a couple of years ago, you were kind enough to give me a template letter, arguing the case with my GP over his reduction in dose of thyroxine, despite being at the same level for 9 years.
this has now arisen again, and I would like to write to my GP, but has the guidance quoted changed or been updated .? the template I have quotes doctors good medical practice 2013. So may be out of date. Is the other information changed, I don’t want to look a fool.
Thank you
previous post from 3 years ago ……still valid
healthunlocked.com/thyroidu...
Refuse to reduce dose unless Ft3 is over range
You need to get FULL thyroid and vitamin testing done privately….if GP won’t
What vitamin supplements are you taking
When were vitamin D, folate, B12 and ferritin last tested
Hi Slow dragon,
Thank you for your prompt response. It’s good to know the info is still relevant.
I Had full bloods last month. Cholesterol and blood sugars need attention. TSH 0.05 hence Gp has reduced dose despite it being same for 9 yrs,. need to get private tests done I think.
I only take bit D, magnesium and marine collagen.
I just sent a letter to my GP last week when he wanted to reduce the levo.for second time in 8 weeks from 100 mcg. He had sneakily changed the 100 to 75 mcg despite a face to face ‘agree to disagree’ appointment knowing perfectly well I couldn’t speak to him on the phone for at least another 3 weeks such is the surgery appointment system…then after wanted to give me 50 mcg. My TSH is 0.02-3 range, ‘overmedicated on Levothyroxine’ ( I do take 15 mcg T3, which he knows about but doesn’t understand), but for him to quote this causes ‘AFib, osteoporosis and even DEATH’…the later is taking over 20 years since I have never had TSH in range. The 75 mcg made my fibromyalgia much worse and I had said in my letter how my quality of life was greatly effected, and really had to stick my heels in, and he was totally ignorant of how the FT4/FT3 , below mid range, were a better indicator of ‘medication’. He only relented as I started to quote NICE guidelines and that was seeing my first NHS endo early Nov. , with passing shot claiming the endo. would only be interested in TSH not the Frees. Just hope I have chosen my endo rightly!
'but for him to quote this causes ‘AFib, osteoporosis and even DEATH’
Wow, that's pushing the truth somewhat. Dying just from suppressed TSH seems highly unlikely. Possibly more plausible in hypER patients, if they have a severe thyroid storm. But that would be caused, I think, by very high levels of FT4 and/or FT3, not the suppressed TSH alone without high free levels.
Yes…he was struggling to find a reason to reinstate so rolled out the ‘big guns’ : DEATH. I had been doing lots of research recently on low TSH and A.fib / heart etc quoted some of those at him too eg hypertension is diastolic rather than systolic. I was pleasantly surprised that although many mention TSH the text usually refers just to TH thyroid hormones, being in range ( some controversially lower/ mid ranges rather than higher end, but at 29% for FT4 I think I’m under medicated!).
This might be of some help:
TaraJR - Endos' quotes on suppressed TSH v high T4/T3
Problems caused by suppressed TSH or high T4/T3?
Leading endocrinologists, well-known in UK and abroad, were asked by a co-lead of ITT Improve Thyroid treatment patient group:
“Is it a suppressed TSH itself or high/over range T4/T3 themselves that can lead to problems eg osteoporosis or atrial fibrillation?” They all said it is the T4/T3 levels…
My quality of life before taking T3 was awful, and I wasn't bothered if I was here or not. Since taking T3 I am vastly better, although my TSH is now suppressed. There are papers showing that the extra risk from a suppressed TSH is small, and I’m willing to take that very small risk. The decision should be a joint one between doctor and patient.
A very low TSH may carry an additional slight risk but, to me, well worth the trade-off against having a decent quality of life. An elevated TSH is as hazardous as a low TSH, or perhaps more so.
Tara Riddle, September 2024
Link to the full document as a PDF:
dropbox.com/scl/fi/trzzzgo4...
Link to this blog entry:
it may have been my draft letter
yes
GMP has changed but I'm too busy at the moment to update my draft.
do you want another copy of the existing draft to be amended by you to suit your own circumstances?
the new GMP is here. you can look through for relevant section about consulting patients about their wishes for their treatment.
gmc-uk.org/professional-sta...
I think the new relevant paragraph is 6
You must provide a good standard of practice and care.
If you assess, diagnose, or treat patients, you must work in partnership with them to assess their needs and priorities. The investigation or treatment you propose, provide or arrange must be based on this assessment, and on your clinical judgement about the likely effectiveness of the treatment options
GMC commentary: Added ‘work in partnership with them to assess their needs and priorities’ to increase the focus on partnership-working in line with Decision making and consent.
From Decision making and consent
Finding out what matters to a patient
16 You must listen to patients and encourage them to ask questions.
17 You should try to find out what matters to patients about their health – their wishes and fears, what activities are important to their quality of life, both personally and professionally – so you can support them to assess the likely impact of the potential outcomes for each option.
18 You must seek to explore your patient’s needs, values and priorities that influence their decision making, their concerns and preferences about the options and their expectations about what treatment or care could achieve.
19 You should ask questions to encourage patients to express what matters to them, so you can identify what information about the options might influence their choice.
20 You should explore with patients what risks they would and wouldn’t be prepared to take to achieve a desired outcome, and how the likelihood of a particular outcome might influence their choice.*
GP neglect 
NEW ACCESS TO Historical Digital GP Records in England
GP Changed my Brand of Liothyronine 
my letter from my endo to gp, this is crap!
Letter template to CCG regarding T3
