Gp Update!: So I’ve just spoken to the gp and I... - Thyroid UK

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Gp Update!

PrincessAnnie profile image
19 Replies

So I’ve just spoken to the gp and I have to say it went better than I thought.

Firstly I don’t have coeliac disease,there’s slight inflammation there,so she wants me to take omeprazole for a few months,it said in the report certain medication can cause this.

I have Gilbert’s syndrome,or so I’ve been told,my liver and kidney bilirubin always shows slightly high so she wants me to do a test to confirm this,first time anyones even suggested that!

Vitamin D and blood sugar tests aren’t back yet but I already have my private vitamin d test to know it’s fine.

The big one THYROID!

I’m on the list for the endocrinologist and have been since last March,I’ve to hand a copy of the private blood tests in and she’s gonna email them over to them,I’m in complete shock🤦‍♀️I said about my T3 being low and she said that they don’t really know all the ins and outs of that or liothyronine and that it’s better to wait and see what endocrinology come back with,I said to her,at least you’re honest!

I finally feel a bit more positive🙏

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PrincessAnnie
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19 Replies
SlowDragon profile image
SlowDragonAdministrator

Medichecks results here

healthunlocked.com/thyroidu...

Omeprazole is a PPI to treat HIGH stomach acid

With such low Ft3 you’re more likely to have LOW stomach acid

Low stomach acid can be an extremely common hypothyroid issue and has virtually identical symptoms to high stomach acid

Low stomach acid rarely considered by a GP

Thousands of posts on here about low stomach acid

healthunlocked.com/search/p...

Web links re low stomach acid and reflux and hypothyroidism

nutritionjersey.com/high-or...

articles.mercola.com/sites/...

thyroidpharmacist.com/artic...

stopthethyroidmadness.com/s...

How to test for low stomach acid

healthygut.com/articles/3-t...

naturalendocrinesolutions.c...

meraki-nutrition.co.uk/indi...

huffingtonpost.co.uk/laura-...

lispine.com/blog/10-telling...

Protect your teeth if using ACV with mother

healthunlocked.com/thyroidu...

Ppi

Omeprazole will tend lower vitamin levels

If you must take it, take it as far away from levothyroxine as possible

gov.uk/drug-safety-update/p...

webmd.com/heartburn-gerd/ne...

pharmacytimes.com/publicati...

PPI and increased risk T2 diabetes

gut.bmj.com/content/early/2...

Iron Deficiency and PPI

medpagetoday.com/resource-c...

futurity.org/anemia-proton-...

onlinelibrary.wiley.com/doi...

sciencedirect.com/science/a...

PrincessAnnie profile image
PrincessAnnie in reply to SlowDragon

Thank you for your knowledgeable reply again,I did stress I wasn’t keen to take them as I’d read up about stomach acid,this has just confirmed I won’t be taking them🙏

SlowDragon profile image
SlowDragonAdministrator in reply to PrincessAnnie

Suggest you do the stomach acid test on yourself

shaws profile image
shawsAdministrator in reply to PrincessAnnie

We always have to check new prescriptions given to us just to ensure none of them interfere with the uptake of thyroid hormones.

Some people can be sensitive to the fillers/binders in a tablet.

PrincessAnnie profile image
PrincessAnnie in reply to shaws

I really only take my levothyroxine and vitamin d.

shaws profile image
shawsAdministrator in reply to PrincessAnnie

Levothyroxine gave me intense palpitations but many people find that it's fine for them. Not many who take levo and feel well will be searching the internet for help/advice.

Few GPs have knowledge of how best to diagnose/treat patients who've hypothyroidism. Even when my (before I was diagnosed) TSH was tested my GP phoned to tell me that I had no problems at all. He did not know what a TSH of 100 meant, i.e. that it was too high! I cried because I was so very unwell.

pennyannie profile image
pennyannie in reply to SlowDragon

Starmen

SlowDragon profile image
SlowDragonAdministrator

Your post RAI for Graves’ disease, so it’s always worth trying strictly gluten free diet

consider trialing strictly gluten free diet for 3-6 months. Likely to see benefits. Can take many months for brain fog to lift.

If no obvious improvement, reintroduce gluten see if symptoms get worse.

chriskresser.com/the-gluten...

Suggest you trial strictly gluten free diet BEFORE starting on PPI

Did you get dose increase in levothyroxine to 100mcg?

TSH far too high for someone on levothyroxine

PrincessAnnie profile image
PrincessAnnie in reply to SlowDragon

She wants to wait and see what the endocrinologist comes back with.

SlowDragon profile image
SlowDragonAdministrator in reply to PrincessAnnie

Jesus wept

How much do you weigh in kilo

If these guidelines work in your favour push for 25mcg dose increase in levothyroxine (even if you only increase initially by 12.5mcg per day ….wait 6 weeks then retest )

guidelines on dose levothyroxine by weight

Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

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

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking levothyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Aim is to bring a TSH under 2.5

UK guidance suggests aiming for a TSH of 0.5–2.5

gp-update.co.uk/SM4/Mutable...

Persevere - have all guidelines printed and be ready to quote them

healthunlocked.com/thyroidu...

PrincessAnnie profile image
PrincessAnnie in reply to SlowDragon

I weigh 8 stone,no idea how much that is in kilo,oh don’t worry I’ve all that ready should they prove to be unhelpful,I had it all ready for the gp this morning🤣🤣

SlowDragon profile image
SlowDragonAdministrator in reply to PrincessAnnie

So dose by weight not going to help push for much of dose increase

8 stone = 50.8 kilo

50.8 kilo x 1.6mcg = 81.28mcg per day

81.28th get x 7 days week = 568.96mcg per week

Approx 570mcg per week

Currently on 75mcg per day = 525mcg per week

Might be able to push for an extra 50mcg per week

PrincessAnnie profile image
PrincessAnnie in reply to SlowDragon

I take 75mg one day and 100mg the next and alternate days like that.

SlowDragon profile image
SlowDragonAdministrator in reply to PrincessAnnie

So you’re at the recommended dose by weight but it is only a guideline…many people need higher dose

TSH over 2 suggests under medicated

Ft4 conversion to Ft3 is poor/terrible

To improve conversion before adding T3

Getting all four vitamins optimal and maintain at optimal levels

Trialing strictly gluten free diet and dairy free diet

Always get same brand levothyroxine at each prescription

Trailing liquid levothyroxine…..usually as a split dose

PrincessAnnie profile image
PrincessAnnie in reply to SlowDragon

My blood sugar results weren’t back though,do you think if there’s diabetes it can have an affect,I know it’s one of the things to be ruled out on guidance for prescribing T3.

Gcart profile image
Gcart in reply to PrincessAnnie

Sorry to intrude but can you help me understand the problem with diabetes and T3 that is suggested ? Thanks

. I am diagnosed prediabetic and take T3

PrincessAnnie profile image
PrincessAnnie in reply to Gcart

I’m not too sure which is why I’ve asked SlowDragon .I just know it’s one of the things that had to be ruled out on the nhs England guidelines before prescribing liothyronine.

SlowDragon profile image
SlowDragonAdministrator in reply to PrincessAnnie

Vast majority of endocrinologists are diabetes specialists and waste of time

PrincessAnnie profile image
PrincessAnnie in reply to SlowDragon

I’m hoping I can get some T3 but we’ll have to wait and see,I’m not building my hopes up😤

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