Medication review recently. Told I needed a "TSH Test". Asked for ferritin, B12, folate and vitamin D to also be tested, as usual, and this time these have been refused. I have historically had severe deficiencies in all of these.I now need to argue my case in front of a GP. I have booked a double appointment just in case, but can anyone help with references that might work to change their mind?
Thanks in advance.
Why has the GP refused? If you have a (recorded) history of severe deficiencies, why is the GP not treating those? Or monitoring your levels?
Sorry, I’m confused - not unusual!
You're confused? I'm confused. I have been given no explanation as to why the tests I have requested have been refused.Apart from prescribing ferrous sulphate and AdCal about fifteen years ago, the GP has not been involved. I buy my own supplements, but use annual testing to inform my choices.
If you have previously been deficient then levels should be retested
What vitamin supplements are you currently taking
What/when were vitamin results when last tested
There’s nothing on your profile
Is your hypothyroidism autoimmune ?
Links about low vitamin levels and thyroid
pubmed.ncbi.nlm.nih.gov/286...
Vitamin D deficiency is frequent in Hashimoto's thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.
pubmed.ncbi.nlm.nih.gov/273...
Vitamin D insufficiency was associated with AITD and HT, especially overt hypothyroidism. Low serum vitamin D levels were independently associated with high serum TSH levels.
pubmed.ncbi.nlm.nih.gov/300...
The thyroid hormone status would play a role in the maintenance of vitamin D sufficiency, and its immunomodulatory role would influence the presence of autoimmune thyroid disease. The positive correlation between free T4 and vitamin D concentrations suggests that adequate levothyroxine replacement in HT would be an essential factor in maintaining vitamin D at sufficient levels.
ncbi.nlm.nih.gov/pmc/articl...
Our results indicated that patients with hypothyroidism suffered from hypovitaminosis D with hypocalcaemia that is significantly associated with the degree and severity of the hypothyroidism. That encourages the advisability of vit D supplementation and recommends the screening for Vitamin D deficiency and serum calcium levels for all hypothyroid patients.
Same applies to low B12 - extremely common in hypothyroid patients
All patients who are hypothyroid should have B12 tested
ncbi.nlm.nih.gov/pubmed/186...
There is a high (approx 40%) prevalence of B12 deficiency in hypothyroid patients. Traditional symptoms are not a good guide to determining presence of B12 deficiency. Screening for vitamin B12 levels should be undertaken in all hypothyroid patients, irrespective of their thyroid antibody status. Replacement of B12 leads to improvement in symptoms, although a placebo effect cannot be excluded, as a number of patients without B12 deficiency also appeared to respond to B12, administration.
ncbi.nlm.nih.gov/pubmed/169...
Patients with AITD have a high prevalence of B12 deficiency and particularly of pernicious anemia. The evaluation of B12 deficiency can be simplified by measuring fasting serum gastrin and, if elevated, referring the patient for gastroscopy.
Folate supplements can help lower homocysteine
ncbi.nlm.nih.gov/pmc/articl...
Levothyroxine can decrease serum homocysteine level partly; still its combination with folic acid empowers the effect. Combination therapy declines serum homocysteine level more successfully.
Low ferritin frequent in hypothyroidism
.anyone help with references that might work to change their mind?
...a complaint to the Practice Manager that you are not being correctly monitored for long term deficiency, with the risk that other health issues are likely to consequently arise, needing additional treatment
The others have given examples
Why not pay for a private test if you can it would help you avoid the dreaded GP
Well it would avoid potential unpleasantness but its a matter of principle surely If Angel has a history of severe deficiencies then they should be monitored periodically. The same as any other long term condition. Diabetics arent expected to pay for their own HB1AC tests, those with CKD dont have to pay for eGFR tests.
It seems to me that thyroid patients really do get the short straw when it comes managing this condition. My concern is that more we pay for things ourselves, whether its medications, monitoring blood tests, consultations and even procedures, then the NHS will continue to do less and less, until eventually it just gets completely privatised.
We've got an odd model of healthcare, we pay for the NHS out of taxation and NI contributions, but so much of it is now unavailable. Dentists, ear wax removal, opticians, private audiology, podiatry, to name a few, are all outside the NHS.
Many people have private health insurance or go private. And yet in spite of this people still have to fund the NHS, you cant opt out, nor do your contributions go down. It does beg the question, where is all the money going.
I really can't see a way round it. I live in France anyway and the health system works differently the GP's actually work for the health service here.
Back in 2006 in the UK I was sent to the private wing Level 4 in Southampton of an NHS Hospital by my GP to have my gallbladder removed the NHS paid for it. ENT was privatised years ago also with a bidding system in place.
I agree with you on principal but how to change it that's the problem.
After 30 minutes of verbal jousting, I have the blood tests I asked for. Phew! However, it looks as though, in my area, they are becoming increasingly restricted.
Ferritin - "We usually only test this if Hb is abnormal." My Hb has always been low, but in range, and last year's tests showed that my ferritin level was falling, although still above 50.
Vitamin D - we assume everyone is deficient and tell them to take an OTC supplement in the winter, so we don't usually test at all.
Vitamin B12 and Folate - "Yours were all right last year so there is no reason to think they will be any different this year."
Thanks to all who gave advice.
'it looks as though, in my area, they are becoming increasingly restricted.'
You are by no means alone. The NHS has never really considered testing vitamins etc. to be important, so if they can skimp on that many GPs do. Well done for achieving what you wanted 
GP appt to discuss blood test results
Asking GP for iron panel test
Gp sticking to blood test ranges
Getting Print Out Test Results from GP/Surgery
Rapidly deteriorating but GP refuses to increase Levo dose based on blood results!
