I’m being fired from my GP practice because I’m taking too much Levothyroxine

[Serendipitious]

Please help. Went to the GP and had the misfortune of seeing the nasty senior partner for a skin rash that won’t go away.

Transitioned from Metavive to Levo in October 2021 but TSH is still around 0.08.

He’s told me he can’t keep me on as I could have a heart attack. FT4 is ok and FT3 is low in range. He can only give me 75mcg. I cannot function on 75mcg I need 100mcg.

How can I challenge this imbecile? Or I am stuck between a rock and a hard place.

[Star13]

Personally I’d find a new GP. The senior partner will be influencing all other GPS in the practice so I think your fighting a losing battle personally plus the stress on you is not worth it. You could go the complaints route but if he digs his heel in……

[Serendipitious in reply to Star13]

Yes when he said that to me today I considered it as the easy route but what if they have the same attitude at another practice? I have one particular GP there who is really helpful but that’s just the one.

[rogergee]

Speak to PALS (Patient Advice and Liaison Service) at the CCG (Clinical Commissioning Group) for your area.

[Jazzw]

I’m so sorry. There must be an awful lot of patients registered with your surgery who are condemned to living miserable lives because of this idiot.

Do you think you’d get anywhere by putting evidence that having a low TSH can be ok in front of him?

For example:

academic.oup.com/jcem/artic...

Interestingly, patients with a serum TSH below the reference range, but not suppressed (0.04–0.4 mU/liter), had no increased risk of cardiovascular disease, dysrhythmias, or fractures. It is unfortunate that we did not have access to serum free T4 concentrations in these patients to ascertain whether they were above or within the laboratory reference range. However, our data indicate that it may be safe for patients to be on a dose of T4 that results in a low serum TSH concentration, as long as it is not suppressed at less than 0.03 mU/liter. Many patients report that they prefer such T4 doses (9, 10). Figure 2 indicates that the best outcomes appear to be associated with having a TSH within the lower end of the reference range.

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

I think you can obtain a copy of the articles from Thyroid UK to either email or print it out and highlight question 6 to show your doctor

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[e-mail]

[Serendipitious in reply to Jazzw]

Yes there's a few bad reviews for this particular GP and I can see the other staff just put up with it.

Thanks for all that information. The issue I have is that I acknowledge that my TSH should really be in the reference range of 0.3-2.0? Can't quite remember exact range but putting me on 75mcg isn't going to do that. Well it's going to make me rather unwell at the expense and it still may not come back into the normal range. I've already seen a private endo who has recommended looking into a synacthen test and investigating pituitary function. Doubt there's an issue in that department, but the point is this senior partner isn't aware of all this history as I usually avoid seeing him and I suspect he may still not buy it.

He will just right seeing as TSH is too low on 100mcg thats why I want you on a lower dose. He's not interested in FT4 and FT3 at all. I think I'll have to work on an appropriately tailored letter. There again like somebody else here said he may still not buy it.