Advice - re paying for a private endocrinologis... - Thyroid UK

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Advice - re paying for a private endocrinologist ( I’m new here)

emmaboultwood profile image
14 Replies

Hello,

I’m just reaching out to see if anyone can advise.

I have had an under-active thyroid for the past 13 years and take 150mg Levothyroxine. They have only ever tested my TSH bad Free T4 levels ( I have asked for them to do T3 levels but this was declined).. Four years ago I put on 2x37.5mcg estradot twice weekly. Just recently having accessing my records I can see that at this point my stable TSH that was always in range changed to 0.01 but a note was put by it “normal for patient”. My Free T4 levels have fluctuated the past 4 years and just recently two months ago went up to 29pmol/L my medication was reduced to 125mg of Levothyroxine and these are my latest results:

TSH 0.01 mIU/L (0.30 - 4.20) -7.4%

Free T4 (fT4) 20.3 pmol/L (11.00 - 22.00) 84.5%

I’m not feeling great, and have a lots symptoms but wonder if considering that I simply can’t even get a doctors appointment at the moment to go privately. I’m a student mental health nurse so money is a bit tight. I just want a clear understanding of what’s going on as I feel that my treatment plan isn’t correct.

Thanks for reading and any feedback would be so appreciated.

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emmaboultwood profile image
emmaboultwood
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14 Replies
SlowDragon profile image
SlowDragonAdministrator

Welcome to the forum

First step before considering booking any consultation is to get FULL thyroid and vitamin testing

Ideally via GP, but if necessary privately

Would GP test vitamin D, folate, ferritin and B12

When were vitamin levels last tested

What vitamin supplements are you currently taking

Do you always get same brand levothyroxine at each prescription

If yes, which brand

If your hypothyroidism autoimmune?

You should have had thyroid antibodies tested at diagnosis

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies 

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. 

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis 

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests early morning, ideally just before 9am and last dose levothyroxine 24 hours before test 

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65 (but doesn’t include antibodies)

monitormyhealth.org.uk/full...

Only do private testing early Monday or Tuesday morning. 

Watch out for postal strikes, probably want to pay for guaranteed 24 hours delivery 

emmaboultwood profile image
emmaboultwood in reply to SlowDragon

Gosh, thank you so much this is so informative. I’m going to look at the links and book in. I can’t tell you how much I appreciate this, I feel so lost with it all. I just know that I don’t feel well and deserve to feel better.

I have taken the same brand Accord for Levothyroxine for about a year.

I have looked back in my records the last time I had my vitamins tested was 6 years ago. I just take a Vitamin D supplement at the moment.

My belief was that I autoimmune- at diagnosis I can only find this:

Black and white
SlowDragon profile image
SlowDragonAdministrator in reply to emmaboultwood

very definitely autoimmune thyroid disease

Accord don’t make 25mcg tablets

So are you currently cutting 25mcg tablets in half?

emmaboultwood profile image
emmaboultwood in reply to SlowDragon

Yes, because although they lowered my dose when I picked up the prescription it was 50mg again, so I have bought a pill cutter!

SlowDragon profile image
SlowDragonAdministrator

can see from your previous post 5 years ago you have autoimmune thyroid disease also called Hashimoto’s

Have you had coeliac blood test done yet if not, GP should test BEFORE considering trial on strictly gluten free diet

nice.org.uk/guidance/ng20/c...

1.1 Recognition of coeliac disease 

1.1.1 Offer serological testing for coeliac disease to:

people with any of the following: 

persistent unexplained abdominal or gastrointestinal symptoms

 faltering growth

prolonged fatigue 

unexpected weight loss

severe or persistent mouth ulcers

unexplained iron, vitamin B12 or folate deficiency

type 1 diabetes, at diagnosis

autoimmune thyroid disease, at diagnosis

irritable bowel syndrome (in adults)

first‑degree relatives of people with coeliac disease.

Jaydee1507 profile image
Jaydee1507Administrator

Welcome to the group.

