help my T3 much at all…troubled converter it would seem!). I also asked her to test in Feb but she tested TT3 instead 🙄 (which was under range). It was tested a couple of weeks ago as well. I’ll get the results on Tuesday and I want to be ready! 😬 I’ve been working on my nutrients since December 2020 and I think everything is heading in the right direction - slowly!

underact15 profile image
underact15 in reply to greygoose

Sorry greygoose I also meant to say that I posted all of my results etc in April and lots of people (including yourself!) were really helpful, thank you 😊 I was just interested to read that low T3 can cause anxiety because my vertigo/walking on a boat feelings feel anxiety related 🤔 and it would be life changing to alleviate them!! My endocrinologist said it would do the opposite and make the anxiety related feelings worse 😭

greygoose profile image
greygoose in reply to underact15

I suppose she thinks that anxiety is a hyper symptoms and doesn't know it can also be caused by hypothyroidism. Doctors do tend to divide symptoms rigidly into hypo and hyper - if they know anything about symptoms at all. But, that is not the case. So many symptoms can be both hypo and hyper symptoms.

Vertigo can be due to low B12, which is why I asked about that. But can also be caused by low T3. And your FT3 is low. But, to know how well you convert, we would need to see the FT4 and FT3 results, when tested at the same time, to compare them.

underact15 profile image
underact15 in reply to greygoose

Thanks greygoose I will challenge her about hypo v hyper symptoms on Tuesday! The walking on a boat/vertigo/anxiety feeling has definitely been much more consistent (every single day 😭) since increasing levo although I have struggled on and off in the past. I’ll do a new post in a few days when I have my latest results but here are my most recent results anyway 😊

Blood test results
SlowDragon profile image
SlowDragonAdministrator

Looking at excellent informative profile

Last full thyroid and vitamin test was March 2020

Might be good time to retest

March 2020

Ferratin 82 (13-150)

VIT d 92 (50-175)

VIT b12 464

Tsh 3.52

T4 18.3

T3 5.09

Tpo antibodies 85 <34

TG ANTIBODIES 90 <115

Remember to stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results

Previous post

healthunlocked.com/thyroidu...

Have you now gone on to strictly gluten free diet

If yes, have you noticed any difference yet

Macey2009 profile image
Macey2009 in reply to SlowDragon

I can't afford to test privately just now. So i am relying on 6 monthly tests via my gp. Yes i have been gluten free for about 5 months now and i haven't noticed a difference.

SlowDragon profile image
SlowDragonAdministrator in reply to Macey2009

If GP included TPO antibodies test…..you might see reduction in TPO antibodies on strictly gluten free diet

But NHS usually only test thyroid antibodies once

Macey2009 profile image
Macey2009 in reply to SlowDragon

Yes maybe. I know they can fluctuate. When my gp tested them they were >1000 and the 3 private tests have been very low. 90-100.

SlowDragon profile image
SlowDragonAdministrator in reply to Macey2009

That difference could be because of different ranges on different lab tests

Macey2009 profile image
Macey2009 in reply to SlowDragon

Hi the range for the tpo antibodies is <34 on both private and NHS tests.

Dear Macey2009,

I don't 'know' you, at least as far as I know anyway. So, as an Outsider, can I answer your question thus.... Why not simply Tell your doctor 'Exactly What You Have Told Us'? You Come across as Genuine, which surely is your Main Concern.

Just approach Him/ Her as you have us.

AndrewT

bluntly .. what would be the point in speaking to them about it at all. unless you actually WANT some antidepressants off them ? .. but i'd try and avoid that.

It wont get you treated for hypo any sooner , they probably wouldn't consider anxiety as a main symptom of hypo,,,even if it was the first time you had EVER been anxious. And since they already have that conversation with you before then frankly .. they will always think .. "ah , but this is a lady who get's anxious anyway" no matter what you do in future.

Your GP does already acknowledge the significance of your TPOab's .. that is why they are monitoring thyroid bloods 6 monthly. So don't feel like they don't accept it . They do accept that your TPOab (especially since they caught them at >1000 ) make it much more likely you will eventually have TSH over range and fT4 below range.. So they do accept they will probably have to treat you at some point. They just don't use the term Hashimoto's .

And even if symptoms are present, they are not usually able to treat with Levo until at least TSH has gone over the lab range, and stayed there for at least 3 months . They have to do this to rule out a temporary rise that would get better by itself, and not everyone with TPOab will need treating.. so Their hands are a bit tied until your TSH is a bit higher.

