is GP right

[fiftyone]

I am hypothyroid and others in my family are too. Now my daughter, aged 42, has had a thyroid test and it shows her T4 is 8.2 (range 8-18). No-one has tested her T3. Not sure of her TSH. However, she always seems to need sleep even during the day and I am concerned she might need thyroxine. The GP says he is not allowed to prescribe it until she is below range. Thoughts anyone? (not gonna do private testing, so forget that)

[Regenallotment Ambassador]

Sorry to hear your daughter is having a rough time, if she has 2 NHS blood tests showing TSH over 4.8 to 5 ish she should be allowed a trial of Levothyroxine under the NICE guidelines but as you probably know she may feel worse before she gets better.

Is your hypothyroidism autoimmune?

Could ask GP to check TPO antibodies to see if she is. That improved the case for trialling Levo for me.

I can say that upping my vitamin D, B12,Ferritin and Folate (after knowing the levels) has helped no end. Could ask GP to check these.

My question for the GP would be, if it’s not thyroid what is it, because it isn’t normal to need a sleep in the day.

Hope she gets the help needed soon

🌱

[fiftyone in reply to Regenallotment]

thank you for that . It is very helpful and I will check with her about her TSH

[helvella Administrator]

He might believe that, but it isn't so. This is a link to the NICE guidelines:

Thyroid disease: assessment and management

NICE guideline [NG145] Published: 20 November 2019

nice.org.uk/guidance/NG145

But every NICE guideline has the following statement ()or similar) at the start:

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

That is, the patient's need overrides these guidelines. And something similar will apply to any other guidelines he might be thinking about.

Unfortunately TSH is regarded as king - and you have not got that result.

But insisting that FT4 has to drop another 2% for him to be able to treat is a matter of pedantry. The bottom of range is derived from the population. And there is more error in it than 2%. And simply being a population statistic means it should not just be picked up and applied without thought.

This is a link to a very good article in the British Medical Journal discussing what the 'normal range' really is. Very readable.

The normal range: it is not normal and it is not a range

helvella.blogspot.com/p/the...

[fiftyone in reply to helvella]

thank you very much. Knowing NICE guidelines etc. is a big help

[SlowDragon Administrator]

GP is incorrect

If Ft4 was below range he would be obligated to treat

With high TSH, low Ft4 and symptoms he could choose to start treatment

Obviously need to know TSH result

Also need two abnormal tests before treatment starts

Book retest in 6-8 weeks, ideally just before 9am

She is legally entitled to printed copies of all her blood test results and ranges.

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

Link re access

patients-association.org.uk...

healthunlocked.com/thyroidu...

In reality some GP surgeries still do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

For full Thyroid evaluation she needs TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

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

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 that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test

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

She could/should request GP test vitamin levels now

[HenriC]

You should both check how much iodine you are consuming. Many throid issues arise out of consuning too much iodine, which governments add to food.