Thyroid blood tests results - Help required

[jazzylady]

I had a thyroidectomy in 2017. I have had an ongoing battle with GP's over treatment. My latest TSH that my GP tested was 0.07. This was the only test he carried out having refused to test F4 & F3.

I was on 75mg T4 & 10mg T3. GP lowered T4 to 50mg against my wishes.

Six weeks later I had gained 6lb, suffering from really bad leg cramps, headaches, feeling cold and joint pain.

I had my TSH, T4 & T3 privately the results were TSH 1.29 mu/L (0.27 - 4.2mu/L). T4 11.5 pmol/L (12 - 22 pmol/L). T3 4 pmol/L (3.1 - 6.8 pmol/L).

I saw the GP today who wasn't interested in the T4 & T3 results, the T4 being low! Fortunately I'd seen a private endocrinologist who instructed him to put dose back up. However GP has stated that he will want to repeat TSH test in 6 weeks time and he will reduce again if TSH is low again.

I'm at a loss at what to do next. Why don't GP's listen? Any advice anybody

[greygoose]

Why don't GPs listen? Because they think they know it all so nothing you have to say could be of any possible interest - you're only an idiot patient, he's the doctor!

Well, if he were really clever, he would know that taking T3 - which you do - is going to result in low TSH, because that is what it does. You can't go against nature, even if you are a know-it-all doctor!

[SlowDragon Administrator]

However GP has stated that he will want to repeat TSH test in 6 weeks time and he will reduce again if TSH is low again.

GP is being a complete arse

You’re on levothyroxine plus T3 under the care of endocrinologist. GP should not meddle

On almost any dose of T3 it’s highly likely TSH will be suppressed or very low. This is irrelevant, as long as Ft4 and ft3 are within range

If GP says " I have to reduce your dose because the guidelines say i can't let you have a below range TSH" .....

The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :

nice.org.uk/guidance/ng145

"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. "

LEVO DOSE SHOULD NOT BE DETERMINED BY TSH

Diogenes/Toft paper:

bmcendocrdisord.biomedcentr...

healthunlocked.com/thyroidu...

The link between TSH, FT4 and FT3 in hyperthyroidism is very different from taking thyroid hormone (T4) in therapy. In hyperthyroidism, FT4 and FT3 are usually well above range and TSH is very low or undetectable. In therapy, FT4 can be high-normal or just above normal, TSH can be suppressed but FT3 (the important hormone that controls your health) will usually be in the normal range. FT4 and TSH are of little use in controlling therapy and FT3 is the defining measure. A recent paper has shown this graphically:

Heterogenous Biochemical Expression of Hormone Activity in Subclinical/Overt Hyperthyroidism and Exogenous Thyrotoxicosis

February 2020 Journal of Clinical and Translational Endocrinology 19:100219

DOI: 10.1016/j.jcte.2020.100219

LicenseCC BY-NC-ND 4.0

Rudolf Hoermann, John Edward M Midgley, Rolf Larisch, Johannes W. Dietrich

LlINK TO PAPER:

ncbi.nlm.nih.gov/pubmed/320...

sciencedirect.com/science/a...

[Kowbie]

Oh they make you sick don’t they, that’s just what my dr said to me not interested in t3 , so I said to her well i hope you never have a thyroid problem because I think you’d be interested in it then , hope you get sorted soon