Form FP92A Hyperthyroidism

[cathdecaf]

I've been diagnosed with hyperthyroidism. Picking up my first Carbimazole prescription today. My pharmacist and GP have confirmed I am entitled to free prescriptions and I was given form FP92A. I cannot figure out which medical condition I'm meant to tick on the form. I've googled the hell out of it, to no avail. Can anyone help, please?

[JenniferW]

Fill in the rest of it and hand it in to your GP practice with a note attached saying could they tick the right box for you before sending it off as you can't work out which box corresponds to your condition. Then it's on the doctor if there's a mistake.

[SeasideSusie Remembering]

cathdecaf

The only thyroid condition listed that entitles a patient to free prescriptions is "myxoedema (hypothyroidism requiring thyroid hormone replacement)", in other words hypOthyroidism/underactive thyroid. HypERthyroidism/overactive/Graves disease is not listed.

Certain benefits also entitle a person to free prescriptions or if you are over 60, under 16 or 16-18 in full time education.

Ask your pharmacist of GP exactly what entitles you to free prescriptions. Do please let us know as this may be useful to other members.

[RedApple Administrator]

cathdecaf, Unless something has changed very recently, only hypOthyroidism, not hypERthyroidism is eligible for free prescriptions. thyroiduk.org/help-and-supp...

[cathdecaf]

Thanks, everybody. I wonder why that is? My doctor said there was a good chance it will be a lifelong condition. Is it because hyper has a chance of being cured and if not, it could tip into hypo at some point? I will have the form taken to my surgery today and if I can get some confirmation back, either way, I will let you know. Thanks again.

[RedApple Administrator in reply to cathdecaf]

Yes, people with hypER can (no guarantees of course) go into remisssion. People with hypO need replacement thyroid hormone medication for life.

[PurpleNails Administrator in reply to cathdecaf]

Doctors say they don’t like patients on carbimazole long term.   Policy is set to limit use to around 18 months.   

Doctors suggest definitive treatment if not in remission naturally at that stage. (often strongly & imply there is no other option to Radioactive iodine or surgery) 

These both result in hypothyroidism, so the treatment induces the need for lifelong treatment.  

This might be why replacement it’s a medically exempt treatment. 

[cathdecaf in reply to PurpleNails]

That makes sense. Thanks.

[pennyannie in reply to cathdecaf]

Well, yes both Graves and Hashimoto's are lifelong conditions as both are auto immune conditions that tend to attack the thyroid and eyes - but it is important to know which one you are dealing with.

Graves can burn itself out - given enough time.

pubmed.ncbi.nlm.nih.gov/338...

Hashimoto's systematically disables the thyroid over a period of years and the patient will become increasingly reliant of thyroid hormone replacement.

[pennyannie]

Hello Cathdecaf and welcome to the forum :

I'm sure I paid for my Carbimazole - though some time ago now.

Do you have a diagnosis of which thyroid antibodies were found over range and positive and a copy of this first blood test showing, presumably, over range T3 and or T4 blood test readings ?

How are you feeling ?

The Carbimazole is an Anti Thyroid drug and basically blocks your own daily thyroid hormone production and puts you into a holding pattern while we wait for the T3 and T4 levels to fall back down into range and hopefully your symptoms relieved.

Your immune system has been triggered and decided to attack your thyroid and there is more than one reason why this can happen and different treatment options and why you do need to know exactly which thyroid antibodies have been found as positive in your blood.

[cathdecaf in reply to pennyannie]

pennyannie, thank you. I haven't been given any details of my levels. I'm planning to get the surgery to allow access to my test results or get them printed off. I had vomiting, headaches and nausea the first two weeks. I have an elevated heart rate and generally feel fatigued and rubbish. I've been on beta-blockers for a few days. Hoping the Carbimazole will assist in getting off those, under GP assistance of course.

[pennyannie in reply to cathdecaf]

OK then - the beta blocker will also ' slow ' T4 to T3 conversion and assist in alleviating symptoms experienced.

What doses of both medications have you been prescribed ?

Please do get the proof of diagnosis which can be run from this very first blood test as not all reasons for hyperthyroidism are treated with Carbimazole.

Register for ' on line ' access to your medical records and just pop the results and ranges up on this forum for further explanation and advice.

Unless you are aware of a swelling or obstruction when eating or breathing there are 2 thyroid auto immune disease you could be looking at :-

Graves Disease - is treated with Carbimazole : elaine-moore.com

Hashimoto's Thyroid Disease is not treated with Carbimzole but you do end up hypothyroid and treated with T4 - Levothyroxine and which is ' exempt ' and you do not need to pay for your prescription.

thyroidpharmacist.com

You might like to dip into Thyroid UK who are the charity who support this patient to patient forum where you can read further on all things ' thyroid ' :

thyroiduk.org

[cathdecaf in reply to pennyannie]

I was started on a low dose of Propranolol as my blood pressure is v slightly on the low side. 10mg x 3 a day. That didn't help, so upped to 20mg 3 times a day. I feel like I have pockets of time now, where I can actually do something but not having a great day so far today. I won't know my Carbimazole dosage until the prescription is picked up for me later today. I can't access my records until I go to the surgery. They will only do it face to face for some reason. It's going to be a while until I can get there again. Trying to talk to the receptionists on the phone is an exasperating brick wall situation. Thank you for all the information. It's so helpful. I feel I'm at the beginning of a massive learning curve.

