What questions for GP?

[Dandelade]

Hi,

Thank you all for previous responses. I have an appointment with GP next week where I’ll be discussing the results from private results.

I know (thanks to you all) that I need to ask/say the list below. My question is given my symptoms, which I’ll list below too, is there anything I’m not aware of that I should be asking?

1. Share results and symptoms, ask for levothyroxine, be prepared to be told to retest private results.

2. Ask for vitamins to be checked at same time (vit d, ferritin, folate, b12).

I’ve already been low carb/ mostly keto now for a few months as was insulin resistant and see this as a lifelong change so would rather not ask for celiac test as don’t want to go back to high carb content. Is this reasonable?

Main symptoms:

A. Extreme tiredness

B. Slurred/ stuttering speech

c. Brain fog lack of concentration

D. Dizzy

E. Nausea

Given the controversy surrounding keto and hypothyroid do I even mention this? Might they put down the hypothyroid to my diet? I don’t think this is the case as the literature I’ve read says it may decrease t3. Which ironically is within range but high tsh, high antibodies and low free t4.

The other question I have is, do levels fluctuate? Some days I’m ok and some not, with no observable reason. Is there a danger of catching my levels on a good day and is there anything I can do to prevent that?

Thank you so much for reading.

[tattybogle]

"Given the controversy surrounding keto and hypothyroid do I even mention this? Might they put down the hypothyroid to my diet? "

GP's unlikely to be interested or knowledgeable about keto diet/effects on thyroid bloods.

But no , they wouldn't consider it a cause of your high TSH .. no point mentioning it .

It would just distract the conversation from what is important .. ie .. confirm high TSH/start Levo .

"The other question I have is, do levels fluctuate? Some days I’m ok and some not, with no observable reason. Is there a danger of catching my levels on a good day and is there anything I can do to prevent that?"

TSH has a circadian rhythm ...is highest middle of the night/very early AM , and gradually falls to its lowest around 1 -2 PM (ish )... (which GP's seem unaware of )

So make sure you only book appointments for NHS thyroid blood tests as early in the day as possible .. preferably before 9 am.

But don't worry , since your TSH is as high as it is .. this small daily variation will not take it low enough to be back in 'normal' range.

As for feeling better some days than others ... aside from the predictable daily rhythm , TSH level is actually pretty stable and slow moving .... it wouldn't be high on a 'bad day' and low on a 'good day' .

I recommend you don't mention daily fluctuations in symptoms to a GP when wanting a hypothyroid diagnosis .. they have been trained to think that day to day variations in symptoms cannot possibly be related to thyroid .. so if you mention it .. they will start thinking about 'other causes' .. which you don't want .. you want them to be thinking about thyroid . eg a patient says "i feel cold all the time, and have done for months".. they will think 'hypothyroid?'.... but if patient says "i feel OK one day, and rubbish the next ".. they will think "well that can't be anything to do with thyroid hormones , they don't work like that"

They are unlikely to consider asking for a coeliac test unless you push them to do one .. so if you don't want to do one that 's fine...

[Dandelade in reply to tattybogle]

Thank you so much, that is really helpful advice!