GP Incompetence - Hashimoto’s and Hypothyroidis... - Thyroid UK

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GP Incompetence - Hashimoto’s and Hypothyroidism treatment

Tufty73 profile image
24 Replies

Has anyone else had a battle with their GP Surgery? I have had a nightmare with mine. I was diagnosed Hypothyroid August 2022 by text (TSH levels were 7.2, Cholesterol 6). No consultation, no information about my condition given, nothing. I thought I was Perimenopausal but the GP said I was too young - I was 49 (😳). I was just prescribed 25mg of Levothyroxine and left. Symptoms improved immediately but came back December 2022. Blood test showed my TSH levels were 1.72. GP said it was within the normal range. I wanted to know what was causing it (ie Hashimoto’s). GP said (via phone call) “it can’t be Hashimoto’s because it’s rare”. I laughed - I thought he was joking. I told him it accounts for 90% of Hypothyroid cases. He said “well it still can’t be that because it comes on suddenly”. Completely wrong. This is the level of incompetence I am dealing with. Blood test revealed my antibody levels were 245 (normal range 0-34).

Fast forward to June this year and my symptoms are getting worse. Blood test revealed my TSH had doubled to 3.56. I wanted my Levothyroxine dose increased. GP refused to do anything because levels were in normal range. I asked to be referred to an Endocrinologist. He said it wouldn’t make any difference but that “we’ll see what they say”. He wrote to his Endocrinologist and the reply back agreed with the GP. But..when I made a freedom of information request to see what the GP had written - it was completely wrong. He’d trivialised my condition and said my main concern was to have my antibodies checked again, amongst other things, all of which were completely untrue.

Meanwhile I’d booked an appointment, privately, with an Endocrinologist (one the GP had suggested before writing to his). I saw her yesterday. She tripled my Levothyroxine dose immediately and said I was perimenopausal. I nearly cried. I felt vindicated. When I told her what the GP had said about Hashimoto’s and not being perimenopausal-she laughed. I said “exactly, this is the level of incompetence I have been dealing with”.

She also said that 25mcg of Levothyroxine was almost a placebo, that she would never start a patient on that dose and that symptoms might improve initially but would return within a couple of months (which is exactly what happened to me). She said my TSH range should be between 0.5 and 2.5 and that my dosage of Levothyroxine should be 1.4 x weight in kg.

She wants to get my Hypothyroid symptoms under control first and then deal with Perimenopause symptoms. What a relief! Finally I’m being treated by someone who actually knows what they are doing. I had to pay for it but it was worth it to deal with an expert rather than incompetent GP’s.

What experiences have you had?

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SlowDragon profile image
SlowDragonAdministrator

Well done

Standard STARTER dose levothyroxine is 50mcg

25mcg is only for very elderly and heart conditions…..even then they still get dose increase as fast as tolerated

Guidelines are quite clear

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

Bloods should be retested 2-3 months after each increase

You may find going from 25mcg to 75mcg in one go too much initially…..usually we increase in 25mcg steps

Which brand is your 25mcg

Which brand is 75mcg

ESSENTIAL to test vitamin D, folate, ferritin and B12

Have you had coeliac blood test yet

Tufty73 profile image
Tufty73 in reply toSlowDragon

Thank you for replying so quickly!

She is going to send strict instructions to my GP Surgery about blood testing, dose and keeping me within 0.5-2.5 TSH range.

Wockhardt is the brand I am using at the moment (but the Chemist keeps changing it -I have been on Teva, Wockhardt and Mercury Pharma). I haven't had any issues with any of those brands.

Endocrinologist suggested taking 3 x 25 mcg Levothyroxine tablets for now until my next prescription (by then she will have written to my GP Surgery and my prescription should have been amended). She also recommended taking a Vitamin D Supplement (1,000 IU May to Oct and 2,000 IU Nov-April). I already take one but I will increase the dose to the levels she suggested. I also take Menopace Max, Selenium, Omega 3 & 6, high strength Vitamin C and Magnesium supplements. I honestly think the Menopace Max Supplement has helped with my mental health as I haven't had any depression/low mood symptoms at all so far.

She also recommended a high dose Evening Primrose Supplement and Soya supplement to help with the Perimenopause Symptoms for now.

