Impending GP appointment advice

[Myristica]

Hello everyone and thankyou for your advice.I was diagnosed last August with hypothyroidism and cautiously started on 25mcg. I assume because of being over 65.

Since then I have been having the usual 6-8 week blood tests and in February finally reached a dosage of 100mcg daily.

My current weight suggests a therapeutic dose should be closer to 200.

Bizarrely on my last blood test only my TSH was tested, not sure if this was an oversight from the lab, request from GP on the form or what?

TSH is now 2.52 (0.27-4.2)

I am starting to feel much better and various things have shown improvement like dry skin, migraine, hair loss, etc; but I definitely want the dose increased.

My appointment with my GP is Monday and I am anticipating a hard time, especially without an FT4 result.

Now in anticipation of this, can anyone offer a quick comeback (for me to try to remember in case I need it) other than "my TSH is still 57.3% through the range?"

[SlowDragon Administrator]

Request next 25mcg dose increase in Levothyroxine to 125mcg

If they refuse politely insist on thyroid levels being retested INCLUDING Ft4 and FT3 plus vitamin D, folate, ferritin and B12

Book early morning test and last dose Levothyroxine 24 hours before test

[Myristica in reply to SlowDragon]

Thank you SlowDragon, yes I always insist on the test before 9am and abstain from taking LT4 for 24hrs. I just long for the day that I can move away from constant blood tests.

[greygoose]

Now in anticipation of this, can anyone offer a quick comeback (for me to try to remember in case I need it) other than "my TSH is still 57.3% through the range?"

I wouldn't say that, if I were you. You'd just confuse him. It would confuse me because it is of absolutely no importance where the TSH percentage is. A TSH is always a TSH, and a 'euthyroid' (normal) TSH is around 1 - the ranges are stupidely wide! But, it's not even good enough for the TSH to be euthyroid when you're hypo because hypos need their thyroid hormone levels higher than euthyroid, so the TSH would be lower.

Remind him that TSH is not a thyroid hormone. It is a pituitary hormone and not all pituitaries work 100% correctly any more than all thyroids do. Which is why you need the actual thyroid hormones tested: T4 and T3. Without them, you cannot know if your dose needs increasing, reducing or staying where it is. It's a bit like filling up your car with petrol because the oil light is on. There's no connection. Not once you're on thyroid hormone replacement, because the TPH axis feedback-link is broken...

I find it's often helpful to blind them with science - of which they know nothing - so that they'll give you what you want just to get rid of you. Just be polite and speak in a reasonable voice but let them know who's boss.

[Myristica in reply to greygoose]

Thank you greygoose. Yes, your second to last paragraph is a good point and I like the analogy of the car.

[greygoose in reply to Myristica]

You're welcome.

[Hectorsmum2]

I find myself bambozalled in conversations with doctors as they are often so very confidently wrong about things. I tend to write letters these days to avoid having to try and reason with the unreasonable over the phone. i am a slow processer not sure if that is thyroid related, anyway they leave me stumpted.

[Myristica]

Just to update, no fight, I got my increase by being 'nice' and explaining that I know what symptoms to look for if I am overmedicated. 👍