What does endocrinologist mean please?

[weewillywinkie]

After seven months compliance with my endocrinologist’s prescription for T-Convert (amongst other things) but without any discernible improvement to my T3 Levels I wrote to him and requested a trial of Liothyronine.

His reply surprised me and I feel duty bound to investigate before progressing further. (I paraphrase):

“I am assuming that your comment that you are poor at converting T4 to T3 is based on T3 levels at the lower end of the population reference range….. I appear not to have any DIO2 genetic test results (to support the comment)

…. you may not have an optimum level of T3 but that is not quite the same as having evidence of Liothyronine deficiency. It may be that your issue is not actually low levels of T3 as much as poor receptor recognition or cellular usage of T3 or T4

…..This coupled with rules stating that GPs, NHS or private doctors, are not entitled to initiate liothyronine prescribing unless guided to do so by an Consultant endocrinologist, makes it impermissible for me to prescribe as you ask.

…..I can refer you to a London based specialist who I am confident would at least discuss matters with you through a telephone or telemedicine consultation…... I suggest that you contact [name]”

This response has surprised me because until now I understood gentleman could prescribe (and indeed, had previously prescribed) Liothyronine and the restrictions against doing so only applied to NHS doctors.

So, my quandaries now are:

Is “Consultant Endocrinologist a rank of medico I have hitherto been un aware of?

What is a “DIO2 genetic test” and should l I get one?

What does “poor receptor recognition or cellular usage of T3 or T4” mean and how do find out if it applies to me please?

At the moment I intend to contact the individual to whom he refers me but additional comments or advice before I do so will be (truly) gratefully received!

Thank you so much

[shaws]

What does an endocrinologist do?

What is the most common disease treated by an endocrinologist?

Why would you see an endocrinologist?

An endocrinologist can diagnose and treat hormone problems and the complications that arise from them. Hormones regulate metabolism, respiration, growth, reproduction, sensory perception, and movement. Hormone imbalances are the underlying reason for a wide range of medical conditions.

medicalnewstoday.com/articl...

[SeasideSusie Remembering]

weewillywinkie

We can't discuss individual doctors on the forum so I'm not asking you to name this doctor that you are seeing, but am I right in assuming you are paying to see him privately (I'm guessing so because an NHS doctor would not prescribe T-Convert)? Is he on the ThyroidUK list?

I appear not to have any DIO2 genetic test results (to support the comment)

What is a “DIO2 genetic test” and should l I get one?

This test is done by Regenerus and is basically a genetic test which will show if you have any variation of the gene affecting conversion of T4 to T3

More information here:

thyroiduk.org/help-and-supp...

and here:

regeneruslabs.com/products/...

With the second link click on MORE INFORMATION to see a sample report which explains more than I can.

[weewillywinkie in reply to SeasideSusie]

Hello Seaside Susie

Rest assured I fully understand the need for anonymity! However, did indeed obtain his name from Thyroid UK where, intriguingly, he is described as having previously prescribed Lio. I am paying him privately.

Most puzzling to me is his comment: "poor receptor recognition or cellular usage of T3 or T4”.

What does it mean please?

I was not previously aware of this alternative possible cause of low T3 and don't know how to determine if it applies to me. Have I been barking up the wrong tree by addressing Lio deficiency?

,

[RedApple in reply to weewillywinkie]

After seven months compliance with my endocrinologist’s prescription for T-Convert

I've not heard of a medically qualified endo 'prescribing' an over the counter supplement such as T-Convert. This sounds more like a 'functional medicine practitioner' or similar.

Most puzzling to me is his comment: "poor receptor recognition or cellular usage of T3 or T4”.

What does it mean please?

I think it means that this chap is trying to sound superior and as if he knows what he's talking about. Whether he really does is questionable though

[RedApple]

weewillywinkie,

Is this a private Endo you're seeing?

You can check the GMC register to see if he's listed. gmc-uk.org/registration-and...

Here's some information about the DIO2 test thyroiduk.org/deiodinase-2-...

and

regeneruslabs.com/products/...

[weewillywinkie in reply to RedApple]

Thank you RedApple, that is a lot clearer now!

[jimh111]

It's very rare for anyone to have poor T4 to T3 conversion due to nutritional deficiencies. if this were to happen TSH would be very high because the pituitary would be unable to convert T4 to T3 and so wouldn't respond to the fT4 in your blood. T-Convert seems to be a con, some cheap minerals at exhorbitant prices with no evidence to back up claims of "increasing conversion of T4 to T3".

Any doctor can prescribe liothyronine although various NHS quangos try to restrict prescribing to endocrinologists. A study found that a common polymorphism of the DIO2 gene (a gene responsible for one form of T4 to T3 conversion) is associated with reduced conversion and a better response to liothyronine therapy. These effects are very minor, make a small difference to fT3 levels and would not explain substantial symptoms. Nonetheless having the polymorphism often allows doctors to rationalise writing prescriptions for liothyronine.

Your doctor seems confused, if they are an endocrinologist they can prescribe liothyronine (any doctor can). I don't see why they feel you need to see a "consultant endocrinologist", is this doctor not an endcrinologist? Their comment re "poor receptor recognition or cellular usage of T3 or T4" is vague and demonstrates little knowledge of thyroidology.

[weewillywinkie in reply to jimh111]

Wow! Thank you so much! Much to digest

[pennyannie in reply to weewillywinkie]

You have had RAI thyroid ablation and RAI is taken up to a lesser extent by other glands and organs within you body which can lead to symptoms similar to those of fibromyalgia and Sjogrens Syndrome .

Does he make any concession for people who had RAI thyroid ablation ?

Why not ask him about the short and long term consequences to taking RAI and could this contribute to your current heath issues.

[weewillywinkie in reply to pennyannie]

Hello (yet again!) pennyannieTo be honest I've lost a lot of confidence in this gentleman and am minded to start again.

Thank you so much for your interest and help

[jimh111 in reply to pennyannie]

Have you read somewhere that T3 receptors influence conversion? I ask because deiodinase is regulated by enzymes and so as far as I know thyroid hormone receptors are not involved.

[weewillywinkie in reply to jimh111]

Hello jimh111

No, I haven't. In fact I am still feeling my way through all this and the latest advice from my endocrinologist has only muddied the waters even more!

[jimh111 in reply to weewillywinkie]

No problem at all. I do suspect RAI can have effects elsewhere in the body. Going by patient reports it seems to but I don't think any useful research has been done. Personally I would try to avoid RAI or use the lowest effective dose but that is a gut feeling rather than sound logic.

[pennyannie in reply to jimh111]

Yes, I did, but I'm afraid I haven't a clue where I read it :

I'm sorry, maybe I should refrain from writing that as I can't substantiate the information.

What I have now written I read in Elaine Moore's first book

Graves Disease - A Practical Guide :

Apolgies.

[SlowDragon Administrator]

Previous post results

CRP HS: 3.4mg/l (Range 0-5)

Ferritin: 169 ug/L Range 30-400)

Folate: 11.9 ug/L (Range > 2.9)

Vitamin B12: 153 pmol/L (Range 25.1-165)

Vitamin D: 129 nmol/L (Range 50-200)

TSH: 0.69 mlU/L (Range 0.27-4.2)

Thyroglobin Antibodies: 57.6IU/ml(Range 0-115)

Thyroid Peroxidase Antibodies: 84.4IU/ml(Range 0-34)

Free T3: 3.4 pmo/L (Range 3.1-6.8)

8.11% through the range

Free Thyroxine: 23.pmol/l (Range 12-22)

110% through the range

150mg Levothyroxine daily

Shows poor conversion

Vitamin levels are good

Have you had coeliac blood test done

Are you on strictly gluten free diet or tried it

Clearly needing T3 prescribed alongside (slightly reduced dose) levothyroxine

Common after RAI