It's so nice to deal with one person. Every time I get in touch with my GP surgery I have to deal with a different Doctor (4 so far) - there is no continuity of service. I have no idea who my GP is and haven't seen any Doctors face to face since 2018. My old Family Doctor retired over ten years ago.

I'm curious about the Coeliac testing suggestion. Having a quick scan of the information that is out there, I could have a couple of the symptoms but only mildly. Interestingly I've just started a Keto diet (3 days) so won't be eating Gluten at all for the foreseeable future. I've already noticed a drastic reduction in bloating. Thanks for the tip!

SlowDragon profile image
SlowDragonAdministrator in reply toTufty73

Suggest you test vitamin D now

NHS easy postal kit vitamin D test £31 via

vitamindtest.org.uk

Vitamin D tablets or gels should be at least 4 hours away from levothyroxine and taken with high fat meal, so that’s usually dinner

Vitamin D mouth spray can be taken anytime, but still an hour away from levothyroxine

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7.

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Interesting article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

SlowDragon profile image
SlowDragonAdministrator in reply toTufty73

Keto not generally recommended when hypo

We do need some carbs for conversion of Ft4 to Ft3

But generally avoid beige carbs (rice, potatoes, bread, cakes, pasta etc)

Having cut gluten out is probably already improving your gut function

How long since you cut gluten out?

Probably not worth going back on gluten to do test as you are already seeing benefits

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

Most common by far is gluten.

Dairy is second most common.

A trial of strictly gluten free diet is always worth doing

Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential

A 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 may slowly lower TPO antibodies

Ideally

While still eating high gluten diet ask GP for coeliac blood test first as per NICE Guidelines

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

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.

Similarly dairy free too.

Approx 50-60% find dairy free beneficial

Hard to cut both at same time

Generally get use to gluten free first ….then try dairy free

Tufty73 profile image
Tufty73 in reply toSlowDragon

Thank you for the advice., much appreciated 👍

I'm sorry but I did laugh in disbelief at your doctor's comments, are you sure he was a real doctor and not the janitor playing a prank 😄. I went into menopause very suddenly at 47. Thankfully my GP was a bit more clued up. I started on HRT pretty quickly.

Similarly my hypothyroid was flagged up following blood tests for breathlessness, although I had to wait 3 months for a second one to confirm it wasnt a blip. My TSH was similar to yours but I did have two below range and falling FT4 results. I started on 50mcg of Levo.

I would say the only issue I had was I was diagnosed during covid (2020) and was left for far too long on 50mcg as follow up blood tests weren't deemed urgent enough and we were all told not to bother the NHS unless it was terminal. By the time I got another blood test my TSH had risen to 6.4 and I needed an increase in Levo.

I'm really annoyed on your behalf that you've had to shell out for a private Endo just to get enough Levo 😡. We can add your clueless GP's comments to our big book of the most stupid things ever said by medics to thyroid patients.

Tufty73 profile image
Tufty73 in reply toSparklingsunshine

Thank you for replying and relaying your story. I'm so pleased your GP was a little bit more knowledgeable (although frustrating that you had to wait to get your Levo dose increased).

The worst doctors were the two male ones - both consistently showed their complete lack of knowledge.

It's shocking isn't it that we have to 'research our condition and fiercely advocate for ourselves' because doctors - despite being paid over £100,000 a year - don't know what they are doing and can't be bothered to read the NICE guidelines or keep up to date with the latest research. They were even obstructive when 'appearing' to refer me to an endocrinologist. It's downright negligent.

I love your last comment - it made me laugh out loud!

Sneedle profile image
Sneedle in reply toSparklingsunshine

big book of the most stupid things ever said by medics to thyroid patients.

🤣

That is the Best comment.

Still chortling.

I want a copy of the Big Book!

BumbleyM profile image
BumbleyM in reply toSneedle

Me too... they say laughter is the best medicine..

tattybogle profile image
tattybogle in reply toSparklingsunshine

"I think we're gonna need a bigger book ....... "

..
Sneedle profile image
Sneedle in reply totattybogle

😆😆That is the perfect picture🤣

Tufty73 profile image
Tufty73 in reply totattybogle

😂😂😂

Sneedle profile image
Sneedle

Reading your post I'm SO pleased you found a professional thyroid medic. You have done really well.Awesome!