You could save some cash by just getting private blood tests and following advice on this group. Your GP might be willing to do the vitamin ones - ferritin, folate, B12 and D3. Unfortunately the NHS rarely test FT3 which is actually the most important result to know about to see where your treatment is at. It's possible you don't convert well, although it might just be that you have some vitamin deficiencies caused by low stomach acid in people with hypo.

Once you have the test results then post them here along with their ranges so people can comment.

emmaboultwood profile image
emmaboultwood in reply to Jaydee1507

Thank you! I’m going to get my vitamin levels tested and look at look at my diet. I’ve just bumbled along with it I’m going to look at the coeliac tests too.

Thanks again

SlowDragon profile image
SlowDragonAdministrator

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels 

Low vitamin levels affect Thyroid hormone working 

Poor gut function with Hashimoto’s can lead leaky gut (literally holes in gut wall) this can cause food intolerances.

Most common by far is gluten.

Dairy is second most common. 

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's test positive for coeliac, but a further 80% find strictly gluten free diet helps or is essential due to gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link) 

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies 

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first 

Assuming test is negative you can immediately go on strictly gluten free diet 

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially) 

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

pubmed.ncbi.nlm.nih.gov/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

emmaboultwood profile image
emmaboultwood in reply to SlowDragon

Thank you, I’m going to spend some time reading the research you’ve posted and look into it. Thank you for all this information and taking the time to post. I do appreciate it!!

shaws profile image
shawsAdministrator

My body didn't like levothyroxine (T4) at all. It gave me severe awful symptoms.

When T3 (liothyronine) was added to T4 (levothyroxine) I immediately felt an improvement and am fortunate to have now been prescribed T3 alone. My body likes T3 and it has calmed any awful symptoms I may have had. I feel well.

SlowDragon profile image
SlowDragonAdministrator in reply to shaws

shaws

that’s not really a helpful comment at this stage

Very very few thyroid patients end up on T3 only

Emma may simply need to improve low vitamin levels and/or trialing strictly gluten free/dairy free diet

shaws profile image
shawsAdministrator in reply to SlowDragon

I remember how awful it was for me (and husband - as he had to cope with my immense palpitations) when on levothyroxine and can sympathise with others who still feel unwell on it.

The original NDTs from 1892 (natural dessicated thyroid hormones) were removed by the 'supposed to be experts' some months ago and limiting 'options'.

emmaboultwood profile image
emmaboultwood in reply to shaws

Thank you for your response. Glad that you’ve found something that works for you

tattybogle profile image
tattybogle

Hi emma, some points to consider given that you say your fT4 has been fluctuating :

The fT4 result is affected by how long after the last dose the blood was taken.

There is a peak in fT4 level between approx 2 -6 hours after taking Levo ... if you tested during this time it could account (it least partly ) for the unusual high fT4 of 29 that led to dose reduction. So, if you don't do this already. always test 24hrs after last dose for consistency .

TSH result is affected by time of day the blood is taken (it has a circadian rhythm) . highest in middle of the night / very early a.m..... falling to lowest around 1-2pm ...then gradually rising again.

So for consistency, best to always test @9am.

My fT4 went a bit high for no apparent reason shortly after menopause .. and i did need my dose reduced a little ( because i had symptoms of overmedication) so i dropped from 150 to 125.and i felt better.

It did it again a few yrs later ~ fT4 went through the roof , but that time i felt perfectly ok ... dose was reduced from 125mcg to 112.5mcg which felt naff for about 4/5 week but then felt ok .. but as fT4 was still way over the top GP insisted on reducing further to 100mcg .. which left me feeling really undermedicated / digestive system only working at snails pace ,, with brain of Zombie... honestly struggled to cross the road without getting run over. GP reluctantly agreed to put it back up to 112.5 despite fT4 still being high.... i have been on that dose since and am feeling ok again now , The high fT4 came down by itself a few months later.

Just mentioning that little tale in case it's helpful ~ Sometimes a 25mcg reduction is too much and a 12.5mcg reduction is all that was needed.

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