GP vs. Endocrinologist

[DiamondGreen]

I am under the care/supervision of an endocrinologist.
I was diagnosed with underactive thyroid over 20 years ago.

My GP is aware and agreed that my endocrinologist takes blood samples and “tweaks” my dose of medicines accordingly.

My blood test results from the

Endocrinologist on 11 July 2023 are as follows:

Serum TSH level 0.05 mU/L [0.6 - 4.8]; Below low reference limit

Serum free T4 level 11.2 pmol/L [11.5 - 22.7] Below low reference limit

Serum free triiodothyronine level 6.1 pmol/L [3.5 - 6.5]

My blood test results from the

GP on 8 November 2023 are as follows:

Serum TSH level 0.03 mU/L [0.3 - 4.2]; Below low reference limit

Serum free T4 level 9.6 pmol/L [9.0 - 23.0]

Serum free triiodothyronine level 4.8 pmol/L [2.4 - 6.0]

GP note on file :

Dose reduced of Levothyroxine and patient informed. (by text message).

Levothyroxine sodium 25microgram tablets - 100 tablet - lunch time

Ended 08 Nov 2023 Clinical grounds by Dr (GP surgery).

My dose at the time of all blood tests was 50 mcg thyroxine + T3 10 mg each morning.

And 25 mcg + T3 10 mg each lunchtime.

I have written to the endocrinologist who has confirmed that I should not reduce my dose.

I have written to my GP (appointments are impossible) who has added my letter to my file, but has not responded.

Please can you help regarding whether the GP is fully justified in reducing my Levothyroxine dose from 75 mcg to 50 mcg ?

Many thanks,

Diamond Green

[TiggerMe Ambassador]

They just tend to do this regardless of Endo when your TSH is low, I usually fire them a direct message via the Surgery website informing them that "I absolutely have not agreed to lower my dose and my frees are well within range...please correct my prescription to ...mcg dose"

Last time I received a call to tell me this had been done from one of the admin 🤷‍♀️ you just have to remind them that they are obliged to run any changes past you first!

This happens every time for me, they can't help but interfere 🙄

[Charlie-Farley]

Disgraceful and as Eeyore says - you need to absolutely get it on the record you did not agree to this and will continue with your endocrinologist so please do not involve yourself Dr.....

Page 2 NG145 (you can download a pdf ) I call it the 'fudge at the front' because they know the guidelines are not that good and let down as many people as they purport to help (who are actually just blooming lucky to fall within the treatment parameters)

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.

All problems (adverse events) related to a medicine or medical device used for treatment

or in a procedure should be reported to the Medicines and Healthcare products Regulatory

Agency using the Yellow Card Scheme.

[SlowDragon Administrator]

My blood test results from the

GP on 8 November 2023 are as follows:

TSH level 0.03 mU/L [0.3 - 4.2];

Serum free T4 level 9.6 pmol/L [9.0 - 23.0]

Serum free triiodothyronine level 4.8 pmol/L [2.4 - 6.0]

You’re taking T3 under the care of an endocrinologist

GP should not be meddling

On T3 TSH is almost ALWAYS suppressed

The most important results are always Ft3 followed by Ft4

And symptoms

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

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

On T3 - day before test split T3 as 2 or 3 smaller doses spread through the day with last dose 8-12 hours before test

My dose at the time of all blood tests was 50 mcg thyroxine + T3 10 mg each morning.

And 25 mcg + T3 10 mg each lunchtime.

Day before test you should take all levothyroxine in morning

Split second dose T3 into 2 x 5mcg …..take last 5mcg at 8pm

Test 8am following morning

Is this how you do your test?

How do you feel?

Many patients on levothyroxine plus T3 find they need BOTH Ft4 and Ft3 at least 60-70% through range

Your results suggest you are perhaps not on high enough dose Levo

How much levothyroxine were you taking BEFORE T3 was added

[SlowDragon Administrator]

Write to GP remind them that you’re under care of endocrinologist and you are on liothyronine as well as levothyroxine. That you will not be reducing your levothyroxine

assuming you did test correctly and if you have seen return of hypothyroid symptoms

Write to endocrinologist and request 25mcg dose increase in Levo

[redhead41]

Neither the T4 nor T3 are optimal so isn't an increase in levo required? On T3 tsh will be suppressed and an increase in levo will increase the T4 which should also increase the T3. At least this is what I believe?????