First GP appointment advice on what to ask please

[Mst27]

The receptionist at my gp surgery told me that my blood tests showed that I had an under active thyroid and vitamin b12 deficiency. I have an appointment tomorrow morning and I wondered if anyone had any advice on what to ask. I thought that I was experiencing symptoms of the menopause and have not felt myself for months. From what I have read most of my symptoms could be related to the two conditions listed above. I am pretty desperate to start feeling better so I am hoping that I can start treatment. Is it likely that I would be started on treatment straight away ?

Any advice or help would be greatly appreciated

[tattybogle]

Is it likely that I would be started on treatment straight away ?

For underactive thyroid (hypothyroidism ) that would depend on the actual numbers on this blood test.

TSH.. this is a message from the pituitary to the thyroid, to ask for more (or less) thyroid hormone (T4) to be produced .. so TSH goes up when we are hypothyroid (not enough T4) and it goes down when we have enough/too much T4.

When we are producing the right amount of T4 , TSH stays around 1 for most people .. but the range is usually 0.4 to 4.5 (ish) (You must have gone over range for them to mention underactive thyroid to you ).

* If it's your first over range TSH result ...

if it is over range but still under 10.... they will want to repeat it in about 3 months (to see if it gets better on it's own ) before prescribing Levothyroxine .

If it is already higher than 10 .. they are more likely to start you on Levo straight away.

* fT4 (free T4) this is the actual thyroid hormone .. (T4 gets turned into T3 which works in your cells .. if T4 / T3 is low TSH rises.

If TSH is over range, then the lab will usually test fT4 too (to see why TSH is high)

If TSH is over range(but under 10) and fT4 is still in range .. then they will retest after about 3 months.. sometimes earlier.

If TSH is over range AND fT4 is under range they may start you on Levo straight away.

Hypothyroid symptoms and the presence (or not) of thyroid antibodies (indicating autoimmune thyroid disease) will also play a part in the GP's decision to start Levothyroxine

[SlowDragon Administrator]

See flow charts on here regarding when to start levothyroxine

Clinical hypothyroidism ….levothyroxine must be prescribed now . If test results show TSH is over 10, and/or Ft4 below range

Subclinical hypothyroidism - means levothyroxine could be started after 2nd abnormal test

If TSH is over 5 after 2 separate blood tests three months apart ….plus symptoms….levothyroxine could/should be prescribed

gp-update.co.uk/Latest-Upda...

Other test results

About 99% of primary hypothyroidism is autoimmune thyroid disease diagnosed by high thyroid antibodies.

If GP hasn’t yet tested thyroid antibodies, request they test them

Also very important to test vitamin D, folate, ferritin and B12 as these are often low when hypothyroid

Starting levothyroxine

Standard starter dose of levothyroxine is 50mcg

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

Different brands of levothyroxine

Unless you know you are lactose intolerant, best to avoid Teva brand levothyroxine initially as it frequently upsets many patients

Most easily tolerated and easily available brands of levothyroxine are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but Accord doesn’t make 25mcg tablets

beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Blood tests

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

Dose levothyroxine is increased slowly upwards in 25mcg steps over several months until on full dose.

[Sparklingsunshine]

Hi

A lot depends on your results, if you can access them online you could post them with the reference ranges. You might be very hypo in which case you are likely to be offered Levothyroxine straight away or they might adopt a wait and see approach. It depends how high your TSH results were and if they measured FT4.

I first had blood tests in February 2020 for thyroid, mine came back borderline hypo. So had to wait 3 months and they retested again in June that year and I'd gone into the abnormal range with low FT4. So I got 50mcg of Levo and its increased steadily ever since. My results are far from optimal but I keep taking the tablets. They usually test every 6-8 weeks after a dose increase.

As regards B12 well again this depends on why you're deficient. If its diet related you're likely to be told to increase dietary sources of B12 or offered high strength supplements.

However if its Pernicious Anemia, like I have, then no amount of tablets will help because we can't absorb B12 because we lack an enzyme produced by the stomach called intrinsic factor. So in that case you are likely to be offered B12 injections which go into your upper arm.

Depending on how low your level is they give you a series of jabs called a loading dose. I think I had 5 every other day then it's a jab every 10-13 weeks. They sting a bit but they can really make a huge difference to how you feel. I know when I need one for sure.

B12 deficiency can be debilitating and untreated can cause permanent neurological damage so it needs sorting out. Hopefully you'll feel better soon.

[PurpleNails Administrator]

It might be best if from now on you get a hold of your blood test results, to see exactly what has (& hasn’t) been tested as well as what the results are.

Its ideal to arrange online access, ask if your practice offer it. If not obtain copies via reception. Don’t ask Dr they don’t like it & don’t accept verbal or hand scribbled notes you need a printed copy with ranges (ranges vary between labs so essential). They shouldn’t ask why but if they do try to resist just say they are for your records. You are legally entitled to them.

For full thyroid function you need:

TSH

FT4

FT3

TPO & TG Antibodies

Folate

Ferritin

B12

Vitamin D

You know B12 is an issue, if you have an underactive thyroid other nutrients are often low & dr may not have tested them all. You need optimal levels. Especially if you need to begin replacement thyroxine (levothyroxine) if levels not optimal it won’t work well. Optimal is not same as in range which what doctors are satisfied with.

[Mst27]

Thank you for your replies. I will update tomorrow with actual blood test results if possible.

[Mst27]

Hi my appointment went well I think. My test results were T4 11.5 (11.0-21.2)

TSH 6.94 (0.27-4.2)

Vitamin b12 195 (197-771)

Folate 2.8 (3.0-20.0)

I have been prescribed 25mg of levothyroxin once a day and supplements for 100mg b12 and 5mg folic acid. I have also been told to take 2000mg of vitamin d but this has not been prescribed. The supplements are for 2 months and I have been advised to try to increase these through my diet.

I know from reading on here to take the levothyroxin on an empty stomach and not to eat for an hour after but wondered if there are any rules about taking the supplements. I thought I had to wait for 2 hours after taking the levothyroxin which I did but not sure I have this right. Also wondered what people thought about my results are they pretty normal for people with an under active thyroid? If there is a normal!

Thanks again for any help understanding all of this it’s a lot to take in when your brain is full of fog .