I notice you are doing some private testing too . so give GP copies of any private TSH results that are over -rage or are showing a pattern of increasing TSH level.

It's all about evidence , they need evidence that allows them to start a life long hormone treatment, and every little helps.

Unfortunately , going in with 'normal ' TSH and saying you are anxious.. won't help in the evidence department.. it will do the opposite.

Sending a ((( hug))) as i know that was probably a bit too blunt.

Macey2009 profile image
Macey2009 in reply to tattybogle

Hi thanks for the reply. No its fine i appreciate your bluntness. I agree as anytime i've had a referral it always has anxiety written on it.

It wasn't actually my gp who requested bloods. It was a rheumatologist. Even then i had to chase it up as the gp never followed up on the letter they sent. I have my next test 2nd August so hoping there's another change in results.

tattybogle profile image
tattybogle in reply to Macey2009

if it helps . with an NHS record of TPOab >1000 . you probably wouldn't have to wait till TSH was over 10 .

I had TSH 5.7 then 2 months later it was 6.8 they found TPOab 2499 ad gave levo , even though T4 was well in range.

And strictly speaking they only need "2x over range (but under 10) TSH ,3 months apart + symptoms" before they can offer trial of levo . So on paper at least that could mean 2x '5 'ish , depending on lab range.

Having evidence of these very high levels of TPOab gives them much more reassurance that they are doing the right thing if they treat, than if they only ever see TPOab that are 'a bit over range'

Macey2009 profile image
Macey2009 in reply to tattybogle

Thank you. That does help. I did feel relief when i saw the tpo result.

It made me feel a bit better knowing there was something going on with my thyroid. If that makes sense.

I suspected for years i had thyroid symptoms.

So i was lucky I guess that the gp tested them and they came back so high.

tattybogle profile image
tattybogle in reply to Macey2009

yes it does help ,seeing something in black and white that is a clear sign of 'there's something going on here'

I presume 'loads of TPOab' is the aftermath of an extremely messy thyoid 'party' in the recent past. And unlike TGab (which can have lots of causes), TPOab are always 'thyroid' in cause

(with a couple of rare exceptions with long names ,that are something to do with encephalitis.. which you'd presumably know about already, 'cos you'd have encephalitis ;) )

So hurray .. you're not nut's .. but you are damaged.

Macey2009 profile image
Macey2009 in reply to tattybogle

You're right it does. Now comes the long wait for results to be out of range. I fear i will have a long wait.

I'm also waiting to see an dermatologist as my gp thinks skin issues are autoimmune. That would make sense as i read you usually get more than one.

tattybogle profile image
tattybogle in reply to Macey2009

yes they do like to have their friends over to play, and as well as that , some skin issue's are directly related to hypo, and dermatologist's often have better knowledge than GP's about this .. so make sure you ask dermatologist if thyroid conditions are related to what ever he's looking at. several people on here were first diagnosed due to dermatologists telling GP's to have a look at thyroid function.

Macey2009 profile image
Macey2009 in reply to tattybogle

Yes i will do. Also now i seem to have lost my leg hair too (although handy not having to shave lol) not sure if that's a thyroid symptom 🙄

tattybogle profile image
tattybogle in reply to Macey2009

that happened to me too ,years before menopuase ( i was diagnosed in my 30's) . but just in patches in the inside of my shins, though .. annoyingly i still got a 'cuff' round my ankles which just looked silly.

now i'm older and cant be arsed to try and look attractive, they've stopped growing completely.. typical.

Macey2009 profile image
Macey2009 in reply to tattybogle

Did you find out the cause of it? I know it lists body hair loss as a hypo symptom.

tattybogle profile image
tattybogle in reply to Macey2009

at the time i though it was just 'me' . now i know more about the action of thyroid hormone's in cells all over the body ,i think it's probably just 'hypo' .. but to be fair i have no idea what normal healthy leg hair should look like as we age since everyone's been brainwashed into shaving it off.

Macey2009 profile image
Macey2009 in reply to tattybogle

That's true. I will mention it to the dermatologist and if it is a hypo symptom then I can add it to my list lol

Macey2009 profile image
Macey2009 in reply to tattybogle

Sorry to bug you. Just one more question. Is it possible to have thyroid symptoms even though you're not actually hypo yet? I mean while the autoimmune process is going on and attacking the thyroid.

tattybogle profile image
tattybogle in reply to Macey2009

yes . look a at this graph healthunlocked.com/thyroidu... tsh-levels-in-healthy-people-with-no-known-thyroid-disease

Tsh doesn't usually move much over your lifetime .. we have our own personal setpoint's which are much narrower than the range for the whole population .