Tufty73 profile image
Tufty73 in reply toSneedle

Thank you 😊

tattybogle profile image
tattybogle

GP obviously needs to do more reading...... so send them this list:

(multiple references recommending GP's keep TSH between 0.4/0.5 and 2/2.5 in all patients on levo (and lower if needed to optimise symptoms). Some are taken directly from GP 'update' resources , one was written specifically for GP's by Specialist Registrar's in Cardiology and Endocrinology, one is taken from the latest Liothyronine Consensus Statement (guidelines written by some of the most influential Endo's in the country (instructions to endo's to ensure levothyroxine treatment is optimised before they consider a patient for a trial of T3/ Levo combination treatment) .

healthunlocked.com/thyroidu.... list-of-references-recommending-gps-keep-tsh-lower-in-range

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

explanation of why TSH 'anywhere in range' does not necessarily mean 'optimal' :

healthunlocked.com/thyroidu... the-shoe-size-analogy.-

Tufty73 profile image
Tufty73 in reply totattybogle

Thank you for replying. Sadly, I've done that and they were not interested.

tattybogle profile image
tattybogle in reply toTufty73

Shawshank Redemption ....... send it every week , lol .

McPammy profile image
McPammy

I think you may find many of us on here have had awful GP treatment regarding thyroid conditions, myself included. I begged and begged for a thyroid test for ages suffering with awful symptoms, all my GP kept saying was I had depression. God that made me mad. Eventually he agreed to a thyroid test. My TSH was 36 (0.35-5.50). I have Hashimotos. No apology. Put on 100mcg levothyroxine. I felt somewhat better but continued to struggle. 10 years struggling. Then I went private. Found out I’m a very poor converter T4 to T3. Put on combined treatment T4 levo plus T3 liothyronine. Oh my good. Never felt so good and energetic in years. Please also keep an eye on your T3. Your endocrinologist sounds like she really knows what she’s talking about similar to my private endocrinologist. Sim for a TSH of 1-2 max if you can. Also keep an eye on your vitamins. Great news you finally got help. I’d report your GP to the surgery manager and maybe even PALS. My GP later admitted to me he knew nothing about the thyroid and I may as well be talking to a plumber on two occasions. He’s now left the practice. They jump now when I mention my private only endocrinologists name. Now I get really good support and treatment. But that’s rare now as I’m symptom free mainly as long as I get my medications.

Tufty73 profile image
Tufty73 in reply toMcPammy

Dear McPammy, I'm so sorry for taking so long to reply and for everything you went through. Thank you for the advice. I am shocked at the level of prevalent lack of knowledge with GP's in the UK. Is this even allowed? I'm contemplating making a complaint. I did write to the doctor 2 weeks ago and haven't had a reply, so maybe I should go to the surgery or practice manager instead. One of the doctors I spoke to (who said Hashimoto's was rare) admitted that I knew more about Hashimoto's and Hypothyroidism (especially when I told him I was in my 3rd year of an MA in Voice Pedagogy) than he did. I'm hoping my GP Surgery jumps when I mention my Private Endocrinologists name like yours...fingers crossed!

serenfach profile image
serenfach

Mine was put down to PTSD and I was sent to a chiropodist...(numb feet)

Lovely lady who said "you need to see a doctor"

Me

Her

So we had a lovely chat for 20 minutes about chickens.

Tufty73 profile image
Tufty73 in reply toserenfach

Dear Serenfach, thank you for your reply. I'm so sorry for taking so long to respond and for the way you have been treated. Seriously?! Like I said above, I am shocked at the high level of ignorance with GP's in this country with thyroid disorders. Hopefully you have managed to find a doctor or endocrinologist who supporting you in dealing with your condition effectively?

serenfach profile image
serenfach

Not so far - I had trained a GP up but he went and retired. The new ones fuss about my TSH being below the range and try and reduce me all the time, and I refuse.

Charlie-Farley profile image
Charlie-Farley

Hi Tufty,

Yup!

Read my bio 🙄 if you click on my face it will take you to my profile (and bio)

Vasiliki99 profile image
Vasiliki99

Yes doctors are often like that they trivialise it though it can make u I'll just try n take my diet well supplements and just cope used to take a bit of T3 but can't find it anyone know where I can source 5 MCG ?

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