GP difficulties

[CarnelianT]

Hi all. I'm struggling with a GP who wants to reduce my levothyroxine from 100mcg to 75mcg. Recently I had my usual 3 monthly bloods monitored for prescription of adalimumab which is prescribed by a tertiary specialist and bypasses my GP practice. My GP had requested a TSH and FT4 without my knowledge and of course I was not prepared having had my usual bedtime levothyroxine the night before, having also eaten, it being 1pm and no stopping of biotin supplements. Surprise surprise I get a phone call from a representative at the practice (someone with little medical knowledge) informing me that the GP wants me to reduce the levo. I refused and stated I was unhappy in the first instance that I had not been informed about the blood test and that as a consequence the results were not a true reflection of what is happening plus not FT3 reading. I have now completed a venous sample with medichecks, having correctly prepared...levo 24 hours before, test at 7.30am, only water prior to test and stopping supplements 7 days before. I have attached the results. I now have to get back to the GP with my results and argument of why I don't want to reduce my levo. I have no symptoms of being hypo. Please could you advise me as I am feeling anxious about responding to the GP. There is no point asking for an endo referral because my experience with the local team was negative since they refused to consider checking FT3 when I last saw them 2 years ago.

[SlowDragon Administrator]

I now have to get back to the GP with my results and argument of why I don't want to reduce my levo.

Free T4 (fT4) 19.1 pmol/L (12 - 22) 71.0%

Free T3 (fT3) 4.5 pmol/L (3.1 - 6.8) 37.8%

Include copy of these results and refuse to reduce dose

If GP says " I have to reduce your dose because the guidelines say i can't let you have a below range TSH" .....

The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :

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. "

You have poor conversion of Ft4 to Ft3

What was ferritin result on Medichecks test?

Increasing numbers of endocrinologists are prepared to consider adding T3 …..as price has dropped

Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists who will prescribe T3

Ideally choose an endocrinologist to see privately initially and who also does NHS consultations so that might eventually transfer to getting T3 on NHS

thyroiduk.org/contact-us/ge...

Roughly where in U.K. are you

Numbers prescribed T3 on NHS ….increasing by approximately 1000 per year

Searchable by ICB areas or even by GP practice (especially if your GP practice has relatively unusual name)

openprescribing.net/analyse...

[Hidden in reply to SlowDragon]

Hi.Thank you very much for your response.

I live in Northamptonshire. My Ferritin is 59.1 (30-264). I'm due to complete a new iron panel. The last one had high transferrin saturation 56.3 (20-50).

I think a private endo is the way to go. I will access the links you have sent. I will also send my results to the GP and explain why I do not want to reduce my levo.

[SlowDragon Administrator in reply to Hidden]

You need to delete your account as Hidden

And only use CarnelianT

[Hidden in reply to SlowDragon]

Will do

[CarnelianT in reply to SlowDragon]

Deleted it

[SlowDragon Administrator in reply to Hidden]

Get full iron panel test before booking private consultation

[Hidden in reply to SlowDragon]

Will do

[tattybogle]

have a look through these : use the argument that your fT4 and fT3 are well within range and the only issue is the low TSH... but research shows that in patients taking levo , large , long term studies have shown that a 'low but not supressed' TSH actually has no greater risks than TSH in range does . (Your TSH is over 0.04 , so 'low but not supressed' applies to you )

healthunlocked.com/thyroidu... useful-evidence-that-tsh-between-0.04-0.4-has-no-increased-risk-to-patients-on-levothyroxine-updated-new-study-does-show-small-risk

healthunlocked.com/thyroidu.... tsh-is-just-the-opinion-of-your-pituitary-about-your-dose-but-your-pituitarys-opinion-is-a-bit-warped-once-you-take-thyroid-hormone.

[Hidden in reply to tattybogle]

Thank you so much, that is really useful