The range is the 95% that is left after they discount the top 2.5% and the bottom 2.5% of results from all the 'healthy' ones they collect.

So imagine if you were one of the people on there who's normal TSH was under 1 , or even of you were in the 2.5% they discount .....and then you find yourself with a TSH of 4... it's still within range .. but it's not within YOUR range.

( Think of the range like the side of a barn .. and your own setpoint like a barn door, but one that could be anywhere along the side of the barn.)

So with different levels of thyroid hormones causing higher or lower TSH than you are used to ,you will feel different.. and often crap.

got to go out now xx forgive any mistakes not got time to check reply

edit . back now...... Was going to say,... the problem is that even though it's perfectly possible to experience symptoms that cause real problems in your life, caused by autoimmune hypothyroidism long before blood results go out of range.. NHS GP's can't prescribe Thyroid hormones until thyroid bloods do go out of range. (even if they DO believe that the symptoms you are experiencing are related to it, and most of them don't ) and at present there is no treatment for the autoimmune part of it, ..... so all they can do is offer things to deal with the symptoms .. ie antidepressants , which while they may well calm your anxiety, will do nothing to help your thyroid produce more hormone, and will quite possibly lead to putting more weight on and ending up on antidepressants for years .. they are very quick to offer them, and very slow to suggest you get off them. ...and a recent study just made them acknowledge that antidepressants can be very hard to come off.

They do help some people , there is a place for them in medicine, but like everything else that alters your brain chemistry.... there's a price to pay.

But even if your GP believes your symptoms might be caused by thyroid disease , and might improve on Levo.. he still can't give you Levo yet.

edited above

Macey2009 profile image
Macey2009 in reply to tattybogle

Thanks so much. Appreciate all your replies. I will hold off speaking to my gp. And once I get my next bloods i will post on here for comments.

Hi Macey2009,

It sounds like you're having a similar problem as myself.

I've had mental health problems for many years and so the gp can't seem or is unable to see past those issues and puts any other health issues down to anxiety.

You do end up feeling like you're going round in circles. It also makes you feel nervous about contacting the gp for help as you just get told it's your anxiety that's causing problems.

I've found that I've had a good response from my gp when I've written to the surgery. Also send a copy of the same letter to the practice manager. Try to keep it brief if possible; probably more chance of them actually reading it?

Outline what the problem is and your symptoms, use bullet points if possible, tell them what you'd like them to do, blood tests etc.

My most recent letter has resulted in my surgery requesting I go for blood tests.

Good luck.

Macey2009 profile image
Macey2009 in reply to Hedgeree

Hi thanks for the reply. Sorry you're going through a tough time too. It was only after seeing a rheumatologist that they acknowledged the high level of antibodies and so i now have 6 monthly thyroid tests. I just feel stuck. I want to tell my gp about changes in my mood but not sure if it's going to help matters.

Hedgeree profile image
Hedgeree in reply to Macey2009

Hi Macey2009,

Very sorry I misread your original post! It does make sense, it's just me not reading properly what you'd said. ☺

I can imagine how difficult it must be for you to now approach your gp; as over time they've said your problems were down to anxiety but now that you do feel a shift in mood and want to discuss it you don't know how or if to go about it at all.

As I said in my original reply I have found it really helpful to write to my gp; I realise that your situation is different as my relationship has soured somewhat but it's an option anyway and might be useful for you to outline your changes in mood.

Take care and best wishes.

My current GP kept suggesting that my reports of pains in my abdomen were health anxiety. Using insurance and then a NHS referral, I ended up having various scans (ultrasound, X-ray, MRI and CT scan) and a colonoscopy done (the consultant wants to do endoscopy/gastroscopy too). Well, what has been confirmed is diverticular disease, bowel polyps, inflamed bowel, trapped gallstone, liver cyst, and a collapsed lower left lung lobe. The temptation to tell the GP what to do with her repeated health anxiety diagnosis is very strong. I won’t (probably), but the tests and resulting actions to address problems have confirmed I was right and that the GP was wrong on every count. I know they have a difficult job, but sometimes they are just not very good at their job. GPs are not gods, are not infallible, and as patients we should never feel bad about standing up for ourselves and demanding better, either from the same GP or by getting moved to a more capable GP. If your GP cannot differentiate between real anxiety and symptoms of other things, that suggests to me that you might want to see a different GP if you can.

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