I had a GP appointment this morning (double appointment) for a Medication Review. I haven’t had one since pre-Covid when I lived in a different part of the country.
I crept into the surgery with fear in my heart as I prepared to explain the ins and outs of NDT. OH came with me as I was in the middle of a migraine attack and sounded like a drunk.
The doctor was very young, Italian and had a wonderful ‘bedside manner’. When we actually got to the elephant in the room (not on my script of course), he looked at my last blood results which had been done in hospital about three months ago. I opened my mouth to explain and then left it open in astonishment. He explained that my TSH was suppressed and that he would think from my results that I was taking T3. I told him that I took two grains of NDT. Not only had he heard of it but he was able to calculate the T3 and T4 content in 2 grains without any assistance. He told me that my FT4 was low because of the FT3. I pretended I didn’t know that. Didn’t want things to go downhill by being a ‘know all’.
He then asked me if I was taking Vitamin D and I told him I was taking 2000 IU following a blood test which showed my Vitamin D levels to be at 70 nmol/L. He asked if I was taking Vitamin K2 and magnesium as well. I confirmed. We then moved on to why I was taking Omeprazole and I explained that Gabapentin, recently prescribed, was causing gastritis and that I’d only recently recovered from multiple stomach ulcers. He asked why I took Gabapentin and I explained that it was the third drug I’d been given in as many months to treat anxiety and vestibular migraine. He asked if it worked and I told him that it had done nothing for the migraines but had helped anxiety just a little - and that I spent every afternoon in a deep sleep bordering on coma.
I told him that I’d quite like to have my own brain returned as it had been ‘rewired’ by psychotropic drugs several times since my total thyroidectomy for various complaints which, prior to the TT, I’d never had. He said that he would wean me off Gabapentin very slowly and wrote out a schedule. A refreshing change to usual rush job which most GPs seem to think is ok and which ends up in dreadful discontinuation syndrome.
My BP had been done several times by Hospital doctors and recorded by GP. It was done again this morning and was still frighteningly high. It didn’t matter how many times he did it, it remained at 189/100. He suggested that I took Propranolol which would bring down the BP and help with anxiety and migraine p. I told him that I’d had it before for prophylactic treatment of migraine and that it had been a miracle cure. It was then that I had to be ace ‘know all’ and tell him that it interferes with T4 to T3 conversion and could be a problem with thyroid meds. The doctor looked perplexed, checked on BNF /NICE and said that there was no interactions. We agreed that I should have the Propranalol and also monitor my thyroid bloods more regularly, increasing dose if / when necessary. When I got home, I checked all interaction sites including drugs.com. I can find no reference to caution / interactions between Propranalol and Levothyroxine. To be honest, while I’ve read quite a few posts on this subject, opinion has always been diverse among users of Propranalol with thyroid drugs.
The GP also told me to take a good B Complex to keep my B12 high in range. He referred to regular PPI use depleting B12 which I knew. I told him that the hospital had told me to stop B Complex as my B12 was very high at 1800 when top of range was 900. He then said that he didn’t care if the top of range was 4 or 5 times over range. He also expressed the view that B12 should always be at top of range. He has organised a B12 serum test as well as TFTs. As I’ve had no B Complex (Thornes Basic) for 4 months it will be interesting to see the result.
Altogether, an interesting morning.
Grazie dottore.
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