Low TSH level

[JRosemaryW]

I had a phone appointment with a GP as I've had headaches for several months. I had NHS blood tests done and my TSH level is 0.03 (0.27-4.20), T3 5 (3.20-6.80). They didn't do T4 but when I had a medichecks test in Jan T4 was 13.5 (12-22) and the TSH and T3 were the same as the NHS one. The EGFR (renal) was low so am having another blood test for that. Im seeing the GP next week and she's said she wants to reduce my Thyroid meds - currently on 75 Thyroxine and 15 liothyronine. I know there have been many posts on this subject but wondered if someone could just pinpoint the best info on low TSH when on T3. I've also seen somewhere that being hypo can have an effect on your kidneys. I don't seem to have any symptoms of being hyper but still many for hypo - more than 40 on the list on the Thyroid UK website. Many thanks.

[tattybogle]

Hi JRosemaryW

lots of references in these two posts :

some are related to Levo only, but most can be used for T3 users too ....sorry you'll have to look at the details for yourself, as i can't remember which references are in each post , and have got a bit of a headache myself .

healthunlocked.com/thyroidu.... tsh-is-just-the-opinion-of-your-pituitary-about-your-dose-but-your-pituitarys-opinion-is-a-bit-warped-once-you-take-thyroid-hormone.

healthunlocked.com/thyroidu.... tsh-is-just-the-opinion-of-your-pituitary-about-your-dose-but-your-pituitarys-opinion-is-a-bit-warped-once-you-take-thyroid-hormone.

[JRosemaryW in reply to tattybogle]

Thanks very much for that, I'll take a look at the links.

[Bearo]

Was your T3 prescribed by an endo? If so your GP shouldn’t be changing your doses. As you’re taking T3 your TSH is going to be a bit lower.

[JRosemaryW in reply to Bearo]

Thanks for your reply, yes the T4 and T3 were prescribed by an endo.

[Bearo]

Perhaps your GP needs reminding that only the endo can change the dose. And the endo should be aware that, as you take T3, your TSH is going to be low.

[Mollyfan in reply to Bearo]

I would suggest that it would not be helpful to tell the GP that they are not allowed to alter the dose….. the person who signs the prescription is legally responsible for any results of taking the drug. The GP is perfectly entitled to say that they are not comfortable prescribing at all if they feel it is outside their expertise and are also entitled to decide how much they prescribe. A reasonable GP ( and this is where we encounter problems!) “should” negotiate with their patients, educate themselves enough to understand what they are doing and, if they are not comfortable, seek someone else to take the responsibility. GPS do not have to do as they are told by consultants, they make up their own minds.

A sensible GP understands that the consultant generally knows more than they do and will take advice but this is not always the case.

A shared care protocol ( such as for liothyronine) is an agreement between the consultant and GP that the GP is acting on advice from the consultant but has to be agreed and signed by the GP.

[Bearo in reply to Mollyfan]

Thanks for the detailed reply - I stand corrected.

[Mollyfan in reply to Bearo]

it is very difficult for patients if they see two doctors who disagree sadly and very frustrating.

[Mollyfan in reply to Bearo]

bma.org.uk/media/1563/bma-p...

BMA official advice re prescribing by GPs. This document makes the situation very clear!

[Bearo in reply to Mollyfan]

is this the section you were referring to? Forgive me if I’m misreading it, but it seems to say the responsibility lies with the original prescriber, so the GP should continue it?

Non-GP prescribing

When a non-GP prescriber initiates a new drug, they accept responsibility for that prescription, but usually have no method of reissuing repeats and so that responsibility invariably falls on GPs. When faced with a request from the patient for a repeat prescription initiated from outside the practice, GPs should review the patient and set up a repeat prescription if appropriate or refer the patient back to initial prescriber.

“Good working practice would advise that anything prescribed for long term prescription should be notified to those likely to continue the medication (i.e. the GP). The responsibility for checking interactions remains with the prescriber who should take a full drug history if they do not have access to the main clinical record. [See also FAQs on supplementary and independent prescribers]”

[Mollyfan in reply to Bearo]

I think the key phrase here is “if appropriate”. The person who signs the prescription is responsible and a GP does not have to accept that responsibility. It is them who would be sued if something went wrong.

[JRosemaryW in reply to Mollyfan]

Thank you very much for all the information. I understand how difficult it is for GPs just wish there was more research on the effects of thyroid medication, T4 and T3, on the whole body rather than just going by TSH.