My GP reduced my thyronine from 100 to 75 without telling me?

Can someone tell me if my GP has the right to reduced my medication without telling Me? I had a blood test over a month ago. I did not receive any communication from the my surgery to say my levels had changed or my prescription was changing. My prescription gets sent directly to my pharmacist who administered my thyronine. I continued taking my meds unbeknown to me the month was made up of 50 the other 25. I usually get two month's supply of 100. I had been taking the 50 without knowing the med had been changed. It was not until I opened the second month's packet that I noticed the size of the pill was smaller. I then realised this was 25. So I have been taking 50 for a month. I have felt very tired, nodding off and have the shakes but thought I had a virus. Does anyone know the protocol for GPs informing patients of reduced or a change in medication. Having taken a 100 for nearly 16 years I just got my meds and carried on taking one a day without even checking the box.

11 Replies

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  • Personally, I think your doctor should have made an appointment for you to see him before reducing your medication.

    The first thing you shoulddo is get a copy of your TSH blood test from the surgery (you are entitled) and post here for someone to comment - please include the ranges.

    Doctors have no reason to reduce your medication just by your TSH. He obviously thinks he knows best but they should aslways consult with the patient first. He should have asked you 'how do you feel'. If you were taking too much meds you would have been in contact with him previously to discuss this.

    Doctors have no reason to reduce medication according to the TSH and this is a link and cursor down to July 15, 2006 question.Phone and tell him you are feeling worse and are increasing your meds. He will just have to give you another prescrition.

    If he is not in agreement you can get a copy of an article by Dr Toft ex President of the BTA and this is an excerpt.

    The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.

    In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

    But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

    This ‘exogenous subclinical hyperthyroidism’ is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).

    Even while taking the slightly higher dose of levothyroxine a handful of patients continue to complain that a sense of wellbeing has not been restored. A trial of levothyroxine and tri-iodothyronine is not unreasonable. The dose of levothyroxine should be reduced by 50µg daily and tri iodothyronine in a dose of 10µg (half a tablet) daily added.

  • Many thanks. I will get a copy today and post. Vey helpful.

  • Serum TSH Level 0.24 mu/L

    Serum free T4 level 19.8 pmol/L

    These are my blood tests results which prompted my Dr to reduce my Levothyroxine from 100mg to 75mg per day. This is my first change in 16 years.

    Any comments, I have no clue as to how much I should be taking on these results unless I get an opinion of a private Dr.

  • I am not medically qualified but your results seem fine to me. The main question the doctor should have asked is 'How do you feel' - if rough a dose increase may be tried. If fine - leave well alone. This is what Dr Lowe said about adjusting doses and cursor down to the question dated January 25, 2002

    Dr Lowe: Your observations don’t suggest to me that your pituitary gland isn’t functioning properly. In fact, your observations are consistent with what science tells us about a patient's T4 dose, her TSH level, and her metabolic health or lack of it. If the goal of a doctor is metabolic health for his patient, he has no scientific basis for adjusting her thyroid hormone dose by her TSH level. If the doctor is going to make the imprudent choice of treating the patient with T4 (rather than T3 or a T3/T4 combination), he should be aware of the relevant physiology and treat her on the basis of it. Otherwise, he's likely to ruin her health, as your doctor appears to be doing to yours.

    web.archive.org/web/2010112...

  • If you go to the GMC site, you can see the guidelines within which doctors should operate:

    gmc-uk.org/guidance/good_me...

    (You will have to read through several screens.)

    In my opinion, changing your medication without any communication seems to break these.

    I also feel that the pharmacy might have been in a position to say "I see your doctor has reduced your dose" as way of making sure you were aware.

    Finally, unfortunately, it does emphasise that we all need to check every prescription we get, each and every time. The medicine. The make. The dose. The expiry date. And best done before leaving the pharmacy. But I am sure you will be watching like a hawk from now on! :-)

  • Thanks for this.

  • Are you sure it was the doctor and the pharmacy didn't make a mistake?

    That happened to me once. For a month I took 75 instead of 175 (put on 14 kilos!!!) because I was rather naive and too trusting.

    When I pointed it out to the pharmacist, the silly *** said "oh, but that's not a very big difference". Just goes to show how little some of them know what they are doing!

