Grrrr! A bit of a rant! 'Hashis patients no longer need to fast before blood draw'?!

[Ebx_design]

Hello everyone, I'm posting to just get something off my chest, apologies but I'm so annoyed and fed up!

In short I'm due the usual general investigation for thyroid, and my NHS clinic while under strain like all others, has usually been willing to do TSH, T4 & T3. (I'm on 100 levo atm).

I booked an appointment the other day, and when I asked for a morning slot due to it being a fasted test (as I always have), they just said 'oh we don't need to do that anymore'. I pushed and said what do you mean, as this is for a thyroid investigation, and the receptionist just said 'we've been told none of that applies anymore so you can be tested any time, and no need to fast'.

Honestly. I'm so fed up with it all!... And I do get this is why people go for private testing, but I'm trying to save a bit of money I suppose, but also if the test does come back wonky, have more ammunition to take back to GP to request seeing an endo, with NHS tests results.

Anyone else heard of this new 'advice' re not fasting for NHS thyroid panel testing?!

Needless to say, I changed the date and got an early appointment despite what I was told. I will certainly still be fasting for it too, otherwise how can we have any consistentcy? But it just makes it even harder to get the right kind of appointment, on TOP of getting the right kinds of test.

Sigh, sorry for the moan!

Ebony

[SeasideSusie Remembering]

Ebx_design

It really isn't worth discussing fasting with a nurse, phlebotomist or doctor, the response you've had is typical, they just don't know enough to know it can be important - by the way it's only for the TSH test that fasting can be important as certain food and drink can affect TSH, fasting doesn't affect FT4 or FT3 levels. However, certain other tests do require fasting, eg glucose test for diabetes, iron test for iron deficiency anaemia also possibly liver, kidney, cholesterol tests.

Of course, if your GP adjusts dose by TSH alone then it's important that your test is done early to give the highest possible TSH to avoid a reduction in dose or to achieve an increase if necessary.

If you want an early morning test just say that you are due in at work for such and such a time and need an early test. If they haven't got an early appointment just say that you can't take time off work and will wait until they can give you an early one.

[meme in reply to SeasideSusie]

cholesterol is no longer tested after fasting. It has been this way for a few years now.

[tattybogle]

it's not a new policy .. its always been the NHS view that Thyroid Function Tests can be done anytime in the 'daytime' and they have always said that levo should be 'taken as usual on the day of the test',, and they don't have it listed as a fasting blood test . They try to keep the 9 am slots for those tests that really do HAVE to be 'fasting'

So they always get slightly wonky TSH results due to the afternoon low point . and slightly wonky fT4 results due to time of last dose compared to test ... but they don't consider the differences in TSH or fT4 result will be significant ~

obviously we don't agree with them on what constitutes 'significant' and try to get our testing to be more consistent and accurate by whatever means possible ... for most of us that involves being 'unable to attend the appointment if it's after 9.30 am due to work commitments that day'.

if you've been getting regular access to TSH /fT4/ and fT3 done early am without having to manipulate the system to get it, you've been doing very well out of them until now.

[jimh111]

Time of day affects TSH level. There is absolutely no evidence that fasting affects thyroid function tests. There was one hopeless Indian study that seemed to show a fasting effect but they measured the fasting and non-fasting levels at different times of the day! They did a follow up study that showed it made no difference but did not have the decency to apologise. Your NHS clinic is correct (apart from 'anymore').

[Ebx_design in reply to jimh111]

Ah I see! OK that does make sense. It looks like from your response along with those from tattybogle and SeasideSusie (thank you!) that maybe I've been getting almost stellar treatment so far without even realising! Oh dear.

I'm glad I still managed to get an a.m. appointment, same time as my previous tests so I can have a sense of consistency for my own spreadsheet. And yeah, I used work as the reason, which is mostly true anyway.

But sheesh. Sorry for the rant, it just felt like one further hurdle in the series of hurdles we all face, in the sense that I often feel quite disparaged that we are pretty much out there on our own in all this. Apart for this fab forum if course!

For context, my last round of tests were a bit wonky, and if these next ones are too (low T3) I might return for interpretation advice. Then the next approach might be to try see an endo, or failing that look at NDT. I don't know. We'll see.

Thanks all

Ebony

[jimh111 in reply to Ebx_design]

The biggest effect on TSH is the menstrual cycle although there has only been one very small study frontiersin.org/articles/10... . It does make the recommendation of testing every six weeks a bit silly with the possibility of going from peak to through.

[humanbean]

Anyone else heard of this new 'advice' re not fasting for NHS thyroid panel testing?!

Not exactly related to fasting, but related to timing... I asked for a phlebotomy appointment by 9am at the latest once at my surgery. The receptionist asked what it was for, and when I said it was for thyroid she refused point blank. I was only offered an appointment in the afternoon. I tried to persuade the receptionist that early morning tests were best for TFTs (without explaining why) and the woman went straight into scowling and frowning mode and refused point blank to offer a time I wanted. I was told that it was unnecessary to have thyroid testing done in the morning, and I could only have an appointment at 2 pm. or thereabouts.

I think the sentence "We save early morning appointments for people who really need them." was said which made me even angrier.

A few weeks/months after this happened to me, I can't remember the circumstances, but I was with my husband at the surgery when he had to make an appointment for phlebotomy - not thyroid related. He was dressed for the office.

When he asked for a phlebotomy appointment the receptionist didn't ask why. She just looked at her computer, looked up at my husband and said, with a big smile on her face "Would 8.30 am be okay?"

I was furious, but it is pretty much what I expect to happen with anything medical. Women are so often treated like scum.

[Ebx_design in reply to humanbean]

This!! Ohmygosh this!!

Hi humanbean ,I generally try to see the best in people, but that really does sound like full on sexism and general dismissal of all things 'women' related. I'm so sorry you experienced this, that sounds really frustrating. I'd have been incandescent too

[Christabel in reply to humanbean]

That's awful. Only too believable.

[Zephyrbear]

They’ve been telling me it’s a non-fasting test for years. My usual response to such statements is “yeah, whatever” and then arrange for an appointment first thing in the morning, usually around 8.30. For my private tests, I have my daughter who is a qualified midwife who’ll come up at 6am to draw my blood before she goes to work!

[Valerie0106]

Yes that is what many of us do anyway I suspect. I have never been told to fast before thyroid tests in 17 years…

[Miffie]

I’ve not been told to fast ever! However with negative antibodies and some 1950s radiation blamed fir my hypothyroidism it may have applied to those with identified Hashi at the surgeries I’ve been with. I was diagnosed pre blood testing in early 1960s. However I was certainly being tested from about mid 1970s.

I can only remember fasting once for GP blood tests and that was for glucose resistance? Certainly a diabetes test.

Currently I am lucky if I get a pre 13:00 slot for testing. I just do my MMH at 8:30 - 9:00 and use that for accurate results. The lab here refuses anything other than TSH if it’s anywhere ‘in range’. A sure sign I am in trouble I thrive on low TSH.

[Christabel]

Could you ask for an early appointment, implying that you have to get to work/take someone to school, and that's why you need to be early?

[jodary]

One difference I noticed this year when I was called for annual thyroid blood test was it was done by text. The text said your annual thyroid blood test is due, please note this test can be done in the afternoon. I was going to ignore the message as in my opinion it is pointless. They have started doing TSH only and it doesn't matter what the result, it will be marked as satisfactory no action. I have recently gained access to my gp record via the NHS app, and my blood results over the last 20+ years make interesting reading. I have had a variety of TSH results ranging from over 8 to under 1. In every case ,satisfactory no action. I now do medichecks and post any queries on here and monitor myself. However the surgery want to tick their box so were very persistent in texting and then ringing. I eventually gave in and let them do their test , TSH only of course. Then they will leave me alone for a year. Totally pointless.

[Ebx_design in reply to jodary]

How on earth did no one say anything about that level of TSH variance? A TSH of 8?

I've really valued being able to see my results in the NHS app too. The idea of being 'in range' is such bs it's beyond belief.

[tattybogle in reply to Ebx_design]

i found a 7.8 in mine (with lab comment 'abnormal contact patient')... when my 'usual' on levo was stable at around 0.05 for the previous decade.

i found it 4 years later .... nobody mentioned it to me , at the time or since.

[EMBoy]

I have been having annual checks since 2010 and have never been advised to fast before giving blood.

[Lovecake]

I always used to have afternoon tests as I couldn’t manage to get to the surgery early due to the fatigue. So my TSH taken at 2pm = 5 most probably would have been higher at 9am if I had known and would have forced myself to get there…….and maybe diagnosed a few years sooner 🤷‍♀️

My surgery now only does blood tests for those who are very frail or have cancer. So we have to book our blood tests online. We have a choice of about 6 venues including the main hospital and a walk-in health space centre. So I was able to book a fairly early appointment, but I have to drive 10 miles and be prepared for traffic if it’s through the rush hour. Not good if you get hungry and don’t do mornings. But on the subject of test timing - booking it yourself online means you can choose the time with no interfering receptionist 🙄

[JaneChapple]

This may beof interest, Ive posted it somewhere else here today

bmcendocrdisord.biomedcentr...

Janexxx😩❤️