GP appt on Friday - what to ask?

[Insomania]

Hi, following my post a few weeks ago, I have more test results and a follow-up appt on Friday with the lead GP.

As mentioned, I've been offered anti-depressants more times than I can remember over the last 20 months since multi-nodular goitre was identified. I've gone on HRT to rule peri-menopause out. I'm under haemotology and having regular iron infusions. I've got a repeat ultrasound late February to remeasure the goitre.

I got excited because I got a TSH result in December outside normal nhs range. Then the GP called it 'borderline' and I was so upset. Feeling so fed-up with all my symptoms, some nights I get 5-6h sleep.

I have asked for a 4 point cortisol saliva test, the message from the surgery was it is not known to be available on nhs but discuss with GP on Friday. So that's on my list.

Any tips for what else I discuss or ask for on Friday please?

I'm also not getting on well with the Thorpe B complex vits (palpitations, skin heat/rash) so a recommendation for a less full-on formulation would be great please.

I am an unpaid carer to my 3x autistic children and do not have a huge amount of time on my own health and wellbeing. I'm even wondering if I have carers burnout rather than thyroid issues?!

Many thanks for your help and advice.

[SlowDragon Administrator]

instead of Thorne B complex

Try Igennus Vitamin B complex

Cheap and good quality

Full dose is 2 per day but most people find one is enough

Perhaps start with half a tablet initially……

[Insomania in reply to SlowDragon]

Thank you so much for the rec, and a good idea to start on low dose.

Any tips for tomoz please? I feel so lost.

[SlowDragon Administrator in reply to Insomania]

Thyroid results look “normal”….though Ft4 is at lower end of range

FT4: 14.4 pmol/l (Range 10.5 - 21)

Ft4 only 37.14% through range

FT3: 5 pmol/l (Range 3.5 - 6.5)

Ft3 higher at 50.00% through range

TSH is not reflecting the fact Ft4 is struggling

Ask for a referral to thyroid specialist endocrinologist for evaluation for central hypothyroidism

Central hypothyroidism 

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

ever had ultrasound scan of thyroid or MRI of your pituitary?

Have you had cortisol levels tested

Iron is on low side

Look at increasing iron rich foods in your diet

[Insomania in reply to SlowDragon]

sorry, the reply below was to you SlowDragon. Thank you

[Insomania]

I’ve been asking for a referral for 18 months to endocrinology but I don’t meet criteria with my blood results.

I have a multi modular goitre identified May 2021. Rescan u/s booked end Feb.

I will ask for a cortisol saliva test tomorrow. If not, I will pay for it.

Thank you for your help 🙂

[SlowDragon Administrator in reply to Insomania]

private consultation approx £200-£250

Email Thyroid U.K. for list of thyroid specialist endocrinologists and doctors

[e-mail]

[Insomania in reply to SlowDragon]

I’ve been so confused as to whether I’d be wasting my money going to a private doctor. But I guess I should try…

[SlowDragon Administrator in reply to Insomania]

Do you wear a Fitbit or equivalent

Helpful if it shows very low resting heart rate

Other indicators of hypothyroidism…..high cholesterol

But thyroid levels don’t really show anything obvious …..though things can change. You may have to just keep on top of maintaining good vitamin levels and wait

[Insomania in reply to SlowDragon]

Cholestrol was checked and all good ✅

My resting HeartRate is quite low 65bpm, goes up to 85bpm when I get palpitations while resting. (iPhone app)

Did a GP update below….

[Insomania in reply to Insomania]

I now have the adrenal saliva test results, which says evolving (phase 2) adrenal gland dysfunction.

Adrenal function test

[Insomania in reply to Insomania]

Adrenal function test graph and comments

Adrenal function test graph and comments

[Insomania]

GP wants me to move on from thinking my thyroid is the cause of my symptoms.

He checked all my results, heard my whole story, concluded everything is normal, bar one low TSH result last month, iron etc being looked after.

I argued the case about secondary hypothyroid but he disagreed. He did offer a cortisol test to rule that out but thinks only a morning blood test is available from nhs. (I will pay for a 4x saliva test myself.)

GP thinks my carer life is taking its toll and is the root cause. Wants to help with that, though I’m already doing what I can with social care assessments for respite, psychotherapy, etc.

I’ve agreed to try Amitriptyline at night for insomnia because that’s my main symptom and sleeping better would be huge.

Let’s see what the cortisol tests bring… anything significant comes from it I’ll see a private endocrinologist from the TUK list for a specialist opinion….

So that’s a Plan!

[SlowDragon Administrator in reply to Insomania]

So if cholesterol is good….it’s doesn’t really look like thyroid is the issue

Still important to keep on top of managing GOOD vitamin levels

Do you take any magnesium supplements…..can significantly improve sleep along with vitamin D

[Kriticat]

Insomnia has been my main curse too, everything is so much harder if you're not getting enough sleep. I have been taking CBD oil since November and it's been fantastic. I still sleep lightly and wake frequently but I no longer lie awake desperately trying to get back to sleep... a few calming breaths and I'm out again. Would love to sleep the whole night through but for now I'm just happy it has improved so much. Best of luck, I can't imagine how hard it must be with children, especially special ones... I was struggling just to take care of myself!

[Insomania in reply to Kriticat]

I’ve been managing on 5mg of melatonin but same, gets me off to sleep ok but I’m awake 2-3h in the early hours. I don’t fight it, read and eventually feel tired again. Dead by day, awake by night, I’ll be amazed if my adrenals are working properly!