[pennyannie in reply to cathdecaf]

I think we have all experienced that brick wall - so try not to take it personally and be further stressed by the system.

Rest, try and relax and do stuff you enjoy doing - are you signed off from work ?

[cathdecaf in reply to pennyannie]

I'm trying to, thanks. I'm not working but my partner works from home, so I have help when I need it. I'm listening to my body but I can't wait until I can go for a walk!

[pennyannie in reply to cathdecaf]

OK then - the thyroid is the victim in all this and not the cause -

The cause is one of your immune system having been triggered to go on the attack,

Depending on which AI disease you are dealing with you can help yourself and learn of your own ' triggers ' and how to calm down your own immune system response.

[PurpleNails Administrator]

This link takes you to a form which asks you questions about location, circumstances & medical conditions.  

It’s different depending if in England ect.  

services.nhsbsa.nhs.uk/chec...

I been on carbimazole years & it’s never been medically exempt.  

Myxoedema - For example, hypothyroidism which needs thyroid hormone replacement

If you are prescribed. Block & replace you would be taking carbimazole & levothyroxine, and that’s expected to be long term.  That can qualify for med ex. 

Is your carbimazole temporary - eg is surgery or Radioactive iodine treatment planned soon & hypothyroidism treatment expected soon?

The same link explains options at end of form.  

There is the option for prepayment of prescription.  The certificate covers all your NHS prescriptions for a set price. You will save money if you need more than 3 items in 3 months, or 11 items in 12 months.

What is the cause of your hyperthyroidism?

[helvella Administrator Thyroid UK in reply to PurpleNails]

We've seen several discussions about whether Block and Replace qualifies or not.

I suspect a lot depends on the view of the person signing the form. I'm sure we've had some who were refused, and others who got exemption.

[PurpleNails Administrator in reply to helvella]

My guess would be some doctors will be prepared to say the levothyroxine part is ultimately expected to be lifelong or long term.  

Others will state block & replace is a temporary treatment.

I agree it will depend on the person “signing off”

[cathdecaf]

Purple Nails, I'm not sure of the cause. I have been subclinical hyper for a few years, untill I became very ill the last few weeks. My GP contacted the endo (who I don't expect to get an appointment with for a few months) and he gave them a prescription based on my blood test results. I am booked in for more blood tests in 3 weeks time. Thanks for all the information. I didn't know about prepayment. Very helpful, thanks.

[PurpleNails Administrator in reply to cathdecaf]

Sub clinical likely means your TSH (thyroid stimulating hormone) is low.  This is a pituitary hormone which signals thyroid to produce.    The opposite occurs with low (hypothyroid) - it rises telling the thyroid more is needed.  

When the TSH is low it’s assumed thyroid hormone are high, but sub clinical mean your TSH is low but your thyroid levels may not necessarily be over range.  

Doctors focus in TSH.  They are prescribing Carbimazole which will lower thyroid hormones & if kept low enough for long enough your TSH *should* rise into range.

I was likely subclinical many years but once I reached hyperthyroid levels carbimazole was given & it lowered my levels to hypothyroid levels but my TSH did not respond.

TSH is not reliable there are many reasons why it becomes low.

  I recommend you get copies of all your results (with lab range) and ensure doctors are watching your FT4 (Free thyroxine) & FT3 (free triiodothyronine) and not allowing you to become too low. 

You can always post results on here & we can fully explain what they mean.  There is lots & lots to learn. 

How much carbimazole have you been prescribed? 

Doctors should ideal be confirming cause & not making you hypothyroid to force TSH to be in range.   

Have antibodies been tested?

Have you had ultrasound of thyroid?

Hashimoto’s or autoimmune thyroiditis often causes thyroid fluctuations in early stages.  Ultimately the damage autoimmune attack causes low function, they may suspect this if mentioned you may ultimately become hypothyroid (carbimazole will hasten the path to hypothyroidism - not correct treatment)

Graves causes continuous stimulation to thyroid, levels tend to go very high very quickly, so carbimazole required to manage levels until in remission.

 I have a toxic nodule causing elevated levels, this can occur slowly over years and is confirmed by a nuclear uptake scan to show function of thyroid. This issue doesn’t remit, carbimazole would be required lifelong or can consider further treatment early on.

Each condition needs to be treated differently.  

If you have any questions please ask.

PS: see you also have propranolol. Reduce slowly once ready to finish. I was made unwell when told to stop abruptly. Now take low dose as migraine preventer.