    Grey

  • NO! Any changes in meds MUST be discussed and AGREED with the patient! Contact the practice manager and complain. If that doesn't help talk to the PCT & PALS .

  • A doctor has a legal duty to discuss your treatment with you. I f he doesn't, he is acting unlawfully.

    The duty arises under section 2 of the Health Act 2009: a doctor MUST have regard to the NHS Constitution. the NHS Constitution says that "You have the right to be involved in discussions and decisions about your healthcare, and to be given information to enable you to do this."

    if a doctor just reduces your medication without discussing this with you his decision is unlawful.

    However, form what you write, it appears that there maybe a mistake either in communication from your GP to the Chemist or at the Chemist.

    if I were you I would speak to the GP immediately saying that what you picked up from the chemist is not sufficient to keep you well. He may then correct the mistake.

    If he says that he has reduced your dose then tell him that he cant do that without discussing it with you.

    Then see him as soon as possible to discuss his unlawful decision.

    A discussion is not the GP telling what he is doing. The NHS Constitution says that he MUST provide you information to do this. If he doesn't, he is acting unlawfully. you have a right to have your say but make sure you have evidence to back up what you tell him, such as on ?? dose you feel OK but on ?? dose you feel terrible. lsit your signs and symptoms that have re-appeared.

    If he has reduced your medication he is likely to say that he worried about the risk of atrial fibrillation or osteoporosis. If so advise him that a recent study (that he should be aware of if he is keeping up to date as required by Good Medical Practice), shows that if TSH is above 0.04mIU/L then there is no risk of atrial fibrillation or osteoporosis and there is no logical reason for him to reduce your meds.

    Google for "Is it safe for patients taking thyroxine to have a low but not suppressed serum TSH concentration? Graham Leese & Robert Flynn of the University of Dundee Endocrine Abstracts (2010) 21 OC5.6" for your evidence to give to him.

    if he still refuses to give you a dose that makes you well, I would say that he has reduced your meds unlawfully and against Good Medical Practice and the reduction your meds is making you ill, He has not given you information as to why he has done this and he making you ill by not giving you a dose that is right for you. If so then I think that his fitness to practice is impaired and I would complain about him.

    Please take someone with you so that they can confirm what both of you say and please put every thing in writing. I make notes of what me and my GP say at consultations.

    Or it could just be a simple mistake.

  • Interesting. I went to see him last night. He said he tried to phone on 18/12/2012 but got no answer. I asked him why he did not leave a message on my answer phone. He ignored that question and went into why he felt he needed to reduce my dosage. I asked him again why if he could not get hold of me why he did not simply write me a letter. No response. Just said not to worry if I was taking 50mg that is the dose he really thinks I should be on and anywhere between 75mg and 50mg is where I need to be. He wants me to take another blood test at the end of the month. Kept going on about how small the dosage is e.g. mg.

    Not once asked me how I felt. Told him feel very tired which triggered the blood test request. It is all very annoying because for the last 16 years I have felt fine on the dose and only knocked out twice a month. Now I feel very tired but he does not seem to think jumping from 100mg to 50mg over a two week period would make a difference.

    I am getting a print out of my blood test results for the blood test in December and the previous and will post on web.

    He is a new Dr taken over my old GP practice, my previous GP was very thorough. His staff also left and the office staff are not very efficient. In the past, I have always had messages left on the answer phone to ring the surgery. Not sure if he lied but he showed me his computer screen to confirm he phone but the bottom line is that he did not get hold of me and therefore should have waited to speak to me.

    Thanks for your comments.

  • Remember that he works for you and he should give you a dose based on how you feel. Ask him to produce his so-called evidence that your dose needs to be reduced. If necessary demand to see the evidence if he continues to brush you off. Be polite but be firm. remind him of his duties referred to discuss and have evidence to back up his assertion. Again, be firm but polite and insist that you remain on your dose.

    Please do not accept the rubbish about suppressed TSH causing atrial fibrillation and osteoporosis.

    Most evidence of such things is when the patient has true HYPERthyroidism and this should be avoided anyway.

    Use the evidence above and tell him he hasn't kept up to date - in a pleasant but firm manner. If you need to, take someone else who can prompt you or speak for you if needed. All my own opinion, this and how I deal with my own GP who I see again on Tuesday. In all dealings with doctors you should always ask them for evidence of what they propose not accept "Cos I say so,- I'm a Doctor"

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