I saw a GP on Wednesday after quite the chain of miscommunication—well, almost complete lack of communication. Most of my GPs have left so I’d never met this one. Quite the old school charmer. Didn’t crack a smile once, spoke to me as those I was 6. Didn’t really say anything, just listened to my chest, took my pulse, printed off some forms for blood tests and told me to book an ECG with the practice nurse. I paused before leaving and asked if he could sign me off work, given we hadn’t actually discussed any of the reasons why I might have pitched up in A&E, which at the moment my money is on stress overload. So he did that too then showed me the door.
I had an armful of blood taken. Lots of the results dropped into my NHS app by yesterday afternoon and the thyroid ones arrived this morning.
Serum TSH level: < 0.01 mIU/L
Normal range: 0.27 to 4.20
Serum free T3 level: 4.8 pmol/L
Normal range: 3.1 to 6.8
Serum free T4 level: 18.5 pmol/L
Normal range: 11.9 to 21.6
Now, because I hadn’t thought I’d get a blood test the same day, I will confess that I hadn’t taken my morning dose of Armour before these tests so the T3 result in particular will be slightly lower than it would have been if they’d been a 12 hour gap instead of 16 hours.
However, I did a Blue Horizon test before setting off to the GP, which gave the following results:
TSH
L <0.01 (0.27 - 4.20)
FT4
18.9 (12 - 22)
FT3
5.2 (3.1 - 6.8)
I’d reduced my dose a smidgeon the day before these blood tests but only by knocking off the ends of two halves of a 3 grain tablet of Armour. I reduced to 2.5 grains yesterday. So I’m fairly sure now that my racing heart probably wasn’t down to too much thyroid hormone.
There is literally nothing in all the other blood tests that explains what happened. My cholesterol isn’t elevated, I don’t have diabetes or indeed prediabetes (but hey, always good to have an accidental MOT as a result of a trip to A&E!).
Which leaves me with sleep deprivation and stress/panic attacks as the cause, I think? Which would make sense as if I call someone for a chat the moment my heart rate starts rising, it goes back down again within minutes.
Not gonna lie, it’s been a horrible week but it feels a bit like recovering from flu in many ways. I’ve felt a little bit better each day and the checks on my heart rate as recorded by an app on my phone tell a story of someone getting over… something, goodness knows what. But slower each day and pretty much back to normal today. I have a headache but that’s not unusual for me.
So I’m not even sure if I needed to reduce my Armour dose from 3 grains to 2.5 grains. But maybe I’ll stick with it for now? I don’t know, to be honest. My GP has sent a text saying they want a repeat set of thyroid tests done (presumably simply because of the suppressed TSH but having looked for an appointment on line I can’t get this done for a month anyway). And it’s probably a red herring. Though not sure if grumpy GP will see it that way. But as discussed on your post Rapunzel —what’s he gonna do? Reduce my unprescribed meds??
Thoughts would be welcome. Thanks for reading and for giving me so much advice and support when I wrote the other day. x
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Jazzw
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Me: “No, I was actually quite relieved to see my FT4 and FT3 results were in range. I take thyroid medication.”
Pause. “We don’t have any record of that.”
Me: “Did the A&E staff not pass on that bit?”
Turns out they didn’t. So we had a whole conversation about Armour and how I’d been looking after myself for many years and how T3 can lower TSH rather more than T4 does.
“But if your TSH is suppressed, you’re over-medicated.”
“With respect, it doesn’t always mean that. And on this occasion, I’m fairly sure it doesn’t. But I have reduced my dose a bit since that blood test was done. Also, you still haven’t acknowledged anything else I told you about me being fairly sure this was work related stress. Or even asked me how I am today, which is actually a lot better than I was a few days ago. If I were over medicated, how would that work?”
“Well, I’m duty bound to tell you that over medication can cause atrial fibrillation.”
“Yes, but that isn’t what I had, is it?”
I told him I was willing to work with him (to a point) but that the aim wouldn’t be to get my TSH into normal range at the expense of my FT4 and FT3 falling off a cliff. Well, actually, I didn’t say that but I will if I have to.
Interesting side note. During the conversation my heart rate went at 123bpm.
5 minutes after the end of what was a stressful conversation? 86bpm.
Am I being stupid? You know how you sit and cogitate after a difficult conversation?
I have already lowered my dose by half a grain a day. Lowering it further doesn’t feel like a good idea without seeing what that does to the results?
I bought an AppleWatch yesterday so I could monitor what’s happening with my heart without getting obsessive about it. Only time my heart rate rises above 85 now is if I climb the stairs or get panicky about going back to work or having difficult conversations with doctors. Most of the time it’s between 62 and 75. It stayed below 72 all night while I slept.
Dr Grumpy tried to tell me that I’d get bulging eyes if I carried on over medicating. I told him that (a) I didn't think I was over medicating but have reduced a bit just to see. And (b) isn’t having bulging eyes more about having Graves?
But also, average heart rate has gone down day on day since Saturday and I haven’t had any sustained runs of high heart rate—it’s come down again within 30 seconds when I focus on calming down.
' isn’t having bulging eyes more about having Graves?'
Thyroid eye disease is not restricted to Graves disease, but that is certainly the most common reason. This GP obviously doesn't understand that being 'over medicated', is not the same thing as having excess thyroid hormone levels produced by the thyroid gland. But he's not alone, most medics don't 'get' that there's a difference.
He said a lot of things (now that I’ve calmed down enough to remember them) that did indeed demonstrate he didn’t know a lot about thyroid issues at all. His first comment about Armour was that I couldn’t possibly know what was in it as it was unregulated.
I very much agree about the Apple Watch (or some alternatives) on the one hand show you are aware, interested, even concerned. But, by measuring in the background, they CAN achieve that without the obsession which is likely when using more manual approaches.
My overnight heart rate can be very high - like 123 at some time like 03:00 in the morning with me absolutely out like a light! But that is very much me - heart rate zooming up and down. Which limits the usefulness of any measurements.
Dr Grumpy can do one, too. You are a wise bird, Jazz and this is just a blip. What's he going to do, offer you 25mcg of levo and tell you to stop everything else as an experiment? I honestly wonder if your Apple Watch is helping or a hindrance. Blood pressure, blood tests and how I feel. That's enough for me and I'm safe in the knowledge that together with my thyroid fam, I know best. Pre thyroid issues, I would never have suggested that. Knowledge is power, innit tho. Hope you resolve this soon, and just remember - you have every right to be a stakeholder in your health journey. 😘
Aww, thanks for the reassurance, Rapunzel. Needed that. I was indeed waiting for him to suggest I had 25mcg of Levo and thought, sure, that’ll help!
Not sure about the watch being a hindrance yet but having been glued to my phone all week half expecting impending doom it’s definitely preferable to repeatedly putting my finger under the camera light. This way it’s picking things up in the background—and so far, nothing that I can’t explain. I’d dearly like my ticker to slow down a bit more quickly after I’ve had the audacity to stand up to make a cup of tea—but it does slow down. I assume if this was AFib it wouldn’t necessarily do that.
I think I have to hold on to thinking of myself as a third person and the advice I’d give someone else if they’d written what I’d written here. Which is to do pretty much what I’m doing. But when you feel rough, even Dr Grumpy can somehow get under your skin and sow seeds of doubt.
Perhaps it’s as well he wasn’t very compelling in his arguments about me developing bulging eyes…
Dr Grumpy tried to tell me that I’d get bulging eyes if I carried on over medicating.
🤣🤣🤣
I'd be tempted to say something like 'is that what happened to you?'
No, you're not being stupid. He is incredibly ignorant. How can he expect to treat people with thyroid problems when he knows so little about it? I just don't get it. He must know he knows nothing. Sigh.
As well as the stress you've been under, could you have been suffering from Covid?
I've had two rounds of Covid in the last three years, both confirmed with a test.
Recently I went through a couple of weeks of feeling grim, but I didn't recognise it as being Covid so I didn't test. However I am now convinced for various reasons that that was what was making me feel bad.
I think it’s possible I had Covid, yes. I did a test on Tuesday but it was possibly too late to register that I’d had it. Had a bad cold the week before all this, the one with the cough that only starts up as you go to bed? So I’d had a week of being fairly sleep-deprived while simultaneously fearing for my pelvic floor. And I do feel a lot like I did when recovering from what I knew was definitely Covid in 2021. It would make a lot of sense.
You look after yourself, hb. I happen to know 😉that people are still dying of COVID. Talking of which, is it safe to start using the bottles of elderberry extract I got, just as COVID was starting? What do you think?😘
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