Silent reflux?!

[BethH77]

Just been to see my GP so she could check lump on my throat. She did and is referring me for ultrasound scan. I also mentioned having hoarse voice and she wants to try me on ant-acids for a month? Thinks it could be silent reflux.....I have no reflux symptoms at all though? I asked if it could make things worse since being hypothyroid can mean lack of absorption anyway and she said she doubts I am anyway as so 'subclinical' and that if the medication doesn't make me feel better soon she will stop it as clearly not a thyroid issue? I am only 25mg and started 5 weeks ago.....(TSH was 5.1 and have all the symptoms) my worry is it isn't a high enough dose but rather than increase it, she will tell me to stop? If you see a private Dr, how does it work with prescriptions etc? Thanks

[tattybogle]

presumably you will be due a repeat blood test soon to asses the response to 25mcg Levo ?. If TSH is then 'within range' but not below 2 then show this article to GP (it's from GPOnline and is written by specialist registrars in cardiology and endocrinology) use it to support your request for GP to trial an increase in Levo to an effective dose ,rather than stop it. It recommends getting TSH to between 0.5 -2 healthunlocked.com/thyroidu.... gps-told-keep-tsh-0.5-2pmol-l-hypothyroidism-causes-raised-cholesterol-thyroid-disease-effects-on-heart-and-cardiovascular-system. Link to GPOnline article is in this post.

[BethH77 in reply to tattybogle]

Thank you, will certainly show her and see what her response is.

[SeasideSusie Remembering]

BethH77

Well, I wouldn't be taking antacids for a hoarse voice. When I have been undermedicated my voice goes hoarse, and being a natterer when I was in company and talking a lot I would eventually lose my voice.

The 25mcg Levo you have been started on is enough to switch off what thyroxine you may be producing naturally but not enough to replace that and then provide the extra you need with being hypothyroid, so theoretically you are likely to be more hypothyroid now than before starting the Levo. You should be scheduled for a new test 6 weeks after starting Levo to check your levels, you are very likely due an increase in dose.

If you see a private Dr, how does it work with prescriptions etc?

You pay his consultation fee, you may have to pay extra for the private prescription, then you will pay for the medication when it's dispensed.

[BethH77 in reply to SeasideSusie]

Thank you, I have a test in 2 weeks time so will see what my results are. I am tempted to do my own now......Do you continue to pay the private Dr for repeat prescriptions?

[SeasideSusie Remembering in reply to BethH77]

Do you continue to pay the private Dr for repeat prescriptions?

I don't know for certain as I've never used a private doctor for prescriptions, but you may have to have a consultation every time which will, of course, cost. Whether they charge extra for the private prescription, or whether it is included in the price of the consultation varies I suppose.

Also bear in mind that a private doctor might want tests done before increasing dose, so that's another cost.

[BethH77 in reply to SeasideSusie]

No easy way to bypass the GP then really

[SeasideSusie Remembering in reply to BethH77]

If I were you I'd refuse the antacids, do your next test with GP as scheduled and make sure you follow our advice:

* test no later than 9am, this gives the highest possible TSH which is needed when looking for an increase in Levo or to avoid a reduction

* nothing to eat or drink except water before the tet, this is because certain foods and coffee (possibly other caffeine containing drinks as well) affect TSH

* last dose of Levo 24 hours before the test testing too close to last dose measures the dose just taken and gives a false high FT4, taken over 24 hours away and gives a false low FT4.

As tattybogle says, TSH must be below 2 (2 is maximum and only if you feel well at that level). Make sure you have that reference handy. And for further information there is the following which says you can have low or suppressed TSH if necessary:

From the British Thyroid Foundation:

btf-thyroid.org/thyroid-fun...

How can blood tests be used to manage thyroid disorders?

.....

Occasionally patients only feel well if the TSH is below normal or suppressed. This is usually not harmful as long as it is not completely undetectable and/or the FT3 is clearly normal.

There are also certain patients who only feel better if the TSH is just above the reference range. Within the limits described above, it is recommended that patients and their supervising doctors set individual targets that are right for their particular circumstances.

.....

Also, Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication for doctors):

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"

*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.

You can obtain a copy of this article from Dionne at ThyroidUK:

[e-mail]

print it and highlight Question 6 to show your GP if necessary.

[BethH77 in reply to SeasideSusie]

Thank you. Yes I remembered the early morning test advice (GP dismissed it) but I insisted anyway so have a before 9am appt luckily.

[BP135 in reply to BethH77]

Hi Beth, just stepping in to say that I sometimes take my daughter to the private hospital to see a dermatologist. I pay him £150 for the first consultation, then £100 for follow ups (prices will vary of course, but just to hopefully give an idea), then he gives me a private prescription which I take to my GP and get it put on an NHS prescription so it's free. The GP does not have to do this, but mine can be a bit difficult at times and he has never questioned the private prescription. I hope that helps and I hope you get the advise you need x

[BethH77 in reply to BP135]

That's really helpful thanks x

[CaroleM-A]

You might want to point out to your GP that the lowest therapeutic dose of levothyroxine is 50 mcg and it’s just a starter dose so you would expect more bloods in 6-8 weeks and then an increase in 25 mcg increments until you see improvement in symptoms

At least that’s how it’s supposed to go.

[BethH77 in reply to CaroleM-A]

I did this last time and she scoffed and said I may not be hypothyroid even.......it seems such hard work to be listened to

[CaroleM-A in reply to BethH77]

Perhaps you could see a different GP at the practice?

[BethH77 in reply to CaroleM-A]

Yes good idea.....

[london81]

when i was severely unwell at the outset of my hashimotos and since when i’ve been under medicated, my voice is very hoarse

across the last few years medics have tried to blame it on acids reflux, laringytis, anything except autoimmune thyroid disease which is the actual root cause

the amount of pills they’ve tried to throw at me is ridiculous

don’t take any meds you don’t feel you need just keep on working on your thyroid issues and posting here, it will be much more productive

[BethH77 in reply to london81]

This is my worry, makes me mad that we all have these same issues yet no-one seems to be addressing it? 💁‍♀️ They should be issuing new advice on how to treat us all.......

[london81]

PS if you type in hoarse voice to the search bar you will find lots of info here

are you autoimmune thyroid i.e. have they ever tested your antibodies? if not i would test them privately alongside vitamins e.g. thriva or another private testing service it has certainly helped me indentify deficiencies etc and address my thyroid issues

[BethH77 in reply to london81]

Yes I tested them privately last year but will do them again. I have been tryimg to get my test results for Iron and B12 but just keep getting told they were normal! Thank you

[CaroleM-A in reply to BethH77]

You are entitled to a copy of all your blood test results normal or otherwise. Just say you want a copy for your records

[london81 in reply to BethH77]

yes that old chestnut ‘normal’ or ‘fine’under GDPR your medical records are your data and you can access them by law. write a letter requesting all blood tests result with ranges for relevant period.i did this and so glad i did as i have a chart now showing all my results which helps me no end, plus it’s good when seeing anyone privately to illustrate the patterns etc

[nellie237]

I am sorry you are having such an awful time with your arrogant and awful GP. "Clearly not a thyroid issue"......poppycock. I sounded like a 60 a day smoker when I was diagnosed.

I hope that you get the correct treatment asap.

[BethH77 in reply to nellie237]

Thank you. It is bad that I am kind of hoping the UT scan shows something so I can come under the hospital for treatment.....but I know that may not be any better 🙈 x

[nellie237 in reply to BethH77]

No, perfectly understandable, I'm sure I would feel the same. x