I just thought i would update you on my doctors appointment this morning
I went in with copies of my medichecks blood test results hoping for a small increase in my levothyroxine (currently on 100mcg) and to get tested for coeliac disease.
He wasn't really interested in the medichecks results ( i offered him a copy) and when i asked about the T4 & T3 he said they only work on TSH results because T4 &T3 only measure the medication in your system not how it's working. When i queried this because T4 needs to convert to T3 as this is what my body needs he said again its only a measure of medication in my system.
When i asked for an increase in medication - for my weight the 1.6ug/kg/day would work out at 150mcg/day - he said that they only used that formula for first medicating, not when I'm already on Levothyroxine.
He did agree that because after the increase in medication in february that something is amiss if my TSH is showing "everything is ok" and i'm still feeling ill so i'm booked in for full bloods, coeliac test, menopause, diabetes .... the full works.
He also said i shouldn't be blinkered into thinking my problems are all thyroid related - blood tests are booked for 14th at 0800 so i shall have to wait and see!
Thank you all for the advice you give on this forum - i could literally spend all day reading through the posts and gaining information.
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Jocarter
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Oh dear oh dear oh dear! Does he actually have a working brain?
they only work on TSH results because T4 &T3 only measure the medication in your system not how it's working.
Well, of course that's what it measures! What else would it measure? lol That's what you want to know. And, what does he think the TSH measures? I'd really love to have a chat with this guy. I don't think he has a clue how the feed back system works.
When i asked for an increase in medication - for my weight the 1.6ug/kg/day would work out at 150mcg/day - he said that they only used that formula for first medicating, not when I'm already on Levothyroxine.
Duh How does he work that out? Talk about gobbldegook. He hasn't understood a darned thing! Can't you see someone else who might be capable of thinking?
I think doctors forget that we are 'human beings'. It s not 'one size fits all' with regard to thyroid hormone replacements.
Do GPs think we are 'robots' and are identical to what our bodies' symptoms will be?
The 'true experts' (being kind) know absolutely nothing on how best to return hypo patients to good health and symptom-free. Rarely is FT4 and FT3 tested either.
All of our 'old-fashioned doctors' had no need of blood tests to diagnose patients as all of their skill was upon the human being who had a dysfunctional thyroid gland. No blood tests were necessary (not invented at that time) and all the emphasis was upon 'how the patient felt' on a particular dose of NDTs.
Natural Dessicated Thyroid Hormones were removed from being prescribed in the UK despite it restoring people's health from 1892 onwards. No need for blood tests but the skill and knowledge of the doctors saved lives.
That comment about 1.6ug per kilo made me laugh. I dont know anyone who started out a replacement event dose based on weight. Its nearly always 50mcg at first, then slowly increased. Unless you are over 65 or have a heart condition, when it's 25mcg. Your GP is a dunce.
Well, as often with GP's and Endo's , he's taken a fact that's 'half right' .. and then used it to put an end to any further more interesting/ helpful discussion .
So yes , fT4 /and fT3 tests do only measure what's in the blood . True .
"The TSH tells you how they are working" .... not quite so true, not at all so 'black and white' .. The TSH tells you how T4/T3 are working on the cells in your hypothalamus and your pituitary gland .... you still have no idea how they are working in the rest of the cells of your body unless you chop bits of it off and send a bit of your heart/ muscles / skin/ brain to the lab ... and this is why they should not just look at fT4/3 OR the TSH.. they should look at the bloody patient and listen to what symptoms they are describing .
The hypothalamus and pituitary (TSH ) can be saying "this dose is enough, thanks" ... but your heart muscle or brain might not agree with it .
So your TSH can only tell him how Levo is working on 'some bits of you' ( assuming those bits are working properly in themselves , which is a big assumption ! ).
and TSH has many other failings which make it unsuitable for deciding/limiting / adjusting dose ... eg. once you take only T4 , the TSH setting is a bit altered from where it was 'set' when you were healthy and getting some T4 and a bit of T3... and TSH has several other 'issues' . for further reading, see diogenes posts.
And yes , "1.6mcg/kg is a formula designed to be used to estimate the starting dose of people who have just had a total thyroidectomy" .. True.
But that doesn't mean it bears any relation to what they actually end up on .. and equally it doesn't mean it can't ever be useful as a guide to the likely/ expected/ reasonable dose for someone who is already on levo replacement .
Hi. OK, so his knowledge of thyroid isn't great, or maybe he just didn't explain it properly, but it's good that he did correctly state that not all problems are thyroid related and he is going to investigate with further blood tests. There is an overlap of symptoms for thyroid problems and other illnesses so he's right to check out why you're still feeling ill. Hopefully you'll get a fuller picture soon.
but it's good that he did correctly state that not all problems are thyroid related
Still, would it not be better to optimise thyroid treatment first (looking at the free Ts, especially free T3, and symptom-relief) before looking for other reasons? Far too many undertreated thyroid patients end up on blood pressure meds, beta-blockers, anti-depressants, anti-anxiety drugs, weight loss drugs, etc, when all that was needed in the first place was to optimise thyroid hormone replacement (making sure there is enough FT3 for the body´s needs). This doctor seems to be really bad, totally clueless about thyroid disease and treatment, so I would not put much faith in anything he says. In my own experience, doctors are all too happy to prescribe all sorts of drugs, as long as they don´t have to increase levo or add T3...because they don´t know enough about it all, and they are terrified of a low TSH...! So, it´s in their interest to say that symptoms are not thyroid-related, when the truth is they have no idea...they are just looking for a way not having to increase levo or, God forbid, prescribe T3 because that scares them. Many doctors seem to think that thyroid hormone is dangerous, which is strange given how many other drugs they are all too happy to prescribe...with far worse side effects!
Don’t you just love this type of doctor so unsympathetic and dismissive and its been my experience that any blood test I paid for gets ignored even if its the same ones my Endo ordered…. I guess these doctors think your paying the Lab tech extra money to provide you with altered lab results…. Looney.
What I am saying is that the TSH does not tell us everything, and that you should rule out low free Ts before dismissing symptoms as not thyroid-related. That´